Two views of self-rated general health status

Favourable changes in economic well-being and self-rated health among the elderly

Adverse economic shocks exert an influence on health perceptions, but little is known about the effect of sudden positive changes in a person's financial situation on self-rated health, particularly among low income people. This paper explores the association between an increase in the amount of non-contribution pensions, public cash transfers given to Costa Rican elderly of low socio-economic status (SES) and changes in self-rated health over time. The analysis is based on data from CRELES, the "Costa Rican Study on Longevity and Healthy Aging", which is based on a probabilistic sample of people born in 1945 or earlier, and living in Costa Rica by 2002. The fieldwork for the first and second waves of CRELES was conducted from 2004 to 2006, and from 2006 to 2008, respectively. The Costa Rican Government raised the amount of the non-contribution pension for the poor 100% before July 2007, and an additional 100% after that date. Due to the CRELES fieldwork schedule, the data have a natural quasi-experimental design, given that approximately half of CRELES respondents were interviewed before July 2007, independently of their status in receiving the public cash transfers. Using random effects ordered probit regression models, we find that people who experienced such increase report a greater improvement in self-rated health between waves than those who experienced a smaller increase and than the rest of the interviewees. Results suggest that increases in income may lead to a greater improvement in self-rated health.

Variations between world regions in individual health: a multilevel analysis of the role of socio-economic factors

BACKGROUND

Living in a particular region might affect health. We aimed to assess variations between regions in individual health. The role of socio-economic factors in the associations was also investigated.

METHODS

World Health Survey data were analysed on 220 487 individuals. Main outcomes included self-reported health, health complaints and disability. The main predictor variable was a modified regional classification of countries. Multilevel logistic regression was used to assess associations between individual health and regions, while accounting for individual and country-level socio-economic factors, notably occupation, education, national income and female literacy.

RESULTS

Individual health varied significantly between regions. For instance, compared with Western Europeans, Southern Asians and Western Africans reported poorer health, the odds ratios (ORs) being 2.05 [95% confidence interval (CI) 1.31-3.23] and 1.88 (95% CI 1.26-2.81), respectively. Accounting for socio-economic factors attenuated or, in a few cases, reversed the associations. For example, the OR for Southern Asia and Western Africa respectively became 0.94 (95% CI 0.37-2.37) and 0.77 (95% CI 0.26-2.25). Individuals from Central Europe and the Former Soviet Union were the most likely to report poor health, OR 1.92 (95% CI 1.07-3.44) and OR 4.17 (95% CI 1.91-9.10) respectively. Overall, men were less likely than women to report poor health.

CONCLUSION

Substantial regional variations in individual health exist, only partly explained by socio-economic factors. Additional policy and health research are needed to investigate Central Europe and Former Soviet Union rates that consistently lag behind Latin America, Asia and Africa.

Stress and prevalence of hearing problems in the Swedish working population

Background

Current human and experimental studies are indicating an association between stress and hearing problems; however potential risk factors have not been established. Hearing problems are projected to become among the top ten disabilities according to the WHO in the near future. Therefore a better understanding of the relationships between stress and hearing is warranted. Here we describe the prevalence of two common hearing problems, i.e. hearing complaints and tinnitus, in relation to different work-and health-related stressors.

Methods

A total of 18,734 individuals were invited to participate in the study, out of which 9,756 (52%) enrolled.

Results

The results demonstrate a clear and mostly linear relationship between higher prevalence of hearing problems (tinnitus or hearing loss or both) and different stressors, e.g. occupational, poorer self-rated health, long-term illness, poorer sleep quality, and higher burnout scores.

Conclusions

The present study unambiguously demonstrates associations between hearing problems and various stressors that have not been previously described for the auditory system. These findings will open new avenues for future investigations.

A Comparison of Self-Rated and Objectively Measured Successful Aging Constructs in an Urban Sample of African American Older Adults

Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.

Family caregivers at risk: who are they?

This study examined the characteristics, activities, challenges, and perceived burden of high-risk family caregivers of persons diagnosed with Alzheimer's disease. A descriptive design was used. A convenience sample of 121 family caregivers participated in the interview. High-risk family caregivers with poor health and one medical condition were compared with low-risk family caregivers. Caregivers with low income, depressive symptoms, and high care demands are more likely to be in the high-risk group. Health care providers need to screen family caregivers for depression and monitor those with high care demands.

Physical activity and self-rated health: Interactive effects of activity in work and leisure domains

OBJECTIVES

This longitudinal study examined the effects of physical activity on self-rated health (SRH); specifically, predicted interactions between leisure activity and job activity, and between leisure activity and age, were evaluated in relation to SRH.

METHODS

Survey data on age and leisure activity together with relevant covariates (education, body mass index, smoking and negative affectivity) were collected from oil industry employees. Three job activity levels were identified (sedentary, active and strenuous). At 5-year follow-up, SRH, body mass index and smoking were reassessed. Hierarchical regression was used to analyse the longitudinal data (N=314).

RESULTS

The job activity x leisure activity interaction (controlled for baseline SRH and covariates) predicted follow-up SRH (p<.025). Individuals in sedentary jobs benefited disproportionately from leisure activity; active and strenuous jobs were associated with lower SRH, irrespective of leisure activity. The age x leisure activity interaction was also significant (p<.025); leisure activity was significantly and positively associated with SRH only among younger individuals. Changes in body mass index and smoking contributed additively to the model, but did not mediate physical activity effects.

CONCLUSIONS

These findings highlight the importance of leisure physical activity for employees in sedentary jobs, but suggest that other factors (such as adverse environmental conditions) may underlie the lower SRH associated with physically demanding work. The results also indicate that, irrespective of job activity level, younger individuals benefit more from leisure physical activity than older ones. Thus, the study informs interventions designed to improve the health of employees through increased physical activity.

Characterizing self-rated health during a period of changing health status

Self-rated health (SRH) is among the most frequently assessed health perceptions. The purpose of this study was to assess the tenability of the recently proposed distinctions of SRH, as a spontaneous assessment of overall health, or as an enduring self-concept. Individuals (n = 449) undergoing total joint replacement for hip or knee osteoarthritis in Toronto, Canada were followed over 6 months of recovery. Health questionnaires, completed pre-surgery, and at 3 and 6 months post-surgery, included measures of pain, physical function, sports/recreation, fatigue, anxiety, depression, social participation, passive/active recreation, and community access. Structural equation modeling was used for the analyses. SRH was found to be responsive to current and changing mental well-being throughout the six months of recovery. Current SRH strongly predicted future SRH. In this clinical sample undergoing significant changes in health status, SRH displayed both enduring and spontaneous features; evidence is provided that both operate simultaneously. SRH may prove to be a simple yet critical health measure for identifying individuals who would benefit most from targeted interventions for improving overall health.

Measuring the health of the Indian elderly: evidence from National Sample Survey data

BACKGROUND

Comparable health measures across different sets of populations are essential for describing the distribution of health outcomes and assessing the impact of interventions on these outcomes. Self-reported health (SRH) is a commonly used indicator of health in household surveys and has been shown to be predictive of future mortality. However, the susceptibility of SRH to influence by individuals' expectations complicates its interpretation and undermines its usefulness.

METHODS

This paper applies the empirical methodology of Lindeboom and van Doorslaer (2004) to investigate elderly health in India using data from the 52nd round of the National Sample Survey conducted in 1995-96 that includes both an SRH variable as well as a range of objective indicators of disability and ill health. The empirical testing was conducted on stratified homogeneous groups, based on four factors: gender, education, rural-urban residence, and region.

RESULTS

We find that region generally has a significant impact on how women perceive their health. Reporting heterogeneity can arise not only from cut-point shifts, but also from differences in health effects by objective health measures. In contrast, we find little evidence of reporting heterogeneity due to differences in gender or educational status within regions. Rural-urban residence does matter in some cases. The findings are robust with different specifications of objective health indicators.

CONCLUSIONS

Our exercise supports the thesis that the region of residence is associated with different cut-points and reporting behavior on health surveys. We believe this is the first paper that applies the Lindeboom-van Doorslaer methodology to data on the elderly in a developing country, showing the feasibility of applying this methodology to data from many existing cross-sectional health surveys.

The importance of socio-demographic factors for the quality of life of adults with congenital heart disease

PURPOSE

We conducted a study to measure the associations of socio-demographic factors with quality of life outcomes among adults with congenital heart disease (CHD).

METHODS

Results are drawn from a questionnaire-based survey in 676 adults with CHD and compared to age and sex-matched controls of a representative national survey. Subjective outcomes were measured as health-related quality of life (hrQoL), health and life satisfaction. The associations of the subjective well-being with the degree of severity of the underlying heart defect and socio-demographic factors such as educational and employment status were quantified in multiple linear regression models.

RESULTS

A significant correlation of the degree of severity of the heart defect was limited to the physical scale of the hrQoL, whereas for the mental scale of the hrQoL and the satisfaction scales, socio-demographic factors showed a stronger association. Furthermore, the associations of socio-demographic factors and subjective well-being were stronger in the patient group than in the control group.

CONCLUSIONS

Socio-demographic factors can be significantly associated with the subjective well-being of adults with CHD. In order to assist the surgical successes of the past decades, which have ensured the survival of most of these patients into adulthood, increased attention should be paid to these domains in the care of adults with CHD.

A comparative analysis of health-related quality of life for residents of U.S. counties with and without coal mining

OBJECTIVES

We compared health-related quality of life (HRQOL) in mining and non-mining counties in and out of Appalachia using the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey.

METHODS

Dependent variables included self-rated health, the number of poor physical and mental health days, the number of activity limitation days (in the last 30 days), and the Centers for Disease Control and Prevention Healthy Days Index. Independent variables included the presence of coal mining, Appalachian region residence, metropolitan status, primary care physician supply, and BRFSS behavioral (e.g., smoking, body mass index, and alcohol consumption) and demographic (e.g., age, gender, race, and income) variables. We compared dependent variables across a four-category variable: Appalachia (yes/ no) and coal mining (yes/no). We used SUDAAN Multilog and multiple linear regression models with post-hoc least-squares means to test for Appalachian coal-mining effects after adjusting for covariates.

RESULTS

Residents of coal-mining counties inside and outside of Appalachia reported significantly fewer healthy days for both physical and mental health, and poorer self-rated health (p < 0.0005) when compared with referent U.S. non-coal-mining counties, but disparities were greatest for people residing in Appalachian coal-mining areas. Furthermore, results remained consistent in separate analyses by gender and age.

CONCLUSIONS

Coal-mining areas are characterized by greater socioeconomic disadvantage, riskier health behaviors, and environmental degradation that are associated with reduced HRQOL.

Creating and using the CDC HRQOL healthy days index with fixed option survey responses

PURPOSE

"Healthy days" are calculated by adding the number of poor physical and mental health days and subtracting the total from 30 days using the US Centers for Disease Control and Prevention Health-Related Quality of Life (HRQOL) scale. This study sought to compute the index with forced responses and hypothesized significant HRQOL differences with demographic and risk behavior variables would be observed.

METHODS

Using the 1997 South Carolina YRBS and a 2007 university data set, variables were created based on the averages within each response option from the index items (e.g., 1-2 days would assigned as 1.5 days, etc.). Then the greater of the two values in each respective cell (poor physical or mental health days) was chosen for the analysis.

RESULTS

Although some differences existed between the two samples, the same general pattern of responses was established. Significant HRQOL differences were observed among selected demographic, substance use, weight perception, and self-rated health variables (P < .05).

CONCLUSIONS

Preliminary evidence suggests the "healthy days" calculation is a valid approach with fixed option responses.

Neighbourhood characteristics, individual attributes and self-rated health among older Canadians

This study drew on three cycles of the Canadian Community Health Survey and the 2001 Census to examine between-neighbourhood variation in positive and negative self-rated health and the relative effect of individual and neighbourhood characteristics on self-rated health among Canadian adults aged > or = 65. Multilevel logistic regression results showed that there was modest, but significant between-neighbourhood variation in self-rated health. Neighbourhood factors including income, education, and percentage of people aged > or = 65, and visible minority accounted for about 50% and 30% of the neighbourhood variation in negative and positive self-rated health, respectively. Relative to neighbourhood-level characteristics, individual characteristics had a stronger effect on self-rated health with involvement in physical activity, alcohol consumption, sense of community belonging, income, and education being the most important. Although the findings suggest that neighbourhood effects on self-rated health are modest and that individual-level factors are relatively more important determinants of health, research concern for contextual influences on health should continue.

A population study on the association between leisure time physical activity and self-rated health among diabetics in Taiwan

Background

There is strong evidence for the beneficial effects of physical activity in diabetes. There has been little research demonstrating a dose-response relationship between physical activity and self-rated health in diabetics. The aim of this study was to explore the dose-response association between leisure time physical activity and self-rated health among diabetics in Taiwan.

Methods

Data came from the 2001 Taiwan National Health Interview Survey (NHIS). Inclusion criteria were a physician confirmed diagnosis of diabetes mellitus and age 18 years and above (n = 797). Self-rated health was assessed by the question "In general, would you say that your health is excellent, very good, good, fair, or poor?" Individuals with a self perceived health status of good, very good, or excellent were considered to have positive health status.

Results

In the full model, the odds ratio (OR) for positive health was 2.51(95% CI = 1.53-4.13), 1.62(95% CI = 0.93-2.84), and 1.35(95% CI = 0.77-2.37), for those with a total weekly energy expenditure of ≥ 1000 kcal, between 500 and 999 kcal, and between 1 and 499 kcal, respectively, compared to inactive individuals. Those with duration over 10 years (OR = 0.53, 95%CI = 0.30-0.94), heart disease (OR = 0.50, 95%CI = 0.30-0.85), and dyslipidemia (OR = 0.65, 95% CI = 0.43-0.98) were less likely to have positive health than their counterparts. After stratified participants by duration, those with a duration of diabetes < 6 years, the adjusted OR for positive health was 1.95(95% CI = 1.02-3.72), 1.22(95% CI = 0.59-2.52), and 1.19(95% CI = 0.58-2.41) for those with a total weekly energy expenditure of ≥ 1000 kcal, between 500 and 999 kcal, and between 1 and 499 kcal, respectively, compared to inactive individuals. In participants with a duration of diabetes ≥ 6 years, total energy expenditure showed a gradient effect on self-perceived positive health. The adjusted OR for positive health was 3.45(95% CI = 1.53-7.79), 2.77(95% CI = 1.11-6.92), and 1.90(95% CI = 0.73-4.94) for those with a total weekly energy expenditure of ≥ 1000 kcal, between 500 and 999 kcal, and between 1 and 499 kcal, respectively, compared to inactive individuals.

Conclusions

Our results highlight that regular leisure activity with an energy expenditure ≧ 500 kcal per week is associated with better self-rated health for those with longstanding diabetes.

Structure of health-related quality of life among people with and without functional limitations

PURPOSE

The objective of this study was to assess the factor structure of nine health-related quality of life (HRQOL) survey items among people with and without disabilities or functional limitations (FL) and determine whether factor loadings were similar for the two groups.

METHODS

Data were from US states and territories in the 2001 and 2002 Behavioral Risk Factor Surveillance System (BRFSS). Confirmatory factor analyses assessed fit of the data to a previously found factor structure.

RESULTS

A two-factor structure was confirmed, conceptually representing physical and mental health. Although this structure fit data for both people with and without FL, factor loadings were significantly different for the two groups. In all but one instance, factor loadings were higher for people with FL than for people without FL.

CONCLUSIONS

Results suggest that people with and without FL conceptualize physical and mental HRQOL similarly. However, the nine items analyzed appear to be a better reflection of the latent constructs of physical and mental HRQOL in the population of people with FL than those without FL.

The interaction of obesity and psychological distress on disability

BACKGROUND

Prior research has shown that psychological problems interact with various chronic medical conditions to amplify disability, but no study has investigated this effect in obesity. The aim of this study was to evaluate the synergistic interaction of psychological distress and obesity on functional disability in an adult community sample.

METHODS

Cross-sectional data were obtained from the 2005 Canadian Community Health Survey, a nationally representative sample of 53,416 respondents aged 18 years or older. Our outcome measures were self-reported disability days and self-rated health. Our covariates of interest were non-specific psychological distress (Kessler K10 scale) and body mass index (BMI). Odds ratios of disability measures were estimated by psychological distress and weight status from logistic regressions, adjusted for sociodemographic and clinical variables.

RESULTS

Disability status was more frequent in individuals with obesity and psychological distress than in those with either obesity or psychological distress alone. Adjusted odds ratios increased progressively across BMI and psychological distress categories. Significant interactions were found for (a) obesity class I (BMI between 30.0 and 34.9 kg m(-2)) and high psychological distress; and (b) obesity class II-III (BMI > 35 kg m(-2)) and moderate to high distress.

CONCLUSION

The results suggest a strong association between psychological distress, obesity and disability. Addressing psychological distress in obese individuals might reduce the public health burden of comorbid obesity and psychological distress by tackling disability.

Health Aspirations in the Context of Age and Self-rated Health

The present research examined the respondents’ preferences for approach and avoidance health aspirations (i.e. health related life goals) in relation to their age and self-rated health (SRH) in a representative Hungarian sample ( N = 4841). Higher age predicted stronger preference for both orientations of health aspirations while SRH attenuated this relationship for approach and amplified it for avoidance health aspiration. Bad SRH predicted elevated preference for approach health aspirations in younger age while it predicted greater preference for avoidance aspirations in older age. Results and implications are discussed with reference to aging and health.

Body weight and health from early to mid-adulthood: a longitudinal analysis

We analyze the influence of body weight in early adulthood, and changes in weight over time, on self-rated health as people age into middle adulthood. While prior research has focused on cross-sectional samples of older adults, we use longitudinal data from the NHANES I Epidemiologic Follow-up Study and double-trajectory latent growth models to study the association between body mass index (BMI) and self-rated health trajectories over 20 years. Results indicate that high BMI in early adulthood and gaining more weight over time are both associated with a faster decline in health ratings. Among white women only, those with a higher BMI at the baseline also report lower initial self-rated health. A small part of the weight-health association is due to sociodemographic factors, but not baseline health behaviors or medical conditions. The findings provide new support for the cumulative disadvantage perspective, documenting the increasing health inequalities in a cohort of young adults.

[Healthy life expectancy to Brazilian elders, 2003]

The increase of the percentage of elderly population in Brazil and the increase in longevity incite a demand for information on the quantity of years spent in good health. The aim of the present study is to measure the life expectancy for the elderly of 60 years and above, by sex and age, in the year of 2003. The Sullivan method was used, which combined the life-table with the current experience of mortality and the self-perceived health. The mortality information was obtained from the life tables published by the IBGE (Brazilian Institute of Geography and Statistics), 2003. The self-perceived health was used and it was dichotomized in good and bad. This information came from the National Research of Household Sample (PNAD), 2003. The results indicate that women live longer, but spend a higher number of years perceiving their health as bad, as compared to men. The results also highlights to the need of considering the differences between sexes in relation to the demand for health care. It is also important to consider the need to have policies designed to allow the increase in the number of years that the elderly can live in good health conditions.

Trends in self-rated health among nurses: a 4-year longitudinal study on the transition from nursing education to working life

For nurses, the transition from higher education to working life involves several types of changes and seems to be a major contributing cause of distress and, consequently, ill health on a longer term basis. The aim of this study was to longitudinally monitor the development of self-rated health (SRH) in nurses, starting from the last semester at the university with subsequent follow-ups when the nurses had entered working life. The Longitudinal Analyses of Nurses' Education and working life is an ongoing nationwide longitudinal project focusing on mapping health and career development in nurses in Sweden. SRH is one of the most widely used single-item measures of perceived health status with a well-established predictive ability on future health outcomes, including morbidity and mortality. This study found a small but significant and continuous decline in SRH among nurses during 3 years of follow-ups, starting from their last semester of nursing education and continuing 3 years into their working life. The most pronounced decline in SRH seems to occur in the transition between student life and working life and is most explicit among the youngest nurses. However, the long-term effect on SRH when entering into working life seems to be more pronounced among the older nurses.

Variation in patients' and pharmacists' attribution of symptoms and the relationship to patients' concern beliefs in medications

BACKGROUND

The process by which symptoms are identified and characterized is related to adverse drug event reporting. Patient and pharmacist symptom attribution may differ and be related to certain patient characteristics.

OBJECTIVES

(1) To compare attribution of symptoms to a cause for patients and pharmacists; (2) to quantify the association between patients' concern beliefs and patient-pharmacist agreement on patients' symptom attribution to medications; and (3) to identify any associations between patients' propensity to agree with pharmacists' assessments of symptom attribution with various clinical and/or sociodemographic characteristics.

METHODS

An Internet survey of Medicare beneficiaries was administered by Harris Interactive ®. The survey elicited information on health symptoms that subjects experienced and to whom they reported these symptoms. If subjects did not experience symptoms and did not report them, the reasons for not reporting were elicited. A clinical expert panel reported ratings about respondents' (1) likelihood of the symptom experienced being attributed to a medication and (2) probability of the symptom being attributed to the reason the patient stated. Frequencies of unreported symptoms for each reason/category were examined. Chi-square and Fisher's exact test analyses examined the variations between patients' and pharmacists' ratings of symptom attribution to medications and associations between attribution and patient sociodemographic and clinical characteristics, such as the number of medications used. Independent sample t tests examined how attributions were related to concern beliefs.

RESULTS

Most patients thought their symptom(s) were the result of their disease, something other than medications or age. There was no statistically significant difference between patients' and pharmacists' symptom attribution (χ(2)=1.376, P=.24). Individuals whose symptom attributions differed from pharmacists were likely to have stronger concern beliefs in medication (t=-3.03, P<.01).

CONCLUSIONS

Patients' concern about their medications may be related to their symptom attributions. Older adults may not consider these concerns when asked about their symptom attributions.

Health and Wellbeing through Work and Retirement Transitions in Mature Age: Understanding Pre—Post and Retrospective Measures of Change

The capacity to measure change is essential in examining successful adaptation to ageing. Few studies measuring change have compared findings using pre—post approaches (employing difference scores) with those from retrospective approaches (employing self-ratings). Where this has occurred, differences have been attributed either to ceiling and floor effects or to the operation of social comparison (Choi, 2002, 2003). Our study compared pre—post and retrospective measures of change in health, health behaviors, and wellbeing over periods of 1 and 3 years among retirees. Retrospective measures were found to be more positive than pre—post measures. This discrepancy was associated with floor and ceiling effects and with a robust self-image, but not with recency, social comparison, or social desirability response sets. Pre—post difference scores have limitations as indicators of change, particularly where ceiling effects operate. A retrospective perception of improvement, combined with deterioration in scores, may result from successful psychological adaptation as people grow older.

Self-rated health--what does it capture at 1 year after childbirth? Investigation of a survey question employing thinkaloud interviews

AIM

This paper reports an investigation of how the survey question 'How would you summarize your state of health at present' is interpreted and what it captures when asked at 1 year after childbirth.

BACKGROUND

Self-rated health measured by a single item question is a well-established patient outcome as it predicts morbidity and the use of health services. However, there is limited understanding of what the question captures in early motherhood.

METHOD

A qualitative design combining data collection by means of a short form, concurrent and retrospective thinkaloud interviews, and a semi-structured interview, with 26 Swedish women during 2005 was employed. The text was analysed by qualitative content analysis. A theoretical framework describing four cognitive tasks usually performed when a respondent answers a survey question guided the analysis: interpretation of the question, retrieval of information, forming a judgement and giving a response.

FINDINGS

The questions of self-rated health left open for the new mothers to evaluate what was most important for her. It captured a woman's total life situation, such as family functioning and well-being, relationship with partner, combining motherhood and professional work, energy, physical symptoms and emotional problems affecting daily life, stressful life events, chronic disease with ongoing symptoms, body image, physical exercise and happiness. Neither childbirth-related events nor childbirth-related symptoms were included in the responses. Less than 'good' self-rated health represented a high burden of health problems.

CONCLUSION

Our results showed that the question on self-rated health was a measure of women's general health and well-being in their present life situation, but it did not seem to measure recovery after childbirth specifically.

The estimation of mortality for ethnic groups at local scale within the United Kingdom

As an input to projections of sub-national populations by ethnicity, this paper develops the first estimates of the mortality risks experienced by the UK ethnic groups. Two estimates were developed using alternative methods. In the first, UK 2001 Census data on limiting long-term illness to predict mortality levels and regression equations between local Standardized Illness and Mortality Ratios for all ethnicities are assumed to apply to individual ethnic groups. In the second, the geographical distribution of ethnic groups by local areas is combined with local mortality for all ethnicities to estimate national mortality rates by ethnicity, which are then employed to estimate local ethnic mortality. A comparison of the two estimates indicates that the method based on illness rates produces more plausible outcomes. The local SMRs produced for each ethnic group were used to generate ethnic group life tables for 432 UK local authority areas in 2001, which included estimates of survivorship probabilities by single year of age, gender and ethnic group for each local area for use in a projection model.

Joint modeling of self-rated health and changes in physical functioning

Self-rated health is an important indicator of future morbidity and mortality. Past research has indicated that self-rated health is related to both levels of and changes in physical functioning. However, no previous study has jointly modeled longitudinal functional status and self-rated health trajectories. We propose a joint model for self-rated health and physical functioning that describes the relationship between perceptions of health and the rate of change of physical functioning or disability. Our joint model uses a non-homogeneous Markov process for discrete physical functioning states and connects this to a logistic regression model for "healthy" versus "unhealthy" self-rated health through parameters of the physical functioning model. We use simulation studies to establish finite sample properties of our estimators and show that this model is robust to misspecification of the functional form of the relationship between self-rated health and rate of change of physical functioning. We also show that our joint model performs better than an empirical model based on observed changes in functional status. We apply our joint model to data from the Cardiovascular Health Study (CHS), a large, multi-center, longitudinal study of older adults. Our analysis indicates that self-rated health is associated both with level of functioning as indicated by difficulty with activities of daily living (ADL) and instrumental activities of daily living (IADL), and the risk of increasing difficulty with ADLs and IADLs.

[Method for the comprehensive improvement of health status and its effectiveness among college and university students]

We review our survey on the effectiveness of complex health state development.

AIMS

1. to complete an examination package which is able to assess a real picture about the bio-psychological and social situation of the person; 2. to determinate the effectiveness of the self-developed complex health-development program package on public health-development; 3. to prove the effectiveness of this project; 4. to determine a multi variable health model.

METHODS

Voluntary students participated the research (n = 125, 29 male, 96 female). Students were sorted into 3 groups by random selection. Their health state was examined before and after the program. Groups number I and II got a health care plan, while Group number I took part in a three-month health development program. Group number III served as control group. The health development program package contained a health care plan, a training plan, a psycho-training, a personal training and consultation.

RESULTS

Students tend to choose the more valuable and effective physical activity and they do that more regularly. The subjective health state improved significantly in the development groups (p 1 = 0.02; p 2 = 0.004). The vital distress improved significantly in group number I and there is a similar tendency in group number II. Significant difference was found between the two examinations of the mood state (Wilcoxon). By the end of the program, students got closer to their maximum performance by 13.4%. The frequency of the weekly exercises is the most important factor in the health state. According to the BMI and BDI, it improves the chance by one and a half to get into the good health state category.

CONCLUSION

The health care plan and/or personal recreational training in small groups can be operated effectively by using the proved selection, preparing and applying methods.

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.

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.

Neighborhood effects on an individual's health using neighborhood measurements developed by factor analysis and cluster analysis

This study suggests a multivariate-structural approach combining factor analysis and cluster analysis that could be used to examine neighborhood effects on an individual's health. Data were from the Taiwan Social Change Survey conducted in 1990, 1995, and 2000. In total, 5,784 women and men aged over 20 years living in 428 neighborhoods were interviewed. Participants' addresses were geocoded with census data for measuring neighborhood-level characteristics. The factor analysis was applied to identify neighborhood dimensions, which were used as entities in the cluster analysis to generate a neighborhood typology. The factor analysis generated three neighborhood dimensions: neighborhood education, age structure, and neighborhood family structure and employment. The cluster analysis generated six types of neighborhoods with combinations of the three neighborhood dimensions. Multilevel binomial regression models were used to assess the effects of neighborhoods on an individual's health. The results showed that the biggest health differences were between two neighborhood types: (1) the highest concentration of inhabitants younger than 15 years, a moderate education level, and a moderate level of single-parent families and (2) the highest educational level, a median level of single-parent families, and a median level of elderly concentrations. Individuals living in the first type had significantly higher chances of having functional limitations and poor self-rated health than the individuals in the second neighborhood type. Our study suggests that the multivariate-structural approach improves neighborhood measurements by addressing neighborhood diversity and examining how an individual's health varies in different neighborhood contexts.

Self-rated health during adolescence: stability and predictors of change (Young-HUNT study, Norway)

Background: Self-rated health (SRH) is an important single-item variable used in many health surveys. It is a predictor for later mortality, morbidity and health service attendance. Therefore, it is important to study how SRH is influenced during adolescence. The present study examined the stability of SRH over a 4-year period in adolescence, and the factors predicting change in it.

Methods: Analyses were based on 4-year longitudinal data from the Young-HUNT studies in Norway among adolescents aged 13–19 years. A total of 2800 students (81%) participated in the follow-up study, and 2399 of these were eligible for data analysis. Cross-tables for SRH at the start of the study (between 1995 and 1997) and 4 years later were used to estimate the stability over the period. Proportional odds logistic regression analyses of SRH during 2000–01 were carried out, controlling for initial SRH, independent variables at the start of the study and changes in the same independent variables over 4 years as covariates.

Results: In 59% of the respondents, SRH remained unchanged through the 4-year observation period during adolescence. Fewer than 4% changed their ratings of SRH by two steps or more on a four-level scale. The self-assessed general well-being, health behaviour variables, being disabled in any way, and body dissatisfaction at the start of the study and the change of these predictors influenced SRH significantly during the 4-year observation. Being diagnosed with a medical condition, or specific mental or somatic health symptoms was of less importance for later SRH. Adolescents with more health service contacts at the start of the study, or who increase their attendance rate during the 4 years, report deterioration of SRH.

Conclusion: SRH is a relatively stable construct during adolescence, and deteriorates consistently with a lack of general well-being, disability, healthcare attendance and health-compromising behaviour.

Sex differences in healthy life expectancy from self-perceived assessments of health in the City of São Paulo, Brazil

Whether life is spent in good health or disability has a critical influence on the use of health-care services. It is also known that average healthy life expectancy differs by sex. This paper reports estimations of healthy and unhealthy life expectancy in old age using self-reported health assessments for the City of São Paulo, Brazil in 2000–01. The data derived from the Health, Well-being and Aging in Latin America and the Caribbean Project (SABE), and from population censuses and mortality statistics. Sullivan's estimation method was used. It combines the age-specific schedule of the current probabilities of death with the prevalence of self-perceived ‘poor’ and ‘good’ health. The paper also reports multivariate analyses of the factors associated with variations by age group and sex in self-perceived health. The findings revealed that, at all ages, women live longer than men and for more years in a healthy state. Among men, those aged 60, 65 and 70 years were expected to live a higher percentage of their remaining life than women in a healthy state, but among those aged 75, 80 and 85 years, the opposite held. Among women, the percentage of remaining years that were unhealthy did not increase as age increased, which differs from previous findings. The multivariate analyses showed that with increasing age, for women the number of chronic diseases decreased but dependency increased, and for men the opposite held. This finding indicated that the percentage of life spent in poor self-perceived health more accurately predicts mortality in men than women.

Quality of depression care for people with coincident chronic medical conditions

OBJECTIVE

Depression is common and associated with poor outcomes for people with chronic medical conditions (CMCs). The goals of this study were (1) to determine the effect of CMCs on the use and quality of depression care and (2) to understand whether the patient-provider relationship mediates the relationship between CMCs and depression care quality.

METHOD

With the use of data from the 1997-1998 National Survey of Alcohol, Drug, and Mental Health Problems (Healthcare for Communities), the relationships between CMCs, depression recognition, receipt of minimally adequate depression care and the patient-provider relationship were assessed with multivariate linear and logistic regression models for 1309 adults who met criteria for major depressive disorder.

RESULTS

Depressed patients with a CMC were more likely to have their depression recognized by a provider (OR=2.10; 95% CI=1.32-3.35) and to take antidepressant medications (32% vs. 19%, P=.02) than those without a CMC. However, having a CMC was not associated with receiving minimally adequate depression care or patient satisfaction. Depression recognition was associated with number of medical visits (OR=1.12; 95% CI=1.09-1.15), having a usual source of care (OR=3.57; 95% CI=2.26-5.63), and provider trust (OR=1.07; 95% CI=1.04-1.11).

CONCLUSION

Depressed people with a comorbid CMC are more likely to have their depression recognized than those without a CMC, though were no more likely to receive minimally adequate depression care. Aspects of the patient-provider relationship, including trust and continuity of care, may help to explain the increased rate of depression recognition among patients with severe CMCs.

Physical activity, exercise and self-rated health: a population-based study from Sweden

Background

In order to screen for the most inactive individuals in the population and target health-related interventions where they are most needed it is important to assess different forms of physical activity in population-based studies. The aims were (1) to identify the most inactive individuals in the population by assessing two dimensions of physical activity, (2) to investigate the correlation between exercise and total physical activity and (3) to investigate the association between exercise, total physical activity and good self-rated health.

Methods

A simple random sample of the Swedish population aged 25–64 years were interviewed about their living conditions, health and lifestyle in a survey performed by Statitics Sweden. In total 1876 women and 1880 men completed the survey during 1999 (response rate 76.6%) when two different questions about physical activity assessed exercise and total physical activity in all domains (e.g. transportation, exercise, and at work). Logistic regression models were used to estimate odds ratios.

Results

The most inactive individuals (no exercise and total physical activity ≤ 2 hours per week) constituted 4.3% of the sample. The correlation between exercise and total physical activity was low (gamma = 0.4, p = 0.02). There were significant associations between higher levels of exercise, total physical activity and good self-rated health after adjustment for age, gender, country of birth, education, employment, marital status, housing tenure, smoking and BMI.

Conclusion

Both exercise and total physical activity were independently associated with good self-rated health. It seems to be advantageous to use more than one question in population based surveys in order to evaluate several dimensions of physical activity and identify the most inactive individuals.

Happiness and life satisfaction prospectively predict self-rated health, physical health, and the presence of limiting, long-term health conditions

PURPOSE

To examine the effect of happiness and life satisfaction on health.

DESIGN

Longitudinal data from waves 1 and 3, conducted in 2001 and 2004, respectively, of the Household Income and Labour Dynamics in Australia survey.

SETTING

Australia.

SUBJECTS

A total of 9981 respondents aged 18 years and older.

MEASURES

Outcomes were self-reported health; the absence of long-term, limiting health conditions; and physical health. Happiness was assessed with the following question: "During the past 4 weeks, have you been a happy person"? Life satisfaction was determined with the following question: "All things considered, how satisfied are you with your life"?

ANALYSIS

We used multiple regression analysis to estimate odds ratios (ORs), beta coefficients (beta), and 95% confidence intervals (CIs) for the associations between baseline happiness or life satisfaction and health at wave 3.

RESULTS

Baseline happiness and life satisfaction both were positively associated at wave 3 with excellent, very good, or good health (OR = 1.50, CI = 1.33-1.70, p < .0001; and OR = 1.62, CI = 1.27-2.08, p < .0001, respectively); with the absence of long-term, limiting health conditions (OR = 1.53, CI = 1.35-1.75, p < .0001; and OR = 1.51, CI = 1.25-1.82, p < .0001, respectively); and with higher physical health levels (beta = .99, CI = .60-1.39, p < .0001; and beta = .99, CI = .20-1.78, p < .0145, respectively).

CONCLUSION

This study showed that happier people and those who were more satisfied with their lives at baseline reported better health (self-rated health; absence of limiting, long-term conditions; and physical health) at the 2-year follow-up when adjusted for baseline health and other relevant covariates.

Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity

OBJECTIVE

To examine the impact of changes in comorbidity--as measured by the Charlson comorbidity index--on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories.

STUDY DESIGN AND SETTING

Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions.

RESULTS

Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia.

CONCLUSION

Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.

Understanding the role of cancer worry in creating a "teachable moment" for multiple risk factor reduction

The manuscript examines the influence of contextual factors on whether and for whom a colon polyp diagnosis might be a teachable moment, as indicated by engagement with a proactively delivered intervention. Baseline and 8-month follow-up data were analyzed from a two-site behavioral intervention trial with patients in Massachusetts and North Carolina, USA who had recently undergone polypectomy for pre-cancerous colon polyps and were randomized to a behavior change intervention condition (N=591). Intervention "buy-in" was used as an indicator of response consistent with the polyp identification serving as a teachable moment. Cancer worry, personal risk, health-related self-identity and other sociodemographic factors were tested to predict intervention buy-in. As predicted, those who were most worried about colon cancer were most likely to engage in the intervention. One indicator of personal risk, number of risk behaviors, was significantly and negatively associated with buy-in. Predictors of intervention buy-in and cancer worry were not consistent. We recommend that expanded measures of affect and health-related self-identity should be considered in future research to understand the motivational potential of health events for increasing engagement in effective behavior change interventions.

Risk factors for self-reported adverse drug events among Medicare enrollees

BACKGROUND

Adverse drug events (ADEs) occur in older adults. ADEs occur in up to 6.5% of all hospitalized patients and outpatients, and about 28% of these events are preventable. The proportion of outpatients with an ADE ranges from 5% to 35%, depending on the exact definition used. There is a critical need to examine the risk factors associated with having an ADE to increase awareness about medication safety among older adults.

OBJECTIVE

To quantify the association between risk factors such as the number of pharmacies used by patients and their concern and necessity beliefs about medicines, and self-reported ADEs.

METHODS

A cross-sectional Internet survey was administered by Harris Interactive. Harris Interactive asked individuals from their online panel who were 65 years of age or older, US residents, and enrolled in Medicare to complete the survey. A convenience sample of 1220 anonymous surveys was obtained. Multiple logistic regression analysis was performed. The dependent variable was self-reported ADEs, defined as the patient's visiting a physician to report an unwanted reaction or medicine problem in the past year. Independent variables included sociodemographics, self-rated health, number of medications, sum of symptoms experienced, concern and necessity beliefs about medicines, number of pharmacies, and whether subjects skipped doses of their medications to save money or stopped taking the drugs due to cost.

RESULTS

Eighteen percent of respondents reported an ADE. ADEs were related to being female (OR 1.56; 95% CI 1.05 to 2.33), number of pharmacies (OR 3.40; 95% CI 1.56 to 7.41), number of symptoms experienced (OR 3.39; 95% CI 1.87 to 6.14), concern beliefs about medicines (OR 1.14; 95% CI 1.08 to 1.20), and having a graduate academic degree (OR 2.17; 95% CI 1.41 to 3.36).

CONCLUSIONS

The number of pharmacies, concern beliefs about medicines, and number of symptoms experienced in the past month were associated with self-reported ADEs. Discussing patients' beliefs about their drug therapy with them is likely to affect their expectations and interpretation of symptoms, as well as future attributions regarding drug therapy.