Two views of self-rated general health status

Divergent pathways to influence: Cognition and behavior differentially mediate the effects of optimism on physical and mental quality of life in Chinese university students

Previous research has indicated that both cognitive and behavioral variables mediate the positive effect of optimism on quality of life; yet few attempts have been made to accommodate these constructs into a single explanatory framework. Adopting Fredrickson's broaden-and-build perspective, we examined the relationships between optimism, self-rated health, resilience, exercise, and quality of life in 365 Chinese university students using path analysis. For physical quality of life, a two-stage model, in which the effects of optimism were sequentially mediated by cognitive and behavioral variables, provided the best fit. A one-stage model, with full mediation by cognitive variables, provided the best fit for mental quality of life. This suggests that optimism influences physical and mental quality of life via different pathways.

Associations between self-rated vision score, vision tests, and self-reported visual function in the Salisbury Eye Evaluation Study

PURPOSE

We attempt to understand the determinants of self-rated vision status by examining associations with vision tests, self-reported visual function, demographic, and health-status characteristics.

METHODS

Participants included 2467 individuals, aged 65 to 84 years, in a longitudinal, population-based cohort study. Participants rated their vision status from 0 to 10. Visual acuity, contrast sensitivity, stereoacuity, and visual fields were assessed. The Activities of Daily Vision Scale (ADVS) questionnaire was administered. Multivariate ordinal and multinomial logistic-regression models examined the association of demographic, health-status characteristics, vision tests, and ADVS subscales with self-rated vision status score. Odds ratios described the association of these characteristics with reporting better vision status.

RESULTS

Better visual acuity, contrast sensitivity, stereoacuity, and visual fields were associated with increased odds of reporting better vision status. Among the vision tests, a 2-line increase in visual acuity was most likely to result in an individual reporting better vision status (odds ratio, 1.49; 95% confidence interval [CI], 1.30-1.70). A 5-point increase in the near vision and far vision ADVS subscale scores was associated with increased odds of reporting good versus poor vision status. A 5-point increase in the near vision subscale was most likely to result in an individual reporting good versus poor vision status (odds ratio, 1.38; 95% CI, 1.28-1.50).

CONCLUSIONS

Self-rated vision status is a multidimensional measure. Near-vision visual function, visual acuity, and contrast sensitivity are important determinants of self-rated vision status in an elderly population. This understanding may improve the ability of eye care providers to maximize self-rated vision status among their patients.

Equity in maternal health in South Africa: analysis of health service access and health status in a national household survey

BACKGROUND

South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources.

METHODS

Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data.

FINDINGS

Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2-6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group.

CONCLUSIONS

Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.

An exploration of workplace social capital as an antecedent of occupational safety and health climate and outcomes in the Chinese education sector

PURPOSE

It is widely acknowledged that teachers are at greater risk of work-related health problems. At the same time, employee perceptions of different dimensions of organizational climate can influence their attitudes, performance, and well-being at work. This study applied and extended a safety climate model in the context of the education sector in Hong Kong. Apart from safety considerations alone, the study included occupational health considerations and social capital and tested their relationships with occupational safety and health (OSH) outcomes.

METHODS

Seven hundred and four Hong Kong teachers completed a range of questionnaires exploring social capital, OSH climate, OSH knowledge, OSH performance (compliance and participation), general health, and self-rated health complaints and injuries. Structural equation modeling (SEM) was used to analyze the relationships between predictive and outcome variables.

RESULTS

SEM analysis revealed a high level of goodness of fit, and the hypothesized model including social capital yielded a better fit than the original model. Social capital, OSH climate, and OSH performance were determinants of both positive and negative outcome variables. In addition, social capital not only significantly predicted general health directly, but also had a predictive effect on the OSH climate-behavior-outcome relationship.

CONCLUSIONS

This study makes a contribution to the workplace social capital and OSH climate literature by empirically assessing their relationship in the Chinese education sector.

Disparities in women's health across a generation: a mother-daughter comparison

BACKGROUND

The U.S. Centers for Disease Control and Prevention has set national goals to eliminate health disparities by race, sex, and socioeconomic status. Progress in meeting these goals has been mixed. This paper provides a different view on the evolving health of U.S. women by examining a sample of daughters and their mothers.

METHODS

The aim was to determine if the health risk profiles of daughters (born 1975-1992) were different from their mothers (born 1957-1964) measured when both were between the ages of 17 and 24 years. The U.S.-based National Longitudinal Survey of Youth 1979 and associated Children and Young Adult Surveys were used. The sample was 2411 non-Hispanic white and African American girls born to 1701 mothers. Outcomes were height, weight, body mass index (BMI), age of menarche, and self-reported health.

RESULTS

In both races, daughters were taller but entered adulthood at greater risk for the development of chronic illness than their mothers. Racial differences were greater in the daughters' generation than in the mothers'. Whites in both generations experienced educational differences in health based upon the mother's educational level, with fewer years of maternal education associated with poorer health. African Americans of both generations experienced differences by maternal education in self-reported health. However, when African American daughters were compared with their mothers, daughters born to college educated women gained more weight and had higher BMI and earlier menarche than did daughters born to high school dropouts.

CONCLUSION

Health deterioration across generations in both races suggests that much work is needed to meet Healthy People 2020 goals of health equity.

Is self-rated health comparable between non-Hispanic whites and Hispanics? Evidence from the health and retirement study

OBJECTIVES

Using subsequent all-cause mortality as a yardstick for retrospective health, this study assessed the comparability of self-rated health (SRH) between non-Hispanic whites and Hispanics.

METHODS

Based on longitudinal data from 6,870 white and 886 Hispanic respondents aged between 51 and 61 in the 1992 Health and Retirement Study, we related SRH in 1992 to risk of mortality in the 1992-2008 period. Logit models were used to predict white-Hispanic differences in reporting fair or poor SRH. Survival curves and cox proportional hazard models were estimated to assess whether and the extent to which the SRH-mortality association differs between non-Hispanic whites and Hispanics.

RESULTS

Hispanic respondents reported worse SRH than whites at the baseline, yet they had similar risk of mortality as whites in the 1992-2008 period. Overall, Hispanics rated their health more pessimistically than whites. This was especially the case for Hispanics who rated their health fair or poor at the baseline, whereas their presumed health conditions, as reflected by subsequent risk of mortality, should be considerably better than their white counterparts.

DISCUSSION

Health disparities between whites and Hispanics aged between 51 and 61 will be overestimated if the assessment has been solely based on differences in SRH between the two groups. Findings from this study call for caution in relying on SRH to quantify and explain health disparities between non-Hispanic whites and Hispanics in the United States.

Self-rated health and cardiovascular disease incidence: results from a longitudinal population-based cohort in Norfolk, UK

INTRODUCTION

Self-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). In a population-based cohort, we examined the association between SRH and incident CVD and whether this association was independent of socio-demographic, clinical and behavioural participant characteristics.

METHODS

Population-based prospective cohort study (European Prospective Investigation of Cancer-Norfolk). 20,941 men and women aged 39-74 years without prevalent CVD attended a baseline health examination (1993-1998) and were followed for CVD events/death until March 2007 (mean 11 years). We used a Cox proportional hazards model to quantify the association between baseline SRH (reported on a four point scale--excellent, good, fair, poor) and risk of developing CVD at follow-up after adjusting for socio-demographic, clinical and behavioural risk factors.

RESULTS

Baseline SRH was reported as excellent by 17.8% participants, good by 65.1%, fair by 16.0% and poor by 1.2%. During 225,508 person-years of follow-up, there were 55 (21.2%) CVD events in the poor SRH group and 259 (7.0%) in the excellent SRH group (HR 3.7, 95% CI 2.8-4.9). The HR remained significant after adjustment for behavioural risk factors (HR 2.6, 95% CI 1.9-3.5) and after adjustment for all socio-demographic, clinical and behavioural risk factors (HR 3.3, 95% CI 2.4-4.4). Associations were strong for both fatal and non-fatal events and remained strong over time.

CONCLUSIONS

SRH is a strong predictor of incident fatal and non-fatal CVD events in this healthy, middle-aged population. Some of the association is explained by lifestyle behaviours, but SRH remains a strong predictor after adjustment for socio-demographic, clinical and behavioural risk factors and after a decade of follow-up. This easily accessible patient-centred measure of health status may be a useful indicator of individual and population health for those working in primary care and public health.

Changes in self-rated health and subjective social status over time in a cohort of healthcare personnel

As part of a prospective cohort study of 1354 female and 347 male healthcare personnel, we examined the stability of subjective social status over ~7 months and the prospective association between subjective social status and self-rated health status. Most (82%) subjective social status ratings were stable (within ±1 point). Lower baseline subjective social status among healthcare personnel was associated with more subsequent reports of fatigue and headache and worsening global self-rated health status. Healthcare personnel who placed themselves on the bottom half of the subjective social status ladder were four times more likely to experience a decline in global self-rated health status and half as likely to improve to excellent self-rated health status.

Question context and priming meaning of health: effect on differences in self-rated health between Hispanics and non-Hispanic Whites

OBJECTIVES

We examined the implications of the current recommended data collection practice of placing self-rated health (SRH) before specific health-related questions (hence, without a health context) to remove potential context effects, between Hispanics and non-Hispanics.

METHODS

We used 2 methodologically comparable surveys conducted in English and Spanish that asked SRH in different contexts: before and after specific health questions. Focusing on the elderly, we compared the influence of question contexts on SRH between Hispanics and non-Hispanics and between Spanish and English speakers.

RESULTS

The question context influenced SRH reports of Spanish speakers (and Hispanics) significantly but not of English speakers (and non-Hispanics). Specifically, on SRH within a health context, Hispanics reported more positive health, decreasing the gap with non-Hispanic Whites by two thirds, and the measurement utility of SRH was improved through more consistent mortality prediction across ethnic and linguistic groups.

CONCLUSIONS

Contrary to the current recommendation, asking SRH within a health context enhanced measurement utility. Studies using SRH may result in erroneous conclusions when one does not consider its question context.

A Multilevel Dyadic Study of the Impact of Retirement on Self-Rated Health

Objectives:

This study examined the effects of retirement on self-rated health for married couples, using interdependence and social stratification theoretical frameworks.

Method:

Dyadic multilevel modeling of data ( N = 2,213 non-Hispanic couples) from 1992 to 2010 of the Health and Retirement Survey.

Results:

Retirement was associated with worse self-ratings of health (SRH) short term (ST) for both husbands and wives during the first couple of years of retirement. In addition, the longer the husbands (but not wives) were retired, the worse was their SRH. Cross-spouse effects varied by gender: When wives retired, their husbands’ SRH improved ST, but when husbands retired their wives’ SRH improved long term. Spouse education moderated the relationship between years since spouse’s retirement and SRH for wives.

Discussion:

Practitioners can use this information to help married couples through retirement planning and transitions. Results suggest that models of retirement in couples should pay greater attention to gender and other social stratification factors, spousal interdependence, and length of time since retirement.

Self-rated health: analysis of distances and transitions between response options

PURPOSE

We explored health differences between population groups who describe their health as excellent, very good, good, fair, or poor.

METHODS

We used data from a population-based survey which included self-rated health (SRH) and three global measures of health: the SF36 general health score (computed from the 4 items other than SRH), the EQ-5D health utility, and a visual analogue health thermometer. We compared health characteristics of respondents across the five health ratings.

RESULTS

Survey respondents (N = 1.844, 49.2 % response) rated their health as excellent (12.2 %), very good (39.1 %), good (41.9 %), fair (6.0 %), or poor (0.9 %). The means of global health assessments were not equidistant across these five groups, for example, means of the health thermometer were 95.8 (SRH excellent), 88.8 (SRH very good), 76.6 (SRH good), 49.7 (SRH fair), and 33.5 (SRH poor, p < 0.001). Recoding the SRH to reflect these mean values substantially improved the variance explained by the SRH, for example, the linear r (2) increased from 0.50 to 0.56 for the health thermometer if the SRH was coded as poor = 1, fair = 2, good = 3.7, very good = 4.5, and excellent = 5. Furthermore, transitions between response options were not explained by the same health-related characteristics of the respondents.

CONCLUSIONS

The adjectival SRH is not an evenly spaced interval scale. However, it can be turned into an interval variable if the ratings are recoded in proportion to the underlying construct of health. Possible improvements include the addition of a rating option between good and fair or the use of a numerical scale instead of the classic adjectival scale.

Factors associated with self-rated health (SRH) of a University of the Third Age (U3A) class participants

INTRODUCTION

A U3A is a way of making elderly people active. Our study aims to investigate the association between socioeconomic variables, selected symptoms, disorders and the SRH of participants of classes at the U3A.

MATERIALS AND METHODS

The study was conducted in 2011 in a group of participants of classes at the U3A in Plock, Poland. The authors examined 250 people aged 60 or older. A survey questionnaire was the study tool. Statistica 9.0. was used for statistical analysis, including ordinal regression models.

RESULTS

Being younger (65-69) increases the chance of returning a good SRH score to over five times compared to being 75 and over (odds ratio (OR)=5.30, confidence interval (CI)=1.76-15.97), p<0.01). The chance of a good SRH score is almost four times more likely in subjects with a disposable income which satisfies basic needs compared to that which does not (OR=3.97, CI=1.12-14.04, p<0.05). Furthermore, lack of symptoms and disorders have a strong influence on good SRH (no leg edema - OR=4.06, CI=1.63-10.12, p<0.01; no headache - OR=2.75, CI=1.34-5.62, p<0.01; no toothache - OR=4.32, CI=1.12-16.68, p<0.05; no hypertension - OR=1.78, CI=1.02-3.14, p<0.05; no degenerative disease - OR=1.88, CI=1.08-3.27, p<0.05). Feeling happy raised the chance of reporting good SRH by almost three times (OR=2.91, CI=1.35-6.27, p<0.01).

CONCLUSIONS

A subjective evaluation of health by the elderly constitutes an important indicator of their health and quality of life. It can become a basis for implementing activities of gerontological prophylaxis and leveling out health inequalities.

Self-rated health and symptomatic knee osteoarthritis over three years: data from a multicenter observational cohort study

OBJECTIVE

To determine if a previously published model of the influence of self-rated health on physical, mental, and social health among patients with joint replacement surgery could be generalized to persons with symptomatic knee osteoarthritis (OA). Our second purpose was to determine if self-rated health mediated changes in physical, mental, and social health.

METHODS

Persons with symptomatic knee OA (n = 1,127) who participated in the Osteoarthritis Initiative study completed the required measures at baseline and at 1-, 2-, and 3-year intervals. The key variable of interest was a single-item self-rated health measure. In addition, measures of physical, mental, and social health and a set of covariate measures over the 3-year period were analyzed. Structural equation modeling was used to test interrelationships among variables, as well as predictive and mediational relationships among self-rated health and mental, physical, and social health after adjusting for baseline covariates.

RESULTS

The full model demonstrated good statistical fit. Prior self-rated health consistently predicted current mental health and social health. Prior social health predicted current self-rated health. Self-rated health also mediated changes in mental health and social health. Only social health changes were mediated by self-rated health over all time periods.

CONCLUSION

Self-rated health predicts a variety of outcomes of symptomatic knee OA. In addition, self-rated health mediates changes in social health and mental health. The use of self-rated health as a simple and efficient clinical assessment has potential for clinical utility because of its predictive capability and association with multiple health domains.

The influence of neighbourhood formality status and socio-economic position on self-rated health among adult men and women: a multilevel, cross sectional, population study from Aleppo, Syria

Background

There is substantial evidence from high income countries that neighbourhoods have an influence on health independent of individual characteristics. However, neighbourhood characteristics are rarely taken into account in the analysis of urban health studies from developing countries. Informal urban neighbourhoods are home to about half of the population in Aleppo, the second largest city in Syria (population>2.5 million). This study aimed to examine the influence of neighbourhood socioeconomic status (SES) and formality status on self-rated health (SRH) of adult men and women residing in formal and informal urban neighbourhoods in Aleppo.

Methods

The study used data from 2038 survey respondents to the Aleppo Household Survey, 2004 (age 18–65 years, 54.8% women, response rate 86%). Respondents were nested in 45 neighbourhoods. Five individual-level SES measures, namely education, employment, car ownership, item ownership and household density, were aggregated to the level of neighbourhood. Multilevel regression models were used to investigate associations.

Results

We did not find evidence of important SRH variation between neighbourhoods. Neighbourhood average of household item ownership was associated with a greater likelihood of reporting excellent SRH in women; odds ratio (OR) for an increase of one item on average was 2.3 (95% CI 1.3-4.4 (versus poor SRH)) and 1.7 (95% CI 1.1-2.5 (versus normal SRH)), adjusted for individual characteristics and neighbourhood formality. After controlling for individual and neighbourhood SES measures, women living in informal neighbourhoods were less likely to report poor SRH than women living in formal neighbourhoods (OR= 0.4; 95% CI (0.2- 0.8) (versus poor SRH) and OR=0.5; 95%; CI (0.3-0.9) (versus normal SRH).

Conclusions

Findings support evidence from high income countries that certain characteristic of neighbourhoods affect men and women in different ways. Further research from similar urban settings in developing countries is needed to understand the mechanisms by which informal neighbourhoods influence women’s health.

Self-rated health and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition-InterAct study: a case-cohort study

OBJECTIVES

To investigate the association between self-rated health and risk of type 2 diabetes and whether the strength of this association is consistent across five European centres.

DESIGN

Population-based prospective case-cohort study.

SETTING

Enrolment took place between 1992 and 2000 in five European centres (Bilthoven, Cambridge, Heidelberg, Potsdam and Umeå).

PARTICIPANTS

Self-rated health was assessed by a baseline questionnaire in 3399 incident type 2 diabetic case participants and a centre-stratified subcohort of 4619 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study which was drawn from a total cohort of 340 234 participants in the EPIC.

PRIMARY OUTCOME MEASURE

Prentice-weighted Cox regression was used to estimate centre-specific HRs and 95% CIs for incident type 2 diabetes controlling for age, sex, centre, education, body mass index (BMI), smoking, alcohol consumption, energy intake, physical activity and hypertension. The centre-specific HRs were pooled across centres by random effects meta-analysis.

RESULTS

Low self-rated health was associated with a higher hazard of type 2 diabetes after adjusting for age and sex (pooled HR 1.67, 95% CI 1.48 to 1.88). After additional adjustment for health-related variables including BMI, the association was attenuated but remained statistically significant (pooled HR 1.29, 95% CI 1.09 to 1.53). I(2) index for heterogeneity across centres was 13.3% (p=0.33).

CONCLUSIONS

Low self-rated health was associated with a higher risk of type 2 diabetes. The association could be only partly explained by other health-related variables, of which obesity was the strongest. We found no indication of heterogeneity in the association between self-rated health and type 2 diabetes mellitus across the European centres.

Does self-rated health predict dementia?

OBJECTIVES

1. To determine if Self-Rated Health (SRH) predicts dementia over a five period in cognitively intact older adults, and in older adults with Cognitive Impairment, No Dementia (CIND); and 2. To determine if different methods of eliciting SRH (age-referenced (AR) versus unreferenced) yield similar results.

DESIGN

Prospective cohort.

POPULATION

1468 cognitively intact adults and 94 older adults with CIND aged 65+ living in the community, followed over five years.

MEASURES

Age, gender, education, subjective memory loss, depressive symptoms, functional status, cognition, SRH and AR-SRH were all measured; dementia was diagnosed on clinical examination. Those with abnormal cognition not meeting criteria for dementia were diagnosed with CIND.

RESULTS

In those who were cognitively intact at time 1, and had good SRH: 69.4% were intact; 6.0% had CIND; 6.9% had dementia, and 17.7% had died at time 2, while in those with poor SRH: 44.9% were intact, 11.1% had CIND, 9.1% had dementia, and 34.8% had died (p<0.001, chi-square test). In multinomial regression models SRH predicted dementia and death. In those with CIND at time 1 and good SRH: 2.3% were intact: 18.6% had CIND; 34.9% had dementia and 44.2% had died at time 2, while in those with poor SRH: 4.8% were intact, 31.0% had CIND, 19.0% had dementia, and 43.6% had died (p=0.30, chi-square test). In multinomial regression models, this was not significant. AR-SRH analyses were similar.

CONCLUSIONS

In cognitively intact older adults SRH predicts dementia. In older adults with CIND, SRH does not predict dementia.

Mothers' perceived physical health during early and middle childhood: relations with child developmental delay and behavior problems

The self-perceived physical health of mothers raising children with developmental delay (DD; N=116) or typical development (TD; N=129) was examined across child ages 3-9 years, revealing three main findings. First, mothers of children with DD experienced poorer self-rated physical health than mothers of children with TD at each age. Latent growth curve analyses indicated that mothers in the DD group experienced poorer health from age 3 but that the two groups showed similar growth across ages 3-9 years. Second, cross-lagged panel analyses supported a child-driven pathway in early childhood (ages 3-5) by which early mother-reported child behavior problems predicted poorer maternal health over time, while the reversed, health-driven path was not supported. Third, this cross-lagged path was significantly stronger in the DD group, indicating that behavior problems more strongly impact mothers' health when children have developmental delay than when children have typical development. The health disparity between mothers of children with DD vs. TD stabilized by child age 5 and persisted across early and middle childhood. Early interventions ought to focus on mothers' well-being, both psychological and physical, in addition to child functioning.

Assessment of everyday beliefs about health: the lay concepts of health inventory, college student version

This research investigated lay conceptualisations about health using a progressive mixed-method approach, culminating in a new self-report measure of lay concepts of health. In Study 1, 223 community and college-aged adults provided everyday descriptors of healthy people. These open-ended qualitative responses were narrowed to 259 distinct descriptors, and subsequently rated on their importance to health by a second lay sample (Study 2). The health descriptors rated as most important were then subjected to exploratory factor analysis in Study 3, resulting in five distinguishable factors. Proposed scale items were then administered again (to college students, in Study 4), and a confirmatory factor analysis (CFA) was performed. The CFA supported a four-factor model, comprised of Social-Emotional Health, Positive Health Practices, Absence of Stress and Anxiety, and Adequate Rest, presented as the college student version of the Lay Concepts of Health Inventory. The measure, as well as limitations and recommendations for future research, are presented.

Self-rated health and morbidity onset among late midlife U.S. adults

OBJECTIVES

Although self-rated health (SRH) is recognized as a strong and consistent predictor of mortality and functional health decline, there are relatively few studies examining SRH as a predictor of morbidity. This study examines the capacity of SRH to predict the onset of chronic disease among the late midlife population (ages 51-61 years).

METHOD

Utilizing the first 9 waves (1992-2008) of the Health and Retirement Study, event history analysis was used to estimate the effect of SRH on incidence of 6 major chronic diseases (coronary heart disease, diabetes, stroke, lung disease, arthritis, and cancer) among those who reported none of these conditions at baseline (N = 4,770).

RESULTS

SRH was a significant predictor of onset of any chronic condition and all specific chronic conditions excluding cancer. The effect was particularly pronounced for stroke.

DISCUSSION

This research provides the strongest and most comprehensive evidence to date of the relationship between SRH and incident morbidity.

[Social relations and self- rated health: the ageing and health project]

OBJECTIVE

To investigate the association between social relationships and self-perceived health in the elderly.

METHODS

cross-sectional study of a representative sample of elderly individuals covered by the Family Health Program and residents in an area of high health vulnerability in Belo Horizonte, MG. Information was obtained through structured interviews. Factors associated with poor or very poor self-perceived health were identified by multiple logistic regression analysis.

RESULTS

363 out of 371 eligible elderly participated; 17.1% of elderly self-perceived their health as poor. There was a positive dose-response relationship between poor self-perceived health and the number of chronic diseases and the degree of difficulty to perform daily life activities. Elderly individuals who perceived their personal relationships as bad and who could not count on anyone if they became bedridden were more likely to self-rate their health as poor. Working was negatively associated with self-perceived poor health.

CONCLUSION

The results confirm the multidimensional structure of self-perceived health including the issues related to health and social relationships. Our results strengthen the role of social relations on health.

Overall perceived health predicts risk of hospitalizations and death in adults with heart failure: a prospective longitudinal study

BACKGROUND

Patient overall perception of health may provide an effective early warning for risk of hospitalization and death among heart failure patients.

OBJECTIVE

Determine whether overall perceived health predicts all-cause hospitalization or death in heart failure patients after adjusting for confounding factors in a sample of adults with heart failure.

DESIGN

Prospective, longitudinal, observational study.

SETTINGS

Three outpatient urban settings in the northeast United States between 2007 and 2010.

PARTICIPANTS

Adults with chronic Stage C heart failure confirmed by echocardiographic and clinical evidence.

METHODS

A secondary analysis was conducted using data collected on 273 Stage C patients with heart failure. Participants in the parent study were followed for 6 months. Overall perceived health was measured by self-report. Hospitalization and death were assessed from electronic hospital records and confirmed with county death records as needed. Cox proportional hazards models were used to examine the association between perceptions of health and rates of hospitalization and death.

RESULTS

Patients with poor or fair perceived health had over 5.5 times the rate of death or hospitalization over the 6-month period (hazard ratio; 95% confidence interval: 2.0-15.6; p=0.001) after controlling for model covariates. The predictive ability of perceived health attenuated over time such that at 30-days patients who reported poor or fair perceived health had only 1.2 times the rate of an event and virtually no difference in event rate by 60-days.

CONCLUSIONS

Overall perceived health is a powerful indicator of impending events and can be a quick tool for prioritizing heart failure patients who are at highest risk of imminent death and hospitalization. Questions about perceived health need to be asked of patients regularly in order to have clinical utility.

Socio-environmental factors associated with self-rated oral health in South Africa: a multilevel effects model

Aim: This study examined the influence of the social context in which people live on self-ratings of their oral health. Method: This study involved a representative sample of 2,907 South African adults (≥16 years) who participated in the 2007 South African Social Attitude Survey (SASAS). We used the 2005 General Household Survey (n = 107,987 persons from 28,129 households) to obtain living environment characteristics of SASAS participants, including sources of water and energy, and household cell-phone ownership (a proxy measure for the social network available to them). Information obtained from SASAS included socio-demographic data, respondents’ level of trust in people, oral health behaviors and self-rated oral health. Results: Of the respondents, 76.3% self-rated their oral health as good. Social context influenced women’s self-rated oral health differently from that of men. Good self-rated oral health was significantly higher among non-smokers, employed respondents and women living in areas with higher household cell-phone ownership. Furthermore, trust and higher social position were associated with good self-rated oral health among men and women respectively. Overall, 55.1% and 18.3% of the variance in self-rated oral health were explained by factors operating at the individual and community levels respectively. Conclusion: The findings highlight the potential role of social capital in improving the population’s oral health.

Effects of (un)employment on young couples' health and life satisfaction

This study investigated effects of employed and unemployed job status on health outcomes with questionnaires in 50 young couples. Analysis of variance revealed higher pessimism, higher stress levels, and lower life satisfaction in couples in which one partner was unemployed. These couples also exhibited more health risk behaviours compared to couples in which both partners were working. The dyadic analysis of data, using an actor-partner interdependence model, demonstrated strong actor and partner effects for male partner's job status. Being unemployed was significantly associated not only with male partner's life satisfaction but also with the life satisfaction of his female partner. In addition, male partner's pessimism was identified as a significant variable which mediates between male partner's job status and female partner's life satisfaction. The study highlights the relevance of the accomplishment of tasks in the domains of work and partnership during young adulthood and it emphasises the gender specific importance.

Poor health in the Korean older population: age effect or adverse socioeconomic position

The objective of this study was to examine the impact of socioeconomic status and age on poor health among elderly people. Data were taken from the 2006 baseline survey of the Korean Longitudinal Study of Aging (KLoSA). We compared self-rated poor health, depressive symptoms, chronic disease, and disability in middle-aged (age 45-64), old (age 65-74), and very old (age 75-105) individuals. Logistic regression models were used to assess the effect of a poor social environment on health. Elderly Koreans generally had poor socioeconomic status and reported a high prevalence of poor health compared with middle-aged people. Respondents aged 65-74 years old and those aged 75+ were approximately three and four times more likely, respectively, to report self-rated poor health than middle-aged people. These differences were reduced by 41-71% after controlling for education, employment, and income. Elderly persons were also more likely to report depression, chronic disease, or disability, and the differences between age groups were reduced after adjustment for socioeconomic status, but to a lesser extent than was self-rated poor health. Our results indicate that a substantial portion of the gap in health status between middle-aged and older Koreans may be accounted for by the typically low socioeconomic status of elderly people. Income security and health-related interventions are required to improve the health of the elderly cohort who are confronted with the synergistic effects of aging and low socioeconomic status on health.

Determinants of change in self-rated health among older adults in Europe: a longitudinal perspective based on SHARE data

The present study aims at detecting factors which may predict a decline or an improvement in self-rated health (SRH) of older adults (persons aged 50 or higher) among socio-demographic characteristics, physical and mental health indicators and risky health behaviours. In the analysis, multinomial logistic regression models are applied to data from waves 1 and 2 of the Survey of Health Ageing and Retirement in Europe (carried out about 3 years apart); persons who report a decline or an improvement in SRH at wave 2 are compared to those who report no change while controlling for SRH at baseline and country of residence. The analysis was carried out for the whole sample and two subgroups, persons aged 50-64 and 65 or higher. The results indicate that female sex and higher educational attainment have a strong protective effect against decline in SRH. Worse health at baseline is an important predictor of subsequent decline but changes occurring between the waves have a more pronounced effect, implying that SRH is influenced more by recent developments. The findings also indicate that improvement in SRH is a more complex concept than decline and is strongly affected by factors other than health. Among behavioural risk factors, low levels of physical activity and a decrease in the levels of activity between the waves are significantly related to decline while frequent drinking seems associated with improvement. Differentiations by age are modest and probably suggest that advancing age is related to a milder view of one's health.

Work-family conflict and health in Swedish working women and men: a 2-year prospective analysis (the SLOSH study)

BACKGROUND

Research has suggested that gender is related to perceptions of work-family conflict (WFC) and an underlying assumption is that interference of paid work with family life will burden women more than men. There is, however, mixed evidence as to whether men and women report different levels of WFC. Even less studies investigate gender differences in health outcomes of WFC. Also the number of longitudinal studies in this field is low.

METHODS

Based on the Swedish Longitudinal Occupational Survey of Health, we prospectively examined the effects of WFC on three different health measures representing a wide spectrum off ill health (i.e. self-rated health, emotional exhaustion and problem drinking). Logistic regression analyses were used to analyse multivariate associations between WFC in 2008 and health 2 years later.

RESULTS

The results show that WFC was associated with an increased risk of emotional exhaustion among both men and women. Gender differences are suggested as WFC was related to an increased risk for poor self-rated health among women and problem drinking among men. Interaction analyses revealed that the risk of poor self-rated health was substantially more influenced by WFC among women than among men.

CONCLUSIONS

We conclude that, despite the fact that women experience conflict between work and family life slightly more often than men, both men's and women's health is negatively affected by this phenomenon.

Efeito do plano amostral em modelo logístico ordinal: uma análise do estado de saúde autorreferido de adultos no Brasil usando a Pesquisa Nacional por Amostra de Domicílios de 2008

Estudos que consideram variáveis individuais e ambientais para explicar as diferenças no estado de saúde autorreferido de indivíduos vêm paulatinamente crescendo no Brasil, mas ainda são escassos. Por razões de tempo e custo, muitas pesquisas utilizam planos amostrais complexos que envolvem aspectos (estratificação, conglomeração e pesos amostrais distintos) que quando ignorados podem influenciar as medidas de razões de chance e as medidas de precisão das estimativas dos parâmetros de modelos estatísticos. Usando a Pesquisa Nacional por Amostra de Domicílios (PNAD 2008), este artigo avalia o impacto nessas medidas quando não se consideram alguns ou todos os aspectos ao ajustar um modelo logístico ordinal para estabelecer a associação entre o estado de saúde autorreferido de adultos e um conjunto de fatores individuais e ambientais. Observou-se que quando não se considera os três aspectos simultaneamente, ocorrem alterações nas magnitudes das medidas de razões de chance do adulto autorreferir melhor estado de saúde associadas à maioria dos fatores, além de grande subestimação dos erros padrões.

Antiretroviral therapy (ART) adherence and correlates to nonadherence among people on ART in Estonia

There are little data on antiretroviral therapy (ART) adherence among patients in Eastern Europe, despite the high incidence of HIV infection and the growing number of HIV-infected individuals who are being prescribed ART. The aim of this study was to measure rates of adherence to ART and factors associated with nonadherence among patients receiving care at an outpatient HIV clinic in Estonia. The study was based on cross-sectional data from a convenience sample of 144 patients receiving outpatient HIV care. Data were obtained via interviewer-administered surveys and data abstraction from clinical records. Adherence was measured from a 3-day patient self-report. Among 144 participants (mean age 33.8 years), two-thirds (63%) had been infected with HIV through intravenous drug use. Most (74%) were co-infected with hepatitis C (HCV). Perfect adherence over the last 3 days was commonly reported (88% [95% CI 81-92%]) with nonperfect adherence associated with greater concerns about the potential adverse consequences of taking ART (adjusted odds ratio [AOR] 4.8, 95% CI 1.2-34.0) and average (versus good/very good) self-reported health status (AOR 4.7, 95% CI 1.2-31.4). Self-reported ART adherence in this sample of Estonian HIV-positive patients in clinical care was similar to rates observed in Western Europe and other developed countries. Results suggest that adherence education and support may be most helpful if they specifically target the development of positive beliefs, reduction of negative expectancies towards ART.

Does Self-Rated Health Predict Death in Older Adults with Depressive Symptoms?

Nous avons analysé une étude de cohorte prospective afin de déterminer (1) si l’auto-évaluation de son propre état de santé (AES) prédit la mortalité chez les personnes plus âgées, avec et sans symptômes dépressifs, et (2) de déterminer s’il y a une interaction entre l’AES et les symptômes dépressifs sur la mortalité. Nous avons suivi pendant cinq ans 1 751 adultes âgés de 65 ans qui habitaient dans les communautés. Les mesures comprenaient l’âge, le sexe, le niveau d’éducation, Center for Epidemiological Studies-Depression (CES-D), the Modified Mini-Mental State Examination (MMS), et le questionnaire Older Americans’ Research Survey (OARS). Notre indicateur de résultats était la duree de vie avant le décès. Les analyses ont été faites sur des sujets avant ou non des symptômes dépressifs. Nous avons construit des modèles de régression de Cox avec un terme d’interaction pour la CES-D et l’AES. L’indice de risque pour la mortalite était de 1,63 pour les sujets atteints de symptômes dépressifs ; il était de 1,68 pour les sujets sans symptômes. Aucune interaction significative n’a été trouvée entre les symptômes dépressifs et l’A-ES pour la mortalité.

Health educator believability and college student self-rated health

OBJECTIVE

To evaluate the self-rated health (SRH) status among college students who reported receiving the majority of their health-related information from health educators.

PARTICIPANTS

Students (n = 49,921) who completed the 2006 National College Health Association survey.

METHODS

Bivariate associations between SRH and the believability of health information received were analyzed. Multiple logistic regression tested the relationship after covariate adjustment.

RESULTS

Although a modest correlation (r = .06, p < .0001) existed between the variables, SRH declined as the believability of health information received from health educators ratings became increasingly unfavorable (χ(2) = 110.96, p < .0001). After covariate adjustment, the relationship persisted with increased odds of reporting fair/poor health for those who reported the health information received from health educators as "neutral" (odds ratio [OR] = 1.31) or "unbelievable" (OR = 2.25) when compared to those who reported the health information received as "believable" (p < .0001).

CONCLUSIONS

The field of health education, and health educators, may positively influence college student SRH.

Whiners and deniers - what does self-rated health measure?

Self-rated health is a widely used measure of health typically obtained from a question, "How do you rate your health?" Despite the measure's popularity, debates continue as to what exactly self-rated health captures. This study augments the rich literature on the construct of self-rated health using a unique measurement approach. We conceptualize self-rated health as consisting of two components: latent health and reporting behaviour. We operationalize a preference-standardized health-related quality of life as a measure of latent health, and its systematic deviation from self-rated health as a measure of reporting behaviour. Using the 2005 Canadian Community Health Survey, we assess comparatively how the deviations between self-rated health and latent health, measured by the Health Utilities Index Mark 3, vary systematically by demographic, socioeconomic, and cultural factors. We present reporting behaviour by these factors in terms of pessimism and optimism relative to the assessment of the average Canadian. Our analysis shows reporting behaviour statistically and clinically significantly varies by age and socioeconomic status: those aged 80+ years and those with less income and education exhibit optimism about their health. In addition, our analysis indicates a tendency for persons with healthier lifestyles to be slightly pessimistic about their health. Our results imply that it may be misleading to take self-rated health at face value as a measure of health status for applications where preferences should be standardized. For this popular measure to continue to play an important role in population health research and policy development, its users must acknowledge and understand the determinants of self-rated health, including reporting behaviour.

Discrepancies in the concordance of self-reported vision status and visual acuity in the Salisbury Eye Evaluation Study

PURPOSE

To examine the association between self-rated vision and distance visual acuity by race and other factors.

DESIGN

Cross-sectional analysis within a longitudinal, population-based cohort study.

PARTICIPANTS AND CONTROLS

Two thousand five hundred twenty individuals, 65 to 84 years of age, including 666 black participants and 1854 white participants.

METHODS

All participants reported their self-rated vision score. Binocular distance visual acuity was assessed. Based on the level of visual acuity and the self-reported vision score, participants were placed into concordant and discrepant groups.

MAIN OUTCOME MEASURES

Multinomial logistic regression models were used to examine the characteristics associated with concordant and discrepant groups.

RESULTS

Black participants were more likely to be represented in the discordant group that reported good vision but had acuity worse than 20/40. In the multivariate analysis, a per-year decrement in years of education received increased the odds of being in both discrepant groups, one that reported good vision but had a visual acuity worse than 20/40 (odds ratio, 1.21; P<0.0001) and the other discrepant group that reported bad vision but had a visual acuity of 20/40 or better (odds ratio, 1.04; P<0.0001). A per-year decrement in years of education received also seemed to explain the excess risk of black race in the discrepant group that reported good vision but had a visual acuity worse than 20/40.

CONCLUSIONS

Given the socioeconomically driven discrepancies in self-reported vision status, self-reported vision status should be used cautiously in surveillance surveys, especially when assessing vision inequalities between socioeconomic groups.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The clustering of health behaviours in Ireland and their relationship with mental health, self-rated health and quality of life

Background

Health behaviours do not occur in isolation. Rather they cluster together. It is important to examine patterns of health behaviours to inform a more holistic approach to health in both health promotion and illness prevention strategies. Examination of patterns is also important because of the increased risk of mortality, morbidity and synergistic effects of health behaviours. This study examines the clustering of health behaviours in a nationally representative sample of Irish adults and explores the association of these clusters with mental health, self-rated health and quality of life.

Methods

TwoStep Cluster analysis using SPSS was carried out on the SLÁN 2007 data (national Survey of Lifestyle, Attitudes and Nutrition, n = 10,364; response rate =62%; food frequency n = 9,223; cluster analysis n = 7,350). Patterns of smoking, drinking alcohol, physical activity and diet were considered. Associations with positive and negative mental health, quality of life and self-rated health were assessed.

Results

Six health behaviour clusters were identified: Former Smokers, 21.3% (n = 1,564), Temperate, 14.6% (n = 1,075), Physically Inactive, 17.8% (n = 1,310), Healthy Lifestyle, 9.3% (n = 681), Multiple Risk Factor, 17% (n = 1248), and Mixed Lifestyle, 20% (n = 1,472). Cluster profiles varied with men aged 18-29 years, in the lower social classes most likely to adopt unhealthy behaviour patterns. In contrast, women from the higher social classes and aged 65 years and over were most likely to be in the Healthy Lifestyle cluster. Having healthier patterns of behaviour was associated with positive lower levels of psychological distress and higher levels of energy vitality.

Conclusion

The current study identifies discernible patterns of lifestyle behaviours in the Irish population which are similar to those of our European counterparts. Healthier clusters (Former Smokers, Temperate and Healthy Lifestyle) reported higher levels of energy vitality, lower levels of psychological distress, better self-rated health and better quality of life. In contrast, those in the Multiple Risk Factor cluster had the lowest levels of energy and vitality and the highest levels of psychological distress. Identification of these discernible patterns because of their relationship with mortality, morbidity and longevity is important for identifying national and international health behaviour patterns.

Associação entre o estado de saúde autorreferido de adultos e a área de localização do domicílio: uma análise de regressão logística ordinal usando a PNAD 2008

O ambiente urbano influencia a saúde e os comportamentos humanos, sendo necessário um melhor entendimento dos determinantes da saúde das populações que vivem nas cidades. A partir dos dados da Pesquisa Nacional por Amostra de Domicílios (PNAD) 2008, usando modelos logísticos ordinais incorporando o plano amostral, o presente artigo avalia a associação entre a área de localização do domicílio (urbana e rural) e o estado de saúde autorreferido da população adulta brasileira, controlando para um conjunto de fatores individuais e do ambiente intradomiciliar e extradomiciliar. Os resultados indicam que ao controlar por fatores individuais e ambientais, a associação entre a área de localização do domicílio e o estado de saúde autorreferido dos adultos se modifica (passando de OR=1,51 para OR=0,96) e perde a sua significância estatística (p-valor=0,208). Entretanto, foram observadas interações estatisticamente significantes entre a área de localização do domicílio e as seguintes variáveis: sexo, cor/raça, morbidade autorreferida, posse de bens básicos e percentual de domicílios adequados quanto a qualidade de moradia.

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.

Health burden in chronic disease: multimorbidity is associated with self-rated health more than medical comorbidity alone

OBJECTIVES

To investigate the association between multimorbidity-a construct comprising several health domains (medical comorbidity, musculoskeletal, physical and social functional status, mental health, and geriatric problems)-and overall self-rated health (SRH), an important chronic disease health outcome. We investigate whether medical comorbidity effects are mediated through other health domains and whether these domains have independent effects on SRH.

STUDY DESIGN AND SETTING

Medicare recipients (n=958) completed a questionnaire 3 years post primary total hip replacement surgery. Self-reported sociodemographic characteristics, SRH, and health domain statuses were ascertained. Probit regressions and path analyses were used to evaluate the independent effects of the health domains on SRH and the interrelationships between domains and to quantify direct and mediated effects.

RESULTS

All domains were independently associated with SRH. Medical comorbidity explained 11.7% of the variance in SRH, and all other health domains explained 27.3%. The impact of medical comorbidity was largely direct (only 21.5% mediated through other domains). Medical comorbidity minimally explained the variance in other domain scores.

CONCLUSION

SRH has multiple determinants. This finding suggests that an exclusive focus on any one domain in health research may limit the researchers' ability to understand health outcomes for which SRH is predictive.

Neighborhood sociodemographic and environmental contexts and self-rated health among Brazilian adults: a multilevel study

The aim of this study was to investigate the association between sociodemographic and environmental contexts on self-rated health. A population-based cross-sectional study with a random sample of 38 neighborhoods (census tracts) and 1,100 adults was carried out. Data analysis used multilevel logistic regression. Data from the Brazilian Census of 2000, mean income, years of study of the head of household and mean number of residents per tract were R$955 (SD = 586), 8 years (SD = 3), and 746 residents (SD = 358) respectively. Higher prevalences of fair/poor self-rated health were found in neighborhoods with greater populations and lower income/schooling levels. After control for individual variables, the odds for fair/poor self-rated health was twice as high in more populous (OR = 2.04; 95%CI: 1.15-3.61) and lower-income neighborhoods (OR = 2.29; 95%CI: 1.16-4.50) compared to less populous, higher-income ones. Self-rated health depends on individual characteristics and the sociodemographic context of neighborhoods.

Perceived health status of Francophones and Anglophones in an officially bilingual Canadian province

OBJECTIVE

It has been reported that being part of a minority group may be negatively associated with self-perceived health. The objective of this analysis was to determine whether there are differences in perceived health between the Francophone minority and Anglophone majority in New Brunswick, the only officially bilingual province in Canada.

METHODS

Data from the first four primary cycles of the Canadian Community Health Survey (2001 to 2007) were obtained for 17,729 New Brunswick residents. Odds of reporting good health among Francophones and Anglophones were compared using multivariate logistic regressions accounting for age, health-related behaviours, socio-demographic variables, and medical conditions.

RESULTS

In the final models, Francophone men and women were less likely than Anglophones to report their health as being good, although these differences were not statistically significant (Odds ratio, 95% confidence interval: 0.88, 0.61-1.26; 0.71, 0.49-1.04, in men and women, respectively).

CONCLUSION

This study suggests that being part of the linguistic minority in New Brunswick is not associated with statistically significant differences in self-perceived health.

Health-related quality of life among central Appalachian residents in mountaintop mining counties

OBJECTIVES

We examined the health-related quality of life of residents in mountaintop mining counties of Appalachia using the 2006 national Behavioral Risk Factor Surveillance System.

METHODS

Dependent variables included self-rated health; the number of poor physical, poor mental, and activity limitation days (in the past 30 days); and the Healthy Days Index. Independent variables included metropolitan status, primary care physician supply, and Behavioral Risk Factor Surveillance System behavioral and demographic variables. We compared dependent variables across 3 categories: mountaintop mining (yes or no), other coal mining (yes or no), and a referent nonmining group. We used SUDAAN MULTILOG and multiple linear regression models with post hoc least squares means to test mountaintop mining effects after adjusting for covariates.

RESULTS

Residents of mountaintop mining counties reported significantly more days of poor physical, mental, and activity limitation and poorer self-rated health (P < .01) compared with the other county groupings. Results were generally consistent in separate analyses by gender and age.

CONCLUSIONS

Mountaintop mining areas are associated with the greatest reductions in health-related quality of life even when compared with counties with other forms of coal mining.