Determinants of self-rated health in old age: a population-based, cross-sectional study using the International Classification of Functioning

BACKGROUND

Self-rated health (SRH) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older populations concerning future health, functional decline, disability, and mortality. The aim of this study was to use the theoretical framework of the International Classification of Functioning, Disability and Health (ICF) to create a better understanding of factors associated with SRH among community-dwelling older people in urban and rural areas.

METHODS

The study design was population-based and cross-sectional. Participants were 185 Icelanders, randomly selected from a national registry, community-dwelling, 65-88 years old, 63% urban residents, and 52% men. Participants were asked: "In general, would you say your health is excellent, very good, good, fair, or poor?" Associations with SRH were analyzed with ordinal logistic regression. Explanatory variables represented aspects of body functions, activities, participation, environmental factors and personal factors components of the ICF.

RESULTS

Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables. Multivariate analysis, however, demonstrated that SRH had an independent association with five variables representing ICF body functions, activities, and personal factors components: The likelihood of a better SRH increased with advanced lower extremity capacity (adjusted odds ratio [adjOR] = 1.05, p < 0.001), upper extremity capacity (adjOR = 1.13, p = 0.040), household physical activity (adjOR = 1.01, p = 0.016), and older age (adjOR = 1.09, p = 0.006); but decreased with more depressive symptoms (adjOR = 0.79, p < 0.001).

CONCLUSIONS

The results highlight a collection of ICF body functions, activities and personal factors associated with higher SRH among community-dwelling older people. Some of these, such as physical capacity, depressive symptoms, and habitual physical activity are of particular interest due to their potential for change through public health interventions. The use of ICF conceptual framework and widely accepted standardized assessments should make these results comparable and relevant in an international context.

Beyond conventional socioeconomic status: examining subjective and objective social status with self-reported health among Asian immigrants

Despite mounting evidence for a strong and persistent association between socioeconomic status (SES) and health, this relationship is largely unknown among Asian immigrants, a fast growing minority group in the US population. Previous research has typically focused on objective SES (primarily education and income) and ignored self-perceived SES. Using data from the National Latino and Asian American Study (NLAAS) (N = 1,570), we examined the impact of subjective as well as objective SES upon multiple self-reported health outcomes among Asian immigrants. Results indicated that conventional SES indicators by and large were non-significantly related to self-rated physical health, physical discomfort, self-rated mental health, and psychological distress. In contrast, subjective SES relative to people in the United States and people in the community showed strong associations with health outcomes above and beyond conventional SES markers. This study suggested a promising avenue to incorporate subjective SES in health disparities research, especially among immigrants.

Religious involvement, social engagement, and subjective health status of older residents of informal neighborhoods of Nairobi

Although past research has extensively documented the effects of religious involvement and social integration on the health outcomes of older people, relatively little research has examined the relationship among older Africans. In this article, we examined the effects of religious affiliation and participation as well as forms of social engagement, including social support, sociability, and community participation on self-reported health. The study used data from a sample of older men and women (50 years and above) from two informal settlements in Nairobi Kenya. Differences in religious groups were statistically significant. Frequency of religious attendance was negatively associated with health, while the number of close friends, social support, and frequency of community participation were positively and independently related to self-reported health.

What do people include when they self-rate their health? Differential associations according to health status in community-dwelling older adults

AIMS

Self-rated health (SRH) is widely regarded a valid and reliable indicator of health status. The validity of self-rated health has been demonstrated in many studies, for example by predicting mortality over and above medical and epidemiological data. However, the meaning of SRH can differ between individuals, especially in elderly individuals with considerable individual differences in their physical health states. It is thus important to determine whether predictors of self-rated health vary according to physical health status in order to interpret self-rated health data.

METHODS

In a representative survey study, 1174 individuals over 65 years of age rated their health and filled in questionnaires on subjective well-being, control beliefs, depressive symptoms, and functional health. Structural equation modeling with latent moderated structural equations was used to determine whether health status (number of illnesses) moderated the association of self-rated health with these predictors.

RESULTS

Self-rated health was predicted by positive affect, depressive symptoms, control beliefs, and physical functioning. Moderated effects were found for positive affect and physical functioning, suggesting that there are stronger associations with positive affect in healthier individuals and stronger associations with physical functioning in less healthy individuals.

CONCLUSIONS

This implies that SRH has differential associations depending on health status, which should be taken into account in interpreting any research with SRH as predictor or criterion.

[Predictors of self-rated health of citizens on the territory of endangered political security]

INTRODUCTION

Self-rated health is generally accepted by researchers as a valid measure of health status. The aims of the study were to investigate how the adult inhabitants of northern Kosovska Mitrovica described their health and which variables were the predictors of self-rated health status among that population.

METHOD

The research was done as a cross-sectional study on the representative sample of 318 adult inhabitants of northern Kosovska Mitrovica in 2006. The instrument of research was a questionnaire containing questions about self-rated health and demographic and socio-economic characteristics, mental health, social interaction, possibilities of performing everyday activities, health behaviour and habits, diseases and injuries, utilization of health care service. The independent variables were defined through the factor analysis taken from these groups of questions. The multivariate stepwise linear regression was done to determine the correlation between self-rated health and independent variables.

RESULTS

More than half of the respondents (54.7%) assessed their health as good or very good. The predictors of self-rated health were gender, mood problems, myocardial infarction, chronic bronchitis, psychic and neurotic disorders, rheumatic arthritis, high blood sugar, utilization of private gynaecologist service and paying for diagnostic service.

CONCLUSION

Most of the respondents from northern Kosovska Mitrovica assessed their own health as good or very good. Bad and very bad health was significantly associated with females, problems with mood, myocardial infarction, chronic bronchitis, psychic or neurotic disorders, rheumatoid arthritis and high blood sugar. Good and very good health was significantly associated with utilization of private gynaecologist service and paying for diagnostic service.

A comparison of objective biomarkers with a subjective health status measure among children in the Philippines

Large health surveys use subjective (self-reported) and objective (biomarkers) measures to assess heath status. However, the linkage or disparity of these measures has not been systematically studied in developing countries.

METHOD

Using data from the Philippine Quality Improvement Demonstration Study, QIDS, this study evaluated the associations between General Self-Reported Health Status (GSRH) and height, weight, hemoglobin, red blood cell folate, C-reactive protein, and blood lead levels. The authors modeled each biomarker as a function of GSRH controlling for socioeconomic status and selection effects. Changes in biomarkers and GSRH in children who had previously been hospitalized were also examined.

RESULTS

GSRH independently predicted hemoglobin, C-reactive protein, stunting, and wasting. GSRH did not vary significantly with folate deficiency and blood lead levels.

CONCLUSIONS

In addition to being a measure of overall child health status, GSRH may be a useful and inexpensive screening tool for identifying children that need further health testing.

Associations of employment frustration with self-rated physical and mental health among Asian American immigrants in the U.S. Labor force

OBJECTIVE

This study examined the associations between employment frustration and both self-rated physical health (SRPH) and self-rated mental health (SRMH) among Asian American immigrants.

DESIGN AND SAMPLE

A cross-sectional quantitative analysis was conducted utilizing data from 1,181 Asian immigrants participating in the National Latino and Asian American Study.

MEASURES

Employment frustration was measured by self-report of having difficulty finding the work one wants because of being of Asian descent. SRPH and SRMH were each assessed using a global one-item measure, with responses ranging from poor to excellent. Control variables included gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a general measure for everyday discrimination.

RESULTS

Ordered logistic regression showed that employment frustration was negatively associated with SRPH. This relationship, however, was no longer significant in multivariate models including English proficiency. The negative association between employment frustration and SRMH persisted even when including all control variables.

CONCLUSIONS

The findings suggest that Asian immigrants in the United States who experience employment frustration report lower levels of both physical and mental health. However, English proficiency may attenuate the relationship of employment frustration with physical health.

Quality of life in older Norwegian adults living at home: a cross-sectional survey

The term quality of life (QoL) has been used in nursing for several years despite having neither a common conceptual model nor a common definition. The Wilson and Cleary Model (WCM), defined in 1995, is used as a conceptual model to identify suitable variables important in planning nursing care in a study among Norwegian older adults. The objective of this study was to investigate how the relationships among depressive symptoms, physical function, health satisfaction, age and environment may predict QoL in a model based on the WCM. The overall model provides empirical evidence for linkages in the WCM. Results showed that QoL is likely to be influenced by the direct effects of environmental conditions, health satisfaction and age. In addition, environmental conditions and age had indirect effects on QoL, in particular via depressive symptoms. Environment had both a significant direct and an indirect effect on QoL. An indirect effect of environment on QoL was shown with depressive symptoms, physical function and perceived health as mediators. There was only a small amount of evidence for age predicting QoL. This model may help nurses and other health care workers to collect and assess information, to suggest suitable interventions and to guide decision making.

[Living longer, working longer? The impact of subjective life expectancy on retirement intentions and behavior]

Virtually all Western countries are seeking to bring retirement ages more in line with increases in longevity. The central question in this paper is whether individuals choose a retirement age that fits their life expectancy. This would be ideal from a public policy perspective. The present study aims to test empirically whether retirement planning varies with expectations of survival among a sample of older employees in the Netherlands. Two questions are addressed: (1) What are older employees' expectations of their remaining lifetime, and what factors influence this subjective life expectancy? (2) Are individuals who perceive longer life horizons (high subjective life expectancy) more inclined to retire later than people who expect to live shorter? Using data from a panel study on retirement behaviour in the Netherlands (N=1621 older employees aged 50-60), regression and survival models are estimated to examine the effect of subjective life expectancy on retirement planning and behaviour. The results indicate that subjective life expectancy is a factor that is taken into account in retirement decision making, at least as far as retirement intentions are concerned. Older employees with longer time horizons have a preference for later retirement. When it comes to actual behaviour, however, time horizon does not appear to play a role. The results suggest that particularly employees with a high perceived life expectancy and an intention to work longer do not succeed in carrying their intentions into effect.

Understanding centenarians' psychosocial dynamics and their contributions to health and quality of life

While it is understood that longevity and health are influenced by complex interactions among biological, psychological, and sociological factors, there is a general lack of understanding on how psychosocial factors impact longevity, health, and quality of life among the oldest old. One of the reasons for this paradox is that the amount of funded research on aging in the US is significantly larger in the biomedical compared to psychosocial domains. The goals of this paper are to highlight recent data to demonstrate the impact of four pertinent psychosocial domains on health and quality of life of the oldest old and supplement recommendations of the 2001 NIA Panel on Longevity for future research. The four domains highlighted in this paper are (1) demographics, life events, and personal history, (2) personality, (3) cognition, and (4) socioeconomic resources and support systems.

Social and cultural meanings of self-rated health: Arab immigrants in the United States

Self-rated health (SRH) is used as an outcome measure in a vast number of epidemiologic studies, yet conceptual research into what the variable captures among diverse ethnic and immigrant groups remains limited. Utilizing data from 46 in-depth interviews among adult Arab immigrants in the United States, we examined the general criteria used to explain an SRH selection and the culturally embedded rationales individuals employ to construct meanings of health. Our findings showed that SRH is determined by two main criteria: presence/absence of health conditions and psychological well-being. In-depth analyses further revealed that Arab immigrants employ culturally embedded rationales to move away from extremes and project a view of good health as a state of balance and poor health as a state of imbalance. Our study adds to the limited conceptual knowledge on the meanings of subjective health evaluations among immigrants, and the findings suggest that exploring rationales provides richer information than focusing on criteria alone.

The image in the mirror and the number on the scale: weight, weight perceptions, and adolescent depressive symptoms

Double jeopardy and health congruency theories suggest that adolescents' joint experience of their weight and weight perceptions are associated with depressive symptoms, but each theory offers a different prediction about which adolescents are at greatest risk. This study investigates the proposed associations and the applicability of both theoretical perspectives using data from 6,557 male and 6,126 female National Longitudinal Study ofAdolescent Health (Add Health) Wave II participants. Empirically, results indicate that focusing on the intersection of weight and weight perceptions better shows which adolescents are at risk of depressive symptoms than an approach that treats both predictors as independent, unrelated constructs. Weight pessimists are at greatest risk of depressive symptoms. Thus, results support the health congruency framework, its extension to subpopulations outside of older adults, and its extension to optimism and pessimism about specific health conditions.

Gerontologic biostatistics: the statistical challenges of clinical research with older study participants

The medical and personal circumstances of older persons present challenges for designing and analyzing clinical research studies in which they participate. These challenges that elderly study samples present are not unique, but they are sufficiently distinctive to warrant deliberate and systematic attention. Their distinctiveness originates in the multifactorial etiologies of geriatric health syndromes and the multiple morbidities accruing with aging at the end of life. The objective of this article is to identify a set of statistical challenges arising in research with older persons that should be considered conjointly in the practice of clinical research and addressed systematically in the training of biostatisticians intending to work with gerontologists, geriatricians, and older study participants. The statistical challenges include design and analytical strategies for multicomponent interventions, multiple outcomes, state transition models, floor and ceiling effects, missing data, and mixed methods. The methodological and pedagogical themes of this article will be integrated by a description of a proposed subdiscipline of "gerontologic biostatistics" and supported by the introduction of new set of statistical resources for researchers working in this area. These conceptual and methodological resources have been developed in the context of several collaborating Claude D. Pepper Older Americans Independence Centers.

Double jeopardy: what social risk adds to biomedical risk in understanding child health and health care utilization

OBJECTIVE

The aim of this study was to test the hypothesis that children with both social and biomedical risk factors are more likely to be in poorer health and utilize more health services than those with either type of risk alone.

METHODS

Variables were identified using the 1998 National Health Interview Survey and tested here on 2002 data. Dependent variables were health (poorer health rating) and service use (hospitalization or greater than 2 emergency services). High social risk was defined as greater than 2 risk factors (parental education less than high school, family income <200% of federal poverty level, and non-2-parent family). High biomedical risk was defined as having a chronic condition or birth weight <2500 grams.

RESULTS

Children with either high social or biomedical risk were significantly more likely to be in poorer health (odds ratio [OR] 3.1-3.4) and to have higher utilization (OR 1.7-2.1) than children at low risk on both dimensions. Children with high risk on both dimensions were significantly more likely to be in poorer health (OR 7.8-7.9) and have higher utilization (OR 3.5-3.7) on both social and biomedical risks and those children rated high risk on either dimension alone. Overall, social risk was as powerful as biomedical risk in these models and added substantially to biomedical risk. Findings were stable using different cut points for social risk and health ratings, and different definitions of chronic condition.

CONCLUSIONS

These findings have implications for health care planners and insurers in estimating the burdens on clinicians and potential costs of delivering care to those with high social risks.

Adult Suicide Mortality in the United States: Marital Status, Family Size, Socioeconomic Status, and Differences by Sex

OBJECTIVE: This paper addresses the relationship between suicide mortality and family structure and socioeconomic status for U.S. adult men and women. METHODS: We use Cox proportional hazard models and individual level, prospective data from the National Health Interview Survey Linked Mortality File (1986-2002) to examine adult suicide mortality. RESULTS: Larger families and employment are associated with lower risks of suicide for both men and women. Low levels of education or being divorced or separated, widowed, or never married are associated with increased risks of suicide among men, but not among women. CONCLUSIONS: We find important sex differences in the relationship between suicide mortality and marital status and education. Future suicide research should use both aggregate and individual level data and recognize important sex differences in the relationship between risk factors and suicide mortality-a central cause of preventable death in the United States.

Evolving self-rated health in middle and old age: how does it differ across Black, Hispanic, and White Americans?

OBJECTIVE

This research focuses on ethnic variations in the intraindividual changes in self-rated health.

METHOD

Data came from the Health and Retirement Study involving up to 6 repeated observations between 1995 and 2006 of a national sample of 18,486 Americans above 50 years of age. Hierarchical linear models were employed in depicting variations in self-rated health across White, Black, and Hispanic Americans.

RESULTS

Subjective health worsened over time albeit moderately. Relative to younger persons, older individuals rated their health poorer with a greater rate of deteriorating health. With reference to ethnic variations in the intercept and slope of perceived health, White Americans rated their health most positively, followed by Black Americans, with Hispanics rating their health least positively. This pattern held even when socioeconomic status, social networks, and prior health were adjusted.

DISCUSSION

Significant ethnic differences exist in the evolvement of self-rated health in middle and late life. Further inquiries may include analyzing ethnic heterogeneities from a person-centered perspective, health disparities across subgroups of Hispanics, effects of neighborhood attributes, and implications of left truncation.

Self-management of health-behaviors among older and younger workers with chronic illness

OBJECTIVE

To examine the self-management of health behaviors carried out by older (aged 50-69 years) and younger workers (aged 20-49 years) with a chronic illness.

METHODS

Questionnaire data was collected from 759 employees with a diagnosed chronic illness. Four categories of self-managing health behaviors were examined: using prescribed medication, monitoring and responding to symptoms, managing an appropriate diet and exercising.

RESULTS

The majority of participants (56-97%) reported being advised to carry out health behaviors at home and at work. Controlling for confounding factors, medication use was associated with younger and older workers. Managing an appropriate diet was associated with younger workers with asthma, musculoskeletal pain or diabetes. Exercising was associated with younger workers with asthma and with older workers with heart disease, arthritis and rheumatism or diabetes.

CONCLUSIONS

The findings indicate that there are differences in diet and exercise activities among younger and older workers.

PRACTICE IMPLICATIONS

To increase self-management in health behaviors at work, improved communication and understanding between the different health professions and the patient/employee is required so that different tailored approaches can be effectively targeted both by age and within the context of the working environment, to those managing asthma, heart disease, diabetes and arthritis and rheumatism.

Key elements composing self-rated health in older adults: a comparative study of 11 European countries

Self-rated health (SRH) is a multidimensional measure, predictive of morbidity and mortality. Comparative studies of determinants, however, are rare due to a lack of comparable cross-national data. This paper contributes towards filling in this gap, using data for persons aged 50 or higher in 11 European countries from the SHARE study (2004). The analysis aims at identifying key elements composing SRH using multinomial logistic regression models. In addition, the homogeneity of associations across populations is assessed. The findings indicate that education, depression, chronic conditions, mobility difficulties, somatic symptoms and levels of physical activity constitute important components of SRH; ADLs and obesity, on the other hand, are not significant and IADLs are important only in a few countries. All these associations point to the expected direction and are homogeneous across countries. However, demographic factors, age and gender, though significant in many countries have divergent associations. Effects of smoking also differentiate between southern and northern Europe.

English proficiency and language preference: testing the equivalence of two measures

OBJECTIVES

We examined the association of language proficiency vs language preference with self-rated health among Asian American immigrants. We also examined whether modeling preference or proficiency as continuous or categorical variables changed our inferences.

METHODS

Data came from the 2002-2003 National Latino and Asian American Study (n = 1639). We focused on participants' proficiency in speaking, reading, and writing English and on their language preference when thinking or speaking with family or friends. We examined the relation between language measures and self-rated health with ordered and binary logistic regression.

RESULTS

All English proficiency measures were associated with self-rated health across all models. By contrast, associations between language preference and self-rated health varied by the model considered.

CONCLUSIONS

Although many studies create composite scores aggregated across measures of English proficiency and language preference, this practice may not always be conceptually or empirically warranted.

What is self-rated health and why does it predict mortality? Towards a unified conceptual model

The association of self-rated health with mortality is well established but poorly understood. This paper provides new insights into self-rated health that help integrate information from different disciplines, both social and biological, into one unified conceptual framework. It proposes, first, a model describing the health assessment process to show how self-rated health can reflect the states of the human body and mind. Here, an analytic distinction is made between the different types of information on which people base their health assessments and the contextual frameworks in which this information is evaluated and summarized. The model helps us understand why self-ratings of health may be modified by age or culture, but still be a valid measure of health status. Second, based on the proposed model, the paper examines the association of self-rated health with mortality. The key question is, what do people know and how do they know what they know that makes self-rated health such an inclusive and universal predictor of the most absolute biological event, death. The focus is on the social and biological pathways that mediate information from the human organism to individual consciousness, thus incorporating that information into self-ratings of health. A unique source of information is provided by the bodily sensations that are directly available only to the individual him- or herself. According to recent findings in human biology, these sensations may reflect important physiological dysregulations, such as inflammatory processes. Third, the paper discusses the advantages and limitations of self-rated health as a measure of health in research and clinical practice. Future research should investigate both the logics that govern people's reasoning about their health and the physiological processes that underlie bodily feelings and sensations. Self-rated health lies at the cross-roads of culture and biology, therefore a collaborative effort between different disciplines can only improve our understanding of this key measure of health status.

Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh

This study examined the cross-sectional association of bone and joint diseases with health-related quality of life (HRQoL) among 850 randomly sampled people aged 60 or more years in a rural area of Bangladesh. Information about arthritis, back and joint pain was collected through self-reports and two physicians' assessments at a health centre. Health-related quality of life was measured using a multi-dimensional generic instrument designed for older people that has questions on the construct's physical, psychological, social, economic, spiritual and environmental dimensions. Bivariate analyses showed that the most negative effects of bone and joint diseases were on the physical and psychological dimensions. Hierarchical linear regression analyses revealed that joint pain, whether doctor-diagnosed or self-reported, and self-reported back pain were all associated with lower HRQoL scores and accounted for almost 20 per cent of the variation (adjusted for age, sex, education, marital status, household size, income, expenditure and occupation). The analyses further revealed that women with self-reported back pain had significantly lower psychological, environmental and overall HRQoL scores than equivalent men, while self-reported joint pain was associated with significantly lower scores only for the environmental dimension. The strong association of bone and joint diseases with HRQoL underscores the importance of regarding these illnesses as public health problems.

Developing summary scores of health-related quality of life for a population-based survey

OBJECTIVE

Health-related quality of life (HRQOL) is an important indicator of public health. The Centers for Disease Control and Prevention's (CDC's) Behavioral Risk Factor Surveillance System (BRFSS) includes nine HRQOL items that can be used to monitor the health status of the nation. The objective of this study was to examine the numerical relationships among these HRQOL items to develop summary scores by combining items.

METHODS

Using 2001 and 2002 BRFSS data from states that included all nine HRQOL questions, factor analyses were performed to determine whether the items would group together into multi-item scales.

RESULTS

Two factors emerged, corresponding conceptually to a physical health construct and a mental health construct. The resulting scales demonstrated acceptable internal consistency and ability to distinguish between population subgroups known to differ on HRQOL.

CONCLUSIONS

This study provides support for condensing the BRFSS core and optional HRQOL questions into two scales. These scales provide more complete information about physical and mental HRQOL than is available from single items, while limiting the number of individual variables required for a given analysis. However, the four core HRQOL questions focus primarily on physical health. Thus, the five supplemental questions should be included when measuring mental health is of interest.

Religion and the quality of life in the last year of life

OBJECTIVES

Religious involvement in old age appears to remain quite stable until the very end of life, reflecting patterns established earlier in life. Are there differences in quality of life (QOL) for those who are religiously involved in that last year compared with those who are not?

METHODS

We studied 499 elderly persons participating in ongoing annual interviews who died in the 12 months following an interview. We examined public and subjective religious involvement and indicators of health-related and psychosocial QOL, including health status and functional ability, family and friendship networks, depression, and well-being.

RESULTS

More deeply religious respondents were more likely to see friends, and they had better self-rated health, fewer depressive feelings, and were observed by the interviewer to find life more exciting compared with the less religious. Respondents receiving strength and comfort from religion reported poorer self-rated health. Those who attended religious services often were most likely to have attended holiday parties, even after adjusting for health status. Significant interactions indicated that the disabled benefited more from both public and subjective religious involvement than the nondisabled.

DISCUSSION

Overall, QOL in the last year of life is positively related to religious involvement, particularly its more subjective dimensions.

Health care expenditure prediction with a single item, self-rated health measure

BACKGROUND

Prediction models that identify populations at risk for high health expenditures can guide the management and allocation of financial resources.

OBJECTIVE

To compare the ability for identifying individuals at risk for high health expenditures between the single-item assessment of general self-rated health (GSRH), "In general, would you say your health is Excellent, Very Good, Good, Fair, or Poor?," and 3 more complex measures.

STUDY DESIGN

We used data from a prospective cohort, representative of the US civilian noninstitutionalized population, to compare the predictive ability of GSRH to: (1) the Short Form-12, (2) the Seattle Index of Comorbidity, and (3) the Diagnostic Cost-Related Groups/Hierarchal Condition Categories Relative-Risk Score. The outcomes were total, pharmacy, and office-based annualized expenditures in the top quintile, decile, and fifth percentile and any inpatient expenditures.

DATA SOURCE

Medical Expenditure Panel Survey panels 8 (2003-2004, n = 7948) and 9 (2004-2005, n = 7921).

RESULTS

The GSRH model predicted the top quintile of expenditures, as well as the SF-12, Seattle Index of Comorbidity, though not as well as the Diagnostic Cost-Related Groups/Hierarchal Condition Categories Relative-Risk Score: total expenditures [area under the curve (AUC): 0.79, 0.80, 0.74, and 0.84, respectively], pharmacy expenditures (AUC: 0.83, 0.83, 0.76, and 0.87, respectively), and office-based expenditures (AUC: 0.73, 0.74, 0.68, and 0.78, respectively), as well as any hospital inpatient expenditures (AUC: 0.74, 0.76, 0.72, and 0.78, respectively). Results were similar for the decile and fifth percentile expenditure cut-points.

CONCLUSIONS

A simple model of GSRH and age robustly stratifies populations and predicts future health expenditures generally as well as more complex models.

Social disconnectedness, perceived isolation, and health among older adults

Previous research has identified a wide range of indicators of social isolation that pose health risks, including living alone, having a small social network, infrequent participation in social activities, and feelings of loneliness. However multiple forms of isolation are rarely studied together making it difficult to determine which aspects of isolation are most deleterious for health. Using population-based data from the National Social Life, Health, and Aging Project, we combine multiple indicators of social isolation into scales assessing social disconnectedness (e.g., small social network, infrequent participation in social activities) and perceived isolation (e.g., loneliness, perceived lack of social support). We examine the extent to which social disconnectedness and perceived isolation have distinct associations with physical and mental health among older adults. Results indicate that social disconnectedness and perceived isolation are independently associated with lower levels of self-rated physical health. However, the association between disconnectedness and mental health may operate through the strong relationship between perceived isolation and mental health. We conclude that health researchers need to consider social disconnectedness and perceived isolation simultaneously.

Validity and stability of self-reported health among adolescents in a longitudinal, nationally representative survey

OBJECTIVES

The goals of this study to assess (1) the stability of self-reported health among a nationally representative sample of youth in adolescence over a period of 6 years, (2) the concordance of self-reported health between parents and children, and (3) the validity of self-reported health across a range of physical and emotional indicators of adolescent well-being.

METHODS

This study uses data from rounds 1 to 7 (1997-2003) of the National Longitudinal Survey of Youth, 1997 Cohort (NLSY97). The sample consists of 6748 youth born between January 1, 1980, and December 31, 1984. Data on one of the youths' parents were also included in the baseline of the survey. Analyses were conducted using polychoric correlations and ordinal logistic regression.

RESULTS

Self-reported health of adolescents over a 7-year period indicated moderate stability (40% agreement after 7 years for girls and 41% for boys). Concordance was also present between parents and their children, although the association was higher among same-gender pairings (mother-daughter and father-son concordances). Adolescents' self-reported health was also linked with the presence or absence of chronic health conditions, emotional problems, and with being overweight or obese but not with sensory conditions or physical deformity.

CONCLUSIONS

Self-reported health is stable from early and middle adolescence to young adulthood. Self-reported health is also a valid measure of a variety of physical and emotional dimensions of adolescent well-being. The stability and validity of self-reported health do not differ by the gender of the child, although there is slightly greater concordance when the reporting parent is the same gender as the child.

Associations between health-related quality of life and smoking status among a large sample of U.S. adults

OBJECTIVE

To examine the association between self-perceived health-related quality of life (HRQoL) and smoking status.

METHODS

We used data from 2006 Behavioral Risk Factor Surveillance System, USA participants in four states (n=17,800) to compare the HRQoL of current smokers who unsuccessfully attempted to quit (unsuccessful quitters), former smokers, and never smokers with the HRQoL of current smokers who made no attempts to quit (non-quitters).

RESULTS

Overall, unsuccessful quitters were more likely than non-quitters to report frequent mental distress, physical distress, and pain but not frequent depressive symptoms; former and never smokers were less likely than non-quitters to report frequent depressive symptoms. When study subjects were stratified by sex, these associations held true for men, but not for women. Among women, the prevalence of frequent mental and physical distress among former smokers and never smokers was not significantly different from the prevalence among non-quitters, whereas unsuccessful quitters were 2.4 times more likely to report frequent mental distress and 2.1 times more likely to report frequent physical distress than were non-quitters.

CONCLUSIONS

Certain HRQoL characteristics were worse among smokers who unsuccessfully attempted to quit and better among former smokers than among smokers who made no attempts to quit.

Can self-rated health identify US women and men with low bone mineral density? A cross-sectional population study

BACKGROUND

Despite its simplicity, self-rated health (SRH) is a significant dimension of health assessment, with demonstrated means to identify individuals at increased risk of morbidity and mortality.

OBJECTIVE

The aim of the present study was to assess whether SRH, age, and modifiable osteoporosis risk factors in a hypothetical screening situation could identify individuals with low bone mineral density (BMD).

METHODS

Data were analyzed from a multiethnic sample of 4905 women and men aged 50 to 79 years from the Third National Health and Nutrition Examination Survey. Low BMD was assessed according to the World Health Organization definition using gender- and race/ethnicity-specific young adult mean values to calculate T-scores. Multiple linear regression analysis was used to determine whether BMD was lower among those with poorer SRH; multiple logistic regression analysis was used to determine whether poor SRH was associated with low BMD.

RESULTS

The study population included 616 and 589 African American; 522 and 564 Mexican American; and 1312 and 1302 white women and men, respectively. The distributions of SRH responses differed for African American and Mexican American women and men compared with the distributions for same-gender whites, with significantly more white women and men reporting excellent or very good health (P < 0.05) and significantly greater proportions of African American and Mexican American women and men reporting poorer health (P < 0.05). Among women and nonwhite men, there was no evidence of an association between BMD and SRH. Linear trends of decreasing BMD with declining SRH were detected for all men with low or normal body mass index (P < 0.001) and overweight men (P < 0.001). When stratified by race/ethnicity, a linear trend of decreasing BMD with declining SRH was found for nonobese white men only (P-trend: <0.001). The likelihood of having low BMD among nonobese white men who reported excellent or very good health was two-thirds that of their male counterparts with poor SRH (P < 0.001).

CONCLUSIONS

Independent of age and modifiable osteoporosis risk factors, poor SRH may be a relevant risk factor for low BMD among older nonobese white men. Further research is needed to determine whether SRH may be a useful risk assessment tool for low BMD in this group of men.

Racial differences in self-rated health at similar levels of physical functioning: an examination of health pessimism in the health, aging, and body composition study

BACKGROUND

The health pessimism hypothesis suggests that Black elders are more pessimistic about health than Whites and therefore tend to report lower self-rated health (SRH) at comparable health status. The current analysis examined the factors associated with SRH and tested the health pessimism hypothesis among older adults at similar levels of physical functioning.

METHODS

The study example included 2,729 Health, Aging, and Body Composition study participants aged 70-79 years. We used hierarchical logistic regression to examine the association between race and SRH while adjusting for demographic, physical health, and psychosocial factors. The analyses were repeated for participants at similar levels of objective functioning to test the health pessimism hypothesis.

RESULTS

The association between race and SRH remained independent of physical and psychosocial health variables, with Whites being 3.7 times more likely than Black elders to report favorable SRH. This association was significant at each level of physical functioning and greater at the higher (odds ratio [OR] = 5.5) versus lower (OR = 2.2) levels of functioning.

CONCLUSIONS

The results suggest greater health pessimism among Black elders and expand previous work by including objective functioning in multidimensional models to deconstruct race variations in the SRH of older adults.

Gender differences in functional status in middle and older age: are there any age variations?

OBJECTIVES

The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups.

METHODS

Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women.

RESULTS

As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups.

DISCUSSION

A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women's socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.

Valued life activity disability played a significant role in self-rated health among adults with chronic health conditions

OBJECTIVE

Because self-rated health (SRH) is strongly associated with health outcomes, it is important to identify factors that individuals take into account when they assess their health. We examined the role of valued life activities (VLAs), the wide range of activities deemed to be important to individuals, in SRH assessments.

STUDY DESIGN AND SETTING

Data were from three cohort studies of individuals with different chronic conditions--rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and chronic obstructive pulmonary disease (COPD). Each cohort's data were collected through structured telephone interviews. Logistic regression analyses identified factors associated with ratings of fair/poor SRH. All analyses included sociodemographic characteristics, general and disease-specific health-related factors, and general measures of physical functioning.

RESULTS

Substantial portions of each group rated their health as fair/poor (RA 37%, SLE 47%, COPD 40%). In each group, VLA disability was strongly associated with fair/poor health (RA: OR=4.44 [1.86,10.62]; SLE: OR=3.60 [2.10,6.16]; COPD: OR=2.76 [1.30,5.85]), even after accounting for covariates.

CONCLUSION

VLA disability appears to play a substantial role in individual perceptions of health, over and above other measures of health status, disease symptoms, and general physical functioning.

Social inequalities in self-rated health by age: cross-sectional study of 22,457 middle-aged men and women

Background

We investigate the association between occupational social class and self-rated health (SRH) at different ages in men and women.

Methods

Cross sectional population study of 22 457 men and women aged 39–79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993–1997. The relationship between self-rated health and social class was examined using logistic regression, with a poor or moderate rating as the outcome.

Results

The prevalence of poor or moderate (lower) self-rated health increased with increasing age in both men and women. There was a strong social class gradient: in manual classes, men and women under 50 years of age had a prevalence of lower self-rated health similar to that seen in men and women in non-manual social classes over 70 years old. Even after adjustment for age, educational status, and lifestyle factors (body mass index (BMI), smoking, physical activity and alcohol consumption) there was still strong evidence of a social gradient in self-rated health, with unskilled men and women approximately twice as likely to report lower self-rated health as professionals (OR_men = 2.44 (95%CI 1.69, 3.50); OR_women = 1.97 (95%CI 1.45, 2.68).

Conclusion

There was a strong gradient of decreased SRH with age in both men and women. We found a strong cross-sectional association between SRH and social class, which was independent of education and major health related behaviors. The social class differential in SRH was similar with age. Prospective studies to confirm this association should explore social and emotional as well as physical pathways to inequalities in self reported health.

Self-rated health among Mayan women participating in a randomised intervention trial reducing indoor air pollution in Guatemala

BACKGROUND

Indoor air pollution (IAP) from solid fuels is a serious health problem in low-income countries that can be alleviated using improved stoves. Although women are the principal users, few studies have investigated the self-assessed impact of the stoves on their health and lives.

METHODS

This study was conducted in rural highland Guatemala, involving 89 intervention and 80 control Mayan Indian young women (mean 27.8 years, SD 7.2). Outcomes were assessed after approximately 18 months use of the new stove. Our objectives were to compare self-rated health and change in health among women participating in a randomised control trial comparing a chimney stove with an open fire, to describe impacts on women's daily lives and their perceptions of how reduced kitchen smoke affects their own and their children's health.

RESULTS

On intention-to-treat analysis, 52.8% of intervention women reported improvement in health, compared to 23.8% of control women (p < 0.001). Among 84 intervention women who reported reduced kitchen smoke as an important change, 88% linked this to improvement in their own health, particularly for non-respiratory symptoms (for example eye discomfort, headache); 57% linked reduced smoke to improvement in their children's health, particularly sore eyes.

CONCLUSION

Women's perception of their health was improved, but although smoke reduction was valued, this was linked mainly with alleviation of non-respiratory symptoms like eye discomfort and headache. More focus on such symptoms may help in promoting demand for improved stoves and cleaner fuels, but education about more severe consequences of IAP exposure is also required.

Returning to the "homeland": work-related ethnic discrimination and the health of Japanese Brazilians in Japan

OBJECTIVES

We investigated whether self-reported ethnic discrimination in the workplace was associated with well-being among Japanese Brazilians who had returned to Japan. Further, we examined interactions between discrimination and education on well-being.

METHODS

We obtained data from a cross-sectional survey of Japanese Brazilian workers (n = 313) conducted in 2000 and 2001. Outcomes were self-rated health, psychological symptoms as measured by the 12-item General Health Questionnaire (GHQ-12) score, and a checklist of somatic symptoms.

RESULTS

Reports of ethnic discrimination were associated with increased risk of poor self-rated health and psychological symptoms (GHQ-12 score), after we controlled for self-assessed workload, supportive relations at work, physically dangerous working conditions, workplace environmental hazards, shift work, number of working hours, age, gender, marital status, income, education, Japanese lineage, length of residence, and Japanese language proficiency. Further, the relationship between discrimination and self-rated health and somatic symptoms was most robust for those with the least education.

CONCLUSIONS

Ethnic discrimination appears to be a correlate of morbidity among Japanese Brazilian migrants. Future research should investigate how educational and workplace interventions may reduce discrimination and possibly improve health.

Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans

OBJECTIVES

We examined whether racial discrimination is associated with increased body mass index (BMI) and obesity among Asian Americans. Further, we explored whether this association strengthens with increasing time in the United States.

METHODS

We analyzed data from the 2002 to 2003 National Latino and Asian American Study (n=1956). Regression models tested whether reports of racial discrimination were associated with BMI and obesity, after accounting for weight discrimination, age, gender, marital status, ethnicity, generation, employment, health status, and social desirability bias (the tendency to seek approval by providing the most socially desirable response to a question).

RESULTS

We found that (1) racial discrimination was associated with increased BMI and obesity after we controlled for weight discrimination, social desirability bias, and other factors and (2) the association between racial discrimination and BMI strengthened with increasing time in the United States.

CONCLUSIONS

Racial discrimination may be an important factor related to weight gain among ethnic minorities.

Determinants of remaining in the community after discharge: results from New Jersey's Nursing Home Transition Program

PURPOSE

To inform states with nursing home transition programs, we determine what risk factors are associated with participants' long-term readmission to nursing homes within 1 year after discharge.

DESIGN AND METHODS

We obtained administrative data for all 1,354 nursing home residents who were discharged, and we interviewed 628 transitioning through New Jersey's nursing home transition program in 2000. We used the Andersen behavioral model to select predictors of long-term nursing home readmission, and we used Cox proportional hazards regressions to examine the relative risk of experiencing such readmissions.

RESULTS

Overall, 72.6% of the 1,354 individuals remained in the community, with 8.6% readmitted to a nursing home for long stays (>90 days) and 18.8% dying during the study year. Cox proportional hazards regression analysis showed that being male, single, and dissatisfied with one's living situation; living with others; and falling within 8 to 10 weeks after discharge were significant predictors of long-term nursing home readmission during the first year after discharge.

IMPLICATIONS

Most of the factors predicting long-term readmission were predisposing, not need, factors. This fact points to the limits of formulaic approaches to assessing candidates for discharge and the importance of working with clients to understand and address their particular vulnerabilities. Consumers, state policy makers, nursing home transition staff, discharge planners, and caregivers can use these findings to understand and help clients understand their particular risks and options, and to identify those individuals needing the greatest attention during the transition period as well as risk-specific services such as fall-prevention programs that should be made available to them.

Intertwining courses of functional status and subjective health among older Japanese

OBJECTIVES

We sought to depict how trajectories of functional status are related to the average changes in self-rated health and its underlying trajectories.

METHODS

Data came from a five-wave panel study of a national sample of 2,200 Japanese older adults between 1987 and 1999. We employed hierarchical linear models and multinomial logistic regression to depict the interrelationships among patterns of temporal change in functional status and self-rated health.

RESULTS

Trajectories of functional status were associated with the average age-related changes in subjective health (i.e., linear and nonlinear slopes). Furthermore, there were significant correlations between the courses of functional health and those of self-rated health. Finally, recovery from poor self-rated health was characterized by having poor health and functional ability at baseline.

DISCUSSION

Researchers can generalize prior observations of the association between functional status and subjective health at one or more points in time to their long-term trajectories. These findings provide further insights into understanding the dynamics between two key dimensions of health among older adults in Japan.

Fundamental causes of health disparities: stratification, the welfare state, and health in the United States and Iceland

Research has established that those with higher social status have better health. Less is known about whether this relationship differs cross-nationally and whether it operates similarly across different institutional arrangements. To examine the relationship between stratification and health, two Western, industrialized societies at opposite ends of an equal/unequal continuum are compared: the United States and Iceland. Using data from the 1998 General Social Survey and the 1998 Health and Living Standards of Adult Icelanders survey, I draw from two theoretical perspectives. First, I explore the notion of fundamental causes of disease by examining whether stratification has similar effects on health. Second, I examine whether the organization of welfare states affects this relationship. The results show that education, employment, and relative poverty have similar effects on health in both nations, thus supporting the notion of a fundamental cause. However in Iceland relative affluence has a weaker relationship with health. Further, being a parent, regardless of marital status, has a stronger positive relationship with good health in Iceland. Welfare state intervention may be most successful in equalizing health outcomes by supporting families and by removing advantages traditionally accumulated by the wealthy in capitalist societies.