Does self-rated health mean the same thing across socioeconomic groups? Evidence from biomarker data

Adverse Childhood Experiences and Suboptimal Self-Rated Health in Adulthood: Exploring Effect Modification by Age, Sex and Race/Ethnicity

PURPOSE

This study examined whether the relationship between adverse childhood experiences (ACEs) and self-rated health among adults in a nationally representative population is modified by age, sex, or race/ethnicity.

DESIGN

Cross-sectional study.

SETTING

United States.

SAMPLE

Data from the 2020 and 2021 Behavioral Risk Factor Surveillance System were obtained from 185 731 (weighted N = 47 862 016) persons 18 years or older.

MEASURES

The ACE cumulative score (range: 0-11) was calculated using 11 questions about childhood emotional abuse, physical abuse, sexual abuse, and household dysfunction before age 18 and classified as 0 (reference), 1, 2, 3, or ≥4. Self-rated health was divided into (excellent/very good/good [reference]) and suboptimal (fair/poor) categories.

ANALYSIS

Multivariable-adjusted logistic regression was conducted to test for the interaction with age, sex, and race/ethnicity with ACEs. After adjustment for potential confounders, an increasing number of ACEs had statistically significantly higher odds of suboptimal self-rated health in a graded manner except for 1 ACE (1 ACE: aOR:1.09; 95% CI: 1.00-1.20, 2 ACEs: 1.16; 1.03-1.30, 3 ACEs: 1.17; 1.03-1.32 and ≥4 ACEs: 1.39; 1.26-1.53). There was a significant interaction between ACEs and age. Younger age (18-24 years) had the strongest association for ≥4 ACEs compared to the older age groups. There was no effect modification by sex or race.

CONCLUSION

ACEs should be considered when creating health-promoting interventions to improve health.

Associations Between Healthy Behaviors and Persistently Favorable Self-Rated Health in a Longitudinal Population-Based Study in Switzerland

BACKGROUND

Self-rated health is a subjective yet valuable indicator of overall health status, influenced by various factors including physical, psychological, and socio-economic elements. Self-rated health could be telling and used by primary care physicians to evaluate overall present and predictive health.

DESIGN

This study investigates the longitudinal evolution of self-rated health in Switzerland during the COVID-19 pandemic, focusing on the association of persistently favorable self-rated health with various predictors.

PARTICIPANTS

This study based on the Specchio cohort, a population-based digital study in Geneva Switzerland, involved participants completing questionnaires from 2021 to 2023.

MAIN MEASURES

Self-rated health was assessed alongside factors like physical and mental health, socio-economic status, and lifestyle behaviors.

KEY RESULTS

The study included 7006 participants in 2021, and 3888 participants who answered all three follow-ups (2021, 2022, and 2023). At baseline, 34.9% of individuals reported very good, 54.6% reported good, 9.6% reported average, and 1.0% reported poor to very poor self-rated health. Overall, 29.1% had a worsening in their self-rated health between 2021 and 2023. A subset of participants (12.1%) maintained very good self-rated health throughout, demonstrating persistently favorable self-rated health during the COVID-19 pandemic. Positive health behaviors were associated with persistently favorable self-rated health (exercise aOR 1.13 [1.03-1.24]; healthy diet aOR 2.14 [1.70-2.68]; less screen time aOR 1.28 [1.03-1.58]; and better sleep quality aOR 2.48 [2.02-3.04]). Mental health and social support also played significant roles.

CONCLUSION

The study underscores the significance of healthy lifestyle choices and social support in maintaining favorable self-rated health, particularly during challenging times like the COVID-19 pandemic. Primary care physicians should focus on promoting these factors, integrating these actions in their routine consultations, and advising patients to undertake in socially engaging activities to improve overall health perceptions and outcomes.

The Association Between Grandchild Care and Biological Aging Among Middle-Aged and Older Adults in China

Background and Objectives

Substantial evidence documents grandchild care is associated with self-reported health, life satisfaction, and depressive symptoms among middle-aged and older adults. However, little is known about the relationship between grandchild care and biological aging, especially in China, which emphasizes the unique cultural value of family. The current study sheds light on the biological consequence of grandchild care by examining the link between grandchild care and biological aging among middle-aged and older adults in China, and how gender and spousal involvement in caregiving affect this link.

Research Design and Methods

In a representative sample of Chinese adults aged 45-80 from the third wave of China Health and Retirement Longitudinal Study in 2015 (n = 3,384), we calculate biological age using Klemera-Doubal Method, and Ordinary Least Square models are used to examine the correlation between grandchild care and biological aging.

Results

High intensity of involvement in grandchild care is related to biological aging, and caring for grandchildren alone predicts greater biological aging. Compared with grandfathers, grandmothers lose more from grandchild care regardless of whether their husbands are involved in the care.

Discussion and Implications

Providing grandchild care should be a way to cope with age-related role discontinuity or loss, rather result in extra stress or burden for grandparents. Reducing the intensity of caregiving or increasing family support may attenuate the extent of biological aging.

Are Changes in Somatic Health Reflected Differently in Updated Self-Ratings by Big-Five Personality Traits?

Objectives: This longitudinal study tests whether the Big-Five personality traits influence the changes individuals make in self-rated health (SRH) as they adjust their initial level to account for information on concurrent changes in disease burden, activities of daily living (ADLs), and pain. Methods: A bi-variate Latent Growth Curve model was fitted to data to estimate longitudinal associations between SRH and each health measure across up-to-five repeated observations, collected from the year 2006 to 2018 from 13,096 participants in the Health and Retirement Study. Results: Negative longitudinal associations between SRH and all three health reports were significantly stronger for those who are more conscientious. No significant moderation was found for the other four personality traits. Discussion: Compared to the less conscientious, highly conscientious people may assign greater importance to specific health reports when rating and revising their assessments of SRH. This moderating effect was previously tested but not supported.

Advancing methods for the biodemography of aging within social contexts

Several social dimensions including social integration, status, early-life adversity, and their interactions across the life course can predict health, reproduction, and mortality in humans. Accordingly, the social environment plays a fundamental role in the emergence of phenotypes driving the evolution of aging. Recent work placing human social gradients on a biological continuum with other species provides a useful evolutionary context for aging questions, but there is still a need for a unified evolutionary framework linking health and aging within social contexts. Here, we summarize current challenges to understand the role of the social environment in human life courses. Next, we review recent advances in comparative biodemography and propose a biodemographic perspective to address socially driven health phenotype distributions and their evolutionary consequences using a nonhuman primate population. This new comparative approach uses evolutionary demography to address the joint dynamics of populations, social dimensions, phenotypes, and life history parameters. The long-term goal is to advance our understanding of the link between individual social environments, population-level outcomes, and the evolution of aging.

Education and age trajectories of chronic conditions: Are tests of the cumulative advantage and disadvantage hypothesis biased by underreporting?

OBJECTIVE

This study examined the impact of underreporting on tests of the cumulative advantage and disadvantage hypothesis (CAD), which predicts age-related increases in health disparities between individuals with higher and lower education.

METHODS

Using the English Longitudinal Study of Ageing (ELSA), we identified underreporting by comparing self-reported hypertension and diabetes with biomedically measured hypertension (systolic blood pressure≥140 mm Hg and/or diastolic blood pressure≥90 mm Hg) and diabetes (fasting glucose level≥7 mmol/l and/or HbA1c≥6.5%). In a sample of 11,859 respondents aged 50 to 85 (54% women, 97% White), we assessed the associations between underreporting and the main analytic constructs in tests of the CAD (education, age, sex, and cohort).

RESULTS

The results showed that self-reported measures underestimated the prevalence of hypertension and diabetes. Underreporting showed weak to moderate associations with the main constructs in tests of the CAD, being more pronounced in individuals with lower education, in older age, in more recent cohorts, and among men. When correcting for underreporting using biomedical measures, the overall prevalence of hypertension and diabetes increased substantially, but education differences in age trajectories of both conditions remained similar.

CONCLUSIONS

Underreporting affected conclusions about the prevalence of hypertension and diabetes, but it did not affect conclusions about the CAD hypothesis for either condition.

Is inconsistent reporting of self-assessed health persistent and systematic? Evidence from the UKHLS

In this paper, we investigate whether individuals provide consistent responses to self-assessed health (SAH) questions in the UK Household Longitudinal Study (UKHLS), and the potential implications for empirical research in case of inconsistent reporting behaviour. We capitalise on an opportunity in the UKHLS, asking respondents the same SAH question twice: with a self-completion and an open interview mode, within the same household interview over four waves. We estimate multivariate models to explore which individual characteristics are systematically relevant for the likelihood and frequency of inconsistent reporting. About 11-24% of those reported a particular SAH category in the self-completion reported inconsistently in the open interview. The probability of inconsistency is systematically associated with individual's demographics, education, income, employment status, cognitive and non-cognitive skills. The same characteristics also predict the frequency of inconsistent reporting across four UKHLS waves. Analysis of the implications of reporting inconsistencies shows no impact of SAH measurement on the association between income and health. A set of dimensions of people's physiological and biological health, captured using biomarkers, is associated equally with both SAH measures, suggesting that the interview mode does not play a role in the relationship between SAH and more objective health measures.

The effect of equalization of public health services on the health China's migrant population: Evidence from 2018 China Migrants Dynamic Survey

Objectives

China has implemented an equalization of public health Services policy for migrants in 40 pilot cities since 2013. The main objective of this study is to explore the effect of this migrant-based reform policy on the health status of the migrant population in China.

Methods

Using the China Migrants Dynamic Survey (CMDS), we included 152,000 migrants aged 15 years or over in 2018. Standardized questionnaires were used to collect socio-economic information and self-reported health status. The Associations between the equalization of public health services and health status were estimated using Multiple regression estimation models and Propensity Score Matching (PSM) methods.

Results

Public health equalization reform in China has a significant and positive effect on the health status of the migrant population (β = 0.033, p < 0.001). Compared to males, higher income, under 60 years of age, inter-provincial mobility, and migrants those already living in urban areas, the equalization of public health Services had shown more significant positive effects on the groups who were inter-provincial migration (β = 0.055, p < 0.001), females (β = 0.055, p < 0.001), having low-income (β = 0.077, p < 0.001), aged over 60 years old (β = 0.191, p < 0.001), and living in rural areas (β = 0.038, p < 0.001). And multiple robustness tests prove that the above results are reliable.

Conclusions and implications

Our findings confirmed the positive health effect of the equalization of public health services reform on china's migrant population, especially among vulnerable groups such as those in low income groups, in rural areas and females. And we recommend that it is necessary to further promote the practices and experiences of the pilot cities. First, strengthen health education for the mobile population and improve their health literacy. Second, further increase the financial investment to improve the coverage of public health services and the equity in resource allocation among regions. Last, strengthen the information-based management of the migrant population and prevent and control infectious diseases.

Factors associated with long-term use of digital devices in the electronic Framingham Heart Study

Long-term use of digital devices is critical for successful clinical or research use, but digital health studies are challenged by a rapid drop-off in participation. A nested e-cohort (eFHS) is embedded in the Framingham Heart Study and uses three system components: a new smartphone app, a digital blood pressure (BP) cuff, and a smartwatch. This study aims to identify factors associated with the use of individual eFHS system components over 1-year. Among 1948 eFHS enrollees, we examine participants who returned surveys within 90 days (n = 1918), and those who chose to use the smartwatch (n = 1243) and BP cuff (n = 1115). For each component, we investigate the same set of candidate predictors for usage and use generalized linear mixed models to select predictors (P < 0.1, P value from Z test statistic), adjusting for age, sex, and time (app use: 3-month period, device use: weekly). A multivariable model with the predictors selected from initial testing is used to identify factors associated with use of components (P < 0.05, P value from Z test statistic) adjusting for age, sex, and time. In multivariable models, older age is associated with higher use of all system components. Female sex and higher education levels are associated with higher completion of app-based surveys whereas higher scores for depressive symptoms, and lower than excellent self-rated health are associated with lower use of the smartwatch over the 12-month follow-up. Our findings show that sociodemographic and health related factors are significantly associated with long-term use of digital devices. Future research is needed to test interventional strategies focusing on these factors to evaluate improvement in long-term engagement.

Discrimination and Health Among First-Generation Hispanic/Latinx Immigrants: the Roles of Sleep and Fatigue

INTRODUCTION

A growing literature documents the associations between discrimination and health. Emerging evidence suggests that among Hispanic/Latinx immigrants, discrimination leads to the deterioration of health outcomes over time. While sleep has been proposed as an important mediator of the relationship between discrimination and health, few studies have explicitly investigated this pathway, particularly among Hispanic/Latinx populations.

OBJECTIVE

To investigate the relationships between racial/ethnic discrimination, sleep, and physical and mental health among Hispanic/Latinx immigrants in the USA. Data and Methods Using data from a parent study of first-generation Hispanic/Latinx immigrants in the southeastern USA, we conducted sequential mediation analyses using the bootstrapping method to investigate whether self-reported sleep duration, sleep quality, and fatigue mediate the relationship(s) between self-reported discrimination, as measured by the discrimination subscale of the Riverside Acculturative Stress Inventory, and self-reported physical and mental health.

RESULTS

Nocturnal awakenings, fatigue, and sleep quality were statistically significant sequential mediators of the relationship between discrimination and physical health (b = -.001, SE = .001, CI [-.0027, -.0001]); fatigue alone also mediated this relationship (b = -.01, SE = .01, CI [-.0279, -.0003]). Nocturnal awakenings, fatigue, and sleep quality were also significant sequential mediators of the relationship between discrimination and mental health (b = -.001, SE = .001, CI [-.0031, -.0001]).

CONCLUSION

Sleep and fatigue play an important role in linking discrimination and health among first-generation Hispanic/Latinx immigrants. The development and implementation of interventions that focus on reducing fatigue among this population could mitigate the effects of unfair treatment on health outcomes.

A general pattern of health erosion in the United States? An examination of self-reported health status from 1997 - 2018

Purpose

Recent research has found a general pattern of health erosion in self-assessed pain and allostatic load among adults in the United States (US). It remains to be determined if self-reported health status, hereafter SRH, also follows this pattern. The aim of this study was to examine whether a general pattern of health erosion is found in SRH among adults in the United States (US).

Methods

Data from the National Health Interview Survey 1997-2018 were used to study sex, educational attainment, and racial/ethnic patterns in SRH by age, period and cohort among adults in the US. The analytic sample consisted of respondents aged 18 years or older at the moment of interview with valid information in the age, sex, education, race/ethnicity and health status question (n = 669,501). Estimates for the percent population reporting poor/fair health were produced by age, period and cohort to study trends in health status by sex, educational attainment and race/ethnicity. All estimates were weighted to account for complex survey design.

Results

No discernible pattern of health erosion, or improvement, is observed in the age, period or cohort analyses of the percent of the population reporting poor/fair SRH by sex, educational attainment or race/ethnicity.

Conclusions

The analysis indicates that self-reported health does not follows the general pattern of health erosion found in self-assessed pain and allostatic load in the US. The percent of the population reporting poor/fair health status has remained relatively stable between 1997 and 2018. Further research is required to determine whether self-reported health is an appropriate metric to track population health in the US.

Assessment of self-rated health: The relative importance of physiological, mental, and socioeconomic factors

BACKGROUND

The general self-rated health (SRH) question is the most common health measure employed in large population surveys. This study contributes to research on the concurrent validity of SRH using representative data with biomarkers from the Czech Republic, a population not previously used to assess the SRH measure. This work determines the relative contribution of biomedical and social characteristics to an individual's SRH assessment. Studies have already explored the associations between SRH and markers of physical health. However, according to a PubMed systematic literature search, the issue of the relative importance of physiological and psychosocial factors that affect individuals' assessments of their SRH has generally been neglected.

METHODOLOGY/PRINCIPAL FINDINGS

Using data from a specialized epidemiological survey of the Czech population (N = 1021), this study adopted ordinary least squares regression to analyze the extent to which variance in SRH is explained by biomedical measures, mental health, health behavior, and socioeconomic characteristics. This analysis showed that SRH variance can be largely attributed to biomedical and psychological measures. Socioeconomic characteristics (i.e. marital status, education, economic activity, and household income) contributed to around 5% of the total variance. After controlling for age, sex, location, and socioeconomic status, biomarkers (i.e. C-reactive protein, blood glucose, triglyceride, low-density lipoprotein, and high-density lipoprotein), number of medical conditions, and current medications explained 11% of the total SRH variance. Mental health indicators contributed to an additional 9% of the variance. Body mass index and health behaviors (i.e. smoking and alcohol consumption) explained less than 2% of the variance.

CONCLUSIONS/SIGNIFICANCE

The results suggested that SRH was a valid measure of physiological and mental health in the Czech sample, and the observed differences were likely to have reflected inequalities in bodily and mental functions between social groups.

Self-Perception or Objective State: A Further Study of the Effects of Retirement on Health

Against the backdrop of an aging global population and the increasing pressure of medical care expenditures for seniors, this paper used a fuzzy regression discontinuity (FRD) model to explore the effects of retirement on the self-assessed health and objective physical and mental health of older people. Using survey data from the China Health and Retirement Longitudinal Study (CHARLS), our model addresses some relevant academic controversies. Our sample was comprised of male respondents from government agencies, enterprises, and public institutions. The research explored the impact of retirement on lifestyle habits and included an in-depth analysis of the mechanism through which retirement influences different aspects of health. The results show that: (1) Retirement does not have any significant impact on objective health, including depression and self-care ability, but it does cause a notable decline in subjective health assessment. (2) Retirement shortened the sleep time of respondents, which may account for lower scores on subjective health self-evaluations, but it did not lead to any noticeable improvement in habits which are harmful to health, such as smoking and drinking. (3) Marriage can help alleviate the problems of depression and smoking among older people, and education has a somewhat broader positive effect on their health and lifestyles; however, neither factor helps to improve the sleep problems of older people. Therefore, this paper recommends that efforts should be made to both optimize retirement policies and seek further ways to improve the health of the retired population.

Do socioeconomic health gradients persist over time and beyond income? A distributional analysis using UK biomarker data

This paper analyses the relationship between health and socioeconomic disadvantage by adopting a dynamic approach accounting for spatial and temporal changes across ten domains including social isolation, environment, financial hardship and security. As a first step we develop a measure of overall multidimensional deprivation and undertake a decomposition analysis to explore the role of breadth and duration of deprivation on shaping the deprivation gradient in health. Subsequently, we employ unconditional quantile regression to conduct a distributional analysis of the gradient to understand how the gradient evolves for people with vulnerability in health. In contrast to the majority of existing studies, we capture health status using a range of nurse measured biomarkers, rather than self reported health measures, taken from the UKHLS and BHPS databases. The first main finding is that the socioeconomic gradient in most of our health measures is not solely attributed to income as it accounts for only 3.8% of total deprivation and thus it is important to account for other domains through a multidimensional deprivation measure in health gradient analysis. Our second finding is the existence of a systematic deprivation gradient for BMI, waist circumference, heart rate, C-reactive protein and HbA1c where evolution over time is an important factor particularly for individuals with greater burden of illness lying at the right tail of the biomarker distribution. Thus cost effective health policy would need to adopt targeted interventions prioritising people experiencing persistent deprivation in dimensions such as housing conditions and social isolation.

A comparison of negative financial events experienced by carers and non-carers following onset of the Great Recession

This study compares carers and non-carers on experiences of harmful financial events during and immediately after the Great Recession. Carer status was associated with experiencing more negative financial events since the Great Recession began, even after controlling for covariates in a negative binomial regression. Carers had a higher odds of reporting: job loss, moving in with family and friends to save money, and selling possessions to make ends meet. Compared to non-carers, carers were more likely to experience adverse financial events during and following the Great Recession.

The Association of Social Capital and Self-Rated Health Between Urban Residents and Urbanized Rural Residents in Southwest China

China has seen an accelerated process of urbanization in the past 30 years. The influence of urbanization on health is complex and primarily influenced by changes in social capital. The purpose of this research was to compare the social capital between urban residents and urbanized rural residents of southwest China and its relationship with self-rated health. It is of great significance to study the difference of social capital between urban and urbanized rural residents to help urbanized rural residents improve their social adaptability and health. Data was collected from 1,646 residents between November and December of 2017 in Chengdu. Three logistic regressions were used to investigate the association between social capital and self-rated health by controlling for demographic variables, lifestyles factors, and health status factors. We observed that urban residents' self-rated health had a higher proportion of “good” than that of urbanized rural residents (P = 0.017). After controlling for factors such as health status and demographic characteristics, participants with higher social capital had better self-rated health. Urbanized rural residents with higher community trust and belonging had better self-rated health (OR = 0.701, 95% CI = 0.503~0.978), however urban residents with higher personal social networks and family relationships had better self-rated health (OR = 0.676, 95% CI = 0.490~0.933 and OR = 0.666, 95% CI = 0.450~0.987, respectively). Different types of communities should focus on the types of social capital from different sources, so as to take more targeted measures to improve the social support of residents and improve their health. Improving residents' social trust and sense of belonging may help urbanized rural residents better adapt to the new living environment and help them complete the identity transformation.

What do time-use patterns tell us about the validity of self-reported health?

OBJECTIVE

This short communication investigates the usefulness of time-use measures to validate subjective health measures such as self-reported health (SRH). It does this by examining time-use patterns and SRH among middle-age adults in the United States distinguished by race/ethnicity and with additional attention to differences in responses based on language of interview for Hispanics.

METHODS

Data for this study come from the 2013-2016 American Time Use Survey. We calculated average time-use for personal care; housework; paid work; leisure; volunteering/travel; caregiving; and education for every racial/ethnic group differentiating by SRH for 27,063 adults aged 25-64 years. A series of ANOVAs were computed to assess differences in time-use by SRH.

RESULTS

Non-Hispanic whites and non-Hispanic Blacks who reported poor/fair SRH spent more time in personal care and leisure, and less time in paid work, volunteering/travel, caregiving and education, in comparison to those who reported Excellent/Very Good/Good SRH. Among Hispanics, differences by SRH were found for personal care, paid work, leisure and volunteering/travel. Hispanics who answered in English displayed partially similar patterns in SRH found for non-Hispanic whites and Blacks. Hispanics who answered in Spanish demonstrated differences in SRH in the areas of paid work, leisure and education, diverging from the other groups.

CONCLUSIONS

Time-use differences by health status are consistent between non-Hispanic whites, non-Hispanic blacks, but not so for Hispanics. To some extent, Hispanics who answered in English have more comparable patterns to non-Hispanic whites and non-Hispanic Blacks than Spanish respondents. Caution should be exercised when self-reported health measures are used to compare diverse samples collected with surveys that are administered in different languages.

Socioeconomic inequality in exclusive breastfeeding behavior and ideation factors for social behavioral change in three north-western Nigerian states: a cross-sectional study

Background

Socioeconomic inequalities could mitigate the impact of social and behavior change (SBC) interventions aimed at improving positive ideation towards the practice of exclusive breastfeeding. This study explores the empirical evidence of inequalities in the practice of exclusive breastfeeding (EBF) and associated ideational dimensions and domains of the theory of Strategic Communication and Behavior Change in three north-western Nigeria states.

Methods

We used cross-sectional data from 3007 randomly selected women with under-two-year-old children; the convenient regression method was applied to estimate the concentration indexes (CIxs) of exclusive breastfeeding behavior, ranked by household wealth index. Inequality was decomposed to associated ideational factors and sociodemographic determinants. Avoidable inequalities and the proportion of linear redistribution to achieve zero inequality were estimated.

Results

Women from wealthier households were more likely to practice exclusive breastfeeding CIx = 0.1236, p-value = 0.00). Attendance of at least four antenatal clinic visits (ANC 4+) was the most significant contributor to the inequality, contributing CIx = 0.0307 (p-value = 0.00) to the estimated inequality in exclusive breastfeeding practice. The elasticity of exclusive breastfeeding behavior with respect to partners influencing decision to breastfeed and ANC4+, were 0.1484 (p-value = 0.00) and 0.0825 (p-value = 0.00) respectively. Inequality in the regular attendance at community meetings (CIx = 0.1887, p-value =0.00); ANC 4+) (CIx = 0.3722, p-value = 0.00); and maternal age (CIx = 0.0161, p-value = 0.00) were pro-rich. A 10.7% redistribution of exclusive breastfeeding behavior from the wealthier half to the poorer half of the population could eliminate the inequality (line of zero inequality). Inequalities were mainly in the cognitive and social norms dimension and were all pro-poor.

Conclusion

Socioeconomic inequalities exist in exclusive breastfeeding behaviors and in associated ideation factors in the three states but are mostly avoidable. A 10.7% redistribution from wealthier to the poorer half of the population will achieve elimination. Messaging for SBC communication interventions to improve breastfeeding practices could be more effective by targeting the mitigation of these inequalities.

Rural-Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural–urban differences. This study investigates rural–urban inequalities in self-reported health outcomes among older adults aged 60+, taking into account both Hukou and actual residence, adjusting for sociodemographic determinants, based on the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Self-Rated Health (SRH) was assessed with a single question, functional abilities were assessed with the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales, and depression was assessed with the 10-item version of the Center for Epidemiologic Studies Depression Scale. Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities, and depression than urban respondents in both years, which were closely related to rural–urban differences in educational level and income. Impairments appeared at a younger age among rural respondents. Analyses using only Hukou registration and not actual residence resulted in underestimation of rural–urban differences. This study may serve as a basis for interventions to address rural–urban differences in health and social services and reduce health inequalities among Chinese older adults.

Health status among NEET adolescents and young adults in the United States, 2016-2018

Adolescents and young adults not employed or in education/training (NEET) could be at higher risk of adverse health outcomes. Approximately 4.6 million Americans aged between 16 and 24 fall in this group. However, differences in health between NEET and non-NEET population remain unaddressed. This study examines the association of NEET status and poor/fair self-reported health status (SRH), among adolescents and young adults in the United States. Data for this study come from the 2016–2018 National Survey on Drug Use and Health (NSDUH). Our analytical sample consisted of 53,690 respondents. We used logistic regression models to investigate the association between NEET and health status in the United States, while controlling for potential covariates. Approximately 14% of our analytical sample was classified as NEET. NEET report poor/fair health status at higher rates than their counterparts who remained in school and/or had a job (11.30% vs. 5.62%). The NEET population was older, had a higher proportion of non-Hispanic Blacks, engaged in more smoking but in less alcohol drinking than non-NEET. In our initial model, NEET were more likely report poor/fair SRH than their non-NEET counterparts (OR = 2.14; p < 0.001). This difference remains strong when demographic and socioeconomic characteristics are accounted for in our empirical models (OR = 1.93, p < 0.001). In our fully specified model, which accounts for health behaviors, NEET continue to have higher odds of reporting poor/fair SRH (OR = 1.77, p < 0.001). Our analyses suggest that NEET populations report worse health than non-NEETs. The health of this population may improve if interventions to reinsert them into either education or employment are effectively deployed.

•

Approximately 14% of the population aged 16 to 25 are not employed or participating in education/training activities (NEET).

•

The NEET population report worse health status than their non-NEET peers.

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NEETs report worse health even when accounting for demographic and socioeconomic characteristics and metropolitan residence.

Nutrition risk prevalence and associated health and social risk factors in Māori and non-Māori: Results from the New Zealand Health, Work and Retirement Study

OBJECTIVE

To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Māori and non-Māori older adults in New Zealand.

METHODS

As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Māori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures.

RESULTS

Half (50.2%) of Māori and 32.7% of non-Māori were at nutrition risk. Independent risk factors were as follows: for Māori, being unpartnered and rating general health as fair, and for non-Māori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness.

CONCLUSIONS

Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.

Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review

Background

Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries.

Methods

We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria.

Results

Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES.

Conclusion

This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.

PROSPERO registration number

CRD42019123222.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-020-01375-1.

An intersectional analysis providing more precise information on inequities in self-rated health

Background

Intersectionality theory combined with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) can facilitate our understanding of health disparities. This enables the application of proportionate universalism for resource allocation in public health. Analyzing self-rated health (SRH) in Sweden, we show how an intersectional perspective allows for a detailed mapping of health inequalities while avoiding simplification and stigmatization based on indiscriminate interpretations of differences between group averages.

Methods

We analyzed participants (n=133,244) in 14 consecutive National Public Health Surveys conducted in Sweden in 2004–2016 and 2018. Applying AIHDA, we investigated the risk of bad SRH across 12 intersectional strata defined by gender, income and migration status, adjusted by age and survey year. We calculated odds ratios (with 95% confidence intervals) to evaluate between-strata differences, using native-born men with high income as the comparison reference. We calculated the area under the receiver operating characteristic curve (AU-ROC) to evaluate the discriminatory accuracy of the intersectional strata for identifying individuals according to their SRH status.

Results

The analysis of intersectional strata showed clear average differences in the risk of bad SRH. For instance, the risk was seven times higher for immigrated women with low income (OR 7.00 [95% CI 6.14–7.97]) than for native men with high income. However, the discriminatory accuracy of the intersectional strata was small (AU-ROC=0.67).

Conclusions

The intersectional AIHDA approach provides more precise information on the existence (or the absence) of health inequalities, and can guide public health interventions according to the principle of proportionate universalism. The low discriminatory accuracy of the intersectional strata found in this study warrants universal interventions rather than interventions exclusively focused on strata with a higher average risk of bad SRH.

Racial discrimination and allostatic load among First Nations Australians: a nationally representative cross-sectional study

BACKGROUND

Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental, and health conditions to affect multisystem dysregulation in a First Nations population.

METHODS

We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background, and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes.

RESULTS

Our psychosocial, environmental, and health measures informed a four-class structure; 'Low risk', 'Challenged but healthy', 'Mental health risk' and 'Multiple challenges'. Mean allostatic load was highest in 'Multiple challenges' compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the 'Multiple challenges' class (t = 1.74, p = .04) and significantly lower in the 'Mental health risk' class (t = - 1.67, p = .05).

CONCLUSIONS

Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges.

Socioeconomic and behavioral determinants of cardiovascular diseases among older adults in Belgium and France: A longitudinal analysis from the SHARE study

Despite advances in the healthcare system, cardiovascular diseases (CVDs) are still an important public health problem with disparities in the burden within and between countries. Studies among the adult population documented that socioeconomic and environmental factors play a role in the incidence and progression of CVDs. However, evidence is scarce on the socioeconomic determinants and the interplay with behavioral risks among older adults. Therefore, we identified socioeconomic and behavioral determinants of CVDs among older adults. Our sample consisted of 14,322 people aged 50 years and above from Belgium and France who responded to the waves 4, 5, 6 and/or 7 of the Survey of Health Ageing and Retirement in Europe. The effect of determinants on the occurrence of CVD was examined using a Generalized Estimating Equation (GEE) approach for binary longitudinal data. The overall rate of heart attack was 8.3%, which is 7.6% in Belgium and 9.1% in France. Whereas, 2.6% and 2.3% in Belgium and France, respectively, had experienced stroke. In the multivariable GEE model, older age [AOR: 1.057, 95%CI: 1.055-1.060], living in large cities [AOR: 1.14, 95%CI: 1.07-1.18], and retirement [AOR: 1.21, 95%CI: 1.16-1.31] were associated with higher risk of CVD. Furthermore, higher level of education [AOR: 0.82, 95%CI: 0.79-0.90], upper wealth quantile [AOR: 0.82, 95%CI: 0.76-0.86] and having social support [AOR: 0.81, 95%CI: 0.77-0.84] significantly lowers the odds of having CVD. A higher hand grip strength was also significantly associated with lower risk of CVD [AOR: 0.987, 95%CI: 0.984-0.990]. This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD. Therefore, community-based interventions aimed at reducing cardiovascular risks need to give more emphasis to high-risk retired older adults with lower education, no social support and those who live in large cities.

To what extent do socioeconomic inequalities in SRH reflect inequalities in burden of disease? The HELIUS study

BACKGROUND

Self-rated health (SRH), an attractive measure for health monitoring, shows persistent inequalities with regard to socioeconomic status (SES). However, knowledge on the extent to which inequalities in SRH reflect inequalities in disease burden is lacking.

METHODS

Data come from the multi-ethnic HEalthy LIfe in an Urban Setting study (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish or Moroccan origin, N = 19 379, aged 18-70). SES was defined by educational and occupational level. Disease burden was operationalized as chronic diseases, physical and mental functioning (measured with SF-12) and depressive symptoms (measured with PHQ-9). We applied logistic regression analyses and reported average marginal effects (AME).

RESULTS

Dutch origin participants with low educational or low occupational level had higher probabilities of reporting fair/poor SRH, compared to the highest levels (AME = 0.20 95% CI: 0.13;0.27; and 0.12 (0.09;0.15), respectively). Associations were attenuated after adjusting for all disease burden indicators, to AME = 0.03 (0.01;0.04) and AME = 0.02 (-0.00;0.04). In all the non-Dutch origin groups, a larger part of the inequalities remained after adjustment.

CONCLUSION

Socioeconomic inequalities in SRH are for a large part explained by higher disease burden in lower socioeconomic groups, but less so in those with non-Dutch origin. Future research should examine if our conclusions also hold for trend data on inequalities in SRH.

The Relationship Between Education and Pain Among Adults Aged 30-49 in the United States

Pain is a major health problem among U.S. adults. Surprisingly little, however, is known about educational disparities in pain, especially among the nonelderly. In this study, we analyze disparities in pain across levels of educational attainment. Using data from the 2010 to 2017 National Health Interview Survey among adults aged 30 to 49 (N = 74,051), we estimate logistic regression models of pain prevalence using a dichotomous summary pain index and its 5 constituent pain sites (low back, joint, neck, headache/migraine, and facial/jaw). We find a significant and steep pain gradient: greater levels of educational attainment are associated with less pain, with 2 important exceptions. First, adults with a high-school equivalency diploma (GED) and those with "some college" have significantly higher pain levels than high school graduates despite having an equivalent or higher attainment, respectively. Second, the education-pain gradient is absent for Hispanic adults. After taking into account important covariates including employment, economic resources, health behaviors, physical health conditions, and psychological wellbeing, educational disparities in pain are no longer statistically significant except for the GED and "some college" categories, which still show significantly higher pain levels than high school graduates. We thus document the overall education-pain gradient in most younger U.S. adult populations, and identify groups where pain is higher than expected (certain educational categories) or lower than expected (eg, less-educated Hispanics). Understanding the causes of these anomalous findings could clarify factors shaping pain prevalence and disparities therein. PERSPECTIVE: Over 50% of U.S. adults age 30 to 49 report pain. Overall, more educated Americans report substantially less pain than the less educated. However, adults with a GED and "some college" report more pain than other groups. Understanding the causes could help illuminate the mechanisms through which social factors influence pain.

Cautionary tails of grip strength in health inequality studies: An analysis from the Canadian longitudinal study on aging

Self-rated health is widely used in studies of the socioeconomic gradient of health in community-based populations. Its subjectivity may lead to under- or over-estimation of a true underlying socioeconomic gradient and has increased interest in searching for alternative, objective measures of health. Grip strength has emerged as one such alternative for community-based older populations, yet no study has directly assessed the relationship between these two measures and compared their associations with socioeconomic status and health behaviours. Using 26,754 participants aged 45-85 years in the baseline data of the Canadian Longitudinal Study on Aging Comprehensive Cohort, we estimated adjusted-grip strength through indirect standardization using age, sex, height, weight, and their square terms and used ANOVA to assess the variance of adjusted-grip strength within and between each self-rated health category. We ran four separate logistic regression models, examining unhealthy tails (those reporting poor health vs. not and those at the bottom 8th percentile of adjusted-grip strength vs. above) and healthy tails (those reporting excellent health vs. not and those at the top 20th percentile of adjusted-grip strength vs. below). Stronger adjusted-grip strength correlated with better self-rated health, but only 2% of the total variance of adjusted-grip strength was explained by variance between the self-rated health categories. While self-rated health largely showed the expected socioeconomic gradients and positive relationships with health enhancing behaviours, adjusted-grip strength showed no clear, consistent associations with either socioeconomic or health behaviour variables. The results give caution about using grip strength as an objective alternative to self-rated health in studies of social inequalities in health. Empirical approaches demand careful considerations as to which dimensions of health and corresponding measures of health are most relevant to the context being studied.

Health and economic scarcity: Measuring scarcity through consumption, income and home ownership indicators in Norway

It is widely recognised that income alone may not accurately reflect people's economic circumstances. In recent years, there has been increasing focus on multidimensional measures of economic scarcity. This study employs the newest survey data from Consumption Research Norway to explore the relationship between economic scarcity and self-reported health (SRH) in Norway. It defines economic scarcity by identifying disadvantaged social groups in terms of consumption, income and wealth/homeownership. Using propensity score matching, we compare health outcomes for economically disadvantaged and advantaged social groups - finding that consumption measures of scarcity are significantly associated with health, while there is no significant relationship between health and homeownership. When using matching estimators, health scores differ significantly between people with higher and lower incomes, but the associations are weakened when other socioeconomic variables are controlled for. This study applies empirical evidence from Norway to the existing health literature and contributes to a relatively new analytical approach by incorporating consumption into the prediction of health outcomes.

Associations between early-life food deprivation during World War II and risk of hypertension and type 2 diabetes at adulthood

The Developmental Origins of Health and Disease (DOHaD) framework suggests that early-life experiences affect long-term health outcomes. We tested this hypothesis by estimating the long-run effects of exposure to World War II-related food deprivation during childhood and adolescence on the risk of suffering from hypertension and type 2 diabetes at adulthood for 90,226 women from the French prospective cohort study E3N. We found that the experience of food deprivation during early-life was associated with a higher risk of developing type 2 diabetes (+0.7%, 95% CI: 0.073-1.37%) and hypertension (+2.6%, 95% CI: 0.81-4.45%). Effects were stronger for individuals exposed at younger ages. Exposed individuals also achieved lower levels of education, slept less, and were more frequently smokers than unexposed individuals. These results are compatible with both the latency and the pathway models proposed in the DOHaD framework which theorise the association between early life exposure and adult health through both a direct link and an indirect link where changes in health determinants mediate health outcomes.

Patterns of Physical Activity and Self-rated Health Among Adult Populations in South Asia

Introduction:

Although South Asians are considered to be at high risk for cardiovascular diseases, research evidence on the health impacts of physical activity (PA) remains very limited. In this study we aimed to explore the patterns of PA and to investigate whether engaging in regular PA is associated with better Self-Rated Health (SRH) among South Asians.

Methods:

Cross-sectional data on population health were drawn from the World Health Survey of WHO. Subjects were 28,020 male and female South Asians (from Bangladesh, India, Nepal, and Sri Lanka) aged 18 years and above. Data were analysed using descriptive and multivariable logistic regression analyses.

Results:

The proportion of the sample population reported good SRH was 44.3%, 58.7%, 37.7%, and 73.7% in Bangladeshis, Indians, Nepalese, and Sri Lankans, respectively. Regular engagement in moderate PA was highest in Nepal (69.7%) and lowest in Bangladesh (37.4%). Vigorous PA was highest in India (29.9%) and lowest in Bangladesh (17.9%). In Bangladesh, compared to those never engaged in MPA, those who engaged for 1-2, 3-4, 5-6, or 7 days a week were 30% [AOR=1.306; 95%CI 1.085-1.572], 33% [AOR=1.326; 95%CI 1.093-1.609], 39% [AOR=1.389; 95%CI 1.125-1.716], and 46% [AOR=1.459; 95%CI 1.249-1.705] more likely to report being in good health, respectively.

Conclusions:

We found that self-reported engagement in physical activities varies in South Asian countries. Since engaging in PA may help improve subjective and objective health status, health policy makers need to focus on designing exercise-friendly neighbourhoods in an attempt to promote population health.

Health Measurement and Health Inequality Over the Life Course: A Comparison of Self-rated Health, SF-12, and Grip Strength

The cumulative (dis)advantage hypothesis predicts education differences in health to increase with age. All previous tests of this hypothesis were based on self-reported health measures. Recent research has suggested that self-reported health measures may not adequately capture differences in key analytical constructs, including education, age, cohort, and gender. In this study, I tested the cumulative (dis)advantage hypothesis using a self-reported subjective measure (self-rated health), a self-reported semi-objective measure (PCS based on SF-12), and an objective measure (grip strength) of general physical health. Hierarchical linear models applied to five waves of panel data (SOEP, 2006-2014, N = 3,635 individuals aged 25 to 83, comprising N = 9,869 person-years) showed large differences between health measures. Among men, education differences in both self-reported measures of health widened substantially with age, consistent with the cumulative (dis)advantage hypothesis. For grip strength, education differences were small and changed little with age, inconsistent with the hypothesis. Among women, education differences in both self-reported measures of health remained stable over the life course, but they widened substantially when measured by grip strength. I conclude that evidence on the cumulative (dis)advantage hypothesis is sensitive to the choice of a health measure.

Ex ante inequality of opportunity in health, decomposition and distributional analysis of biomarkers

We use a set of biomarkers to measure inequality of opportunity (IOp) in the risk of major chronic conditions in the UK. Applying a direct ex ante IOp approach, we find that inequalities in biomarkers attributed to circumstances account for a non-trivial part of the total variation. For example, observed circumstances account for 20 % of the total inequalities in our composite measure of multi-system health risk, allostatic load. We propose an extension to the decomposition of ex ante IOp to complement the mean-based approach, analysing the contribution of circumstances across the quantiles of the biomarker distributions. Shapley decompositions show that, for most of the biomarkers, the percentage contribution of socioeconomic circumstances (education and childhood socioeconomic status), relative to differences attributable to age and gender, increase towards the right tail of the biomarker distribution, where health risks are more pronounced.

Racial-ethnic disparities in self-reported health status among US adults adjusted for sociodemographics and multimorbidities, National Health and Nutrition Examination Survey 2011-2014

Objective: To investigate racial-ethnic disparities in self-reported health status adjusting for sociodemographic factors and multimorbidities.Design: A total of 9499 adult participants aged 20 years and older from the United States (US); reported by the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey - for years 2011-2014. The main outcome measure was self-reported health status categorized as excellent/very good, good (moderate), and fair/poor.Results: Of the NHANES participants, 40.7% reported excellent/very good health, 37.2% moderate health and 22.1% fair/poor health. There were 42.8% who were non-Hispanic whites, 20.2% were Hispanic, 23.8% were non-Hispanic blacks, and 13.2% were non-Hispanic Asians. Compared to non-Hispanic whites, Hispanics [Odds Ratio (OR) = 2.91, 95% Confidence Interval (CI) = 2.28-3.71] and non-Hispanic blacks [OR = 1.51, 95% CI = 1.26-1.83] were more likely to report fair/poor health, whereas, non-Hispanic Asians [OR = 1.42, 95% CI = 1.14-1.76] were more likely to report moderate health than excellent/very good health. Compared to those with no chronic conditions, participants with two or three chronic conditions [OR = 9.35, 95% CI = 7.26-12.00] and with four or more chronic conditions [OR = 38.10, 95% CI = 26.50-54.90] were more likely to report fair/poor health than excellent/very good health status.Conclusion: The racial-ethnic differences in self-reported health persisted even after adjusting for sociodemographics and number of multimorbidities. The findings highlight the potential importance of self-reported health status and the need to increase health awareness through health assessment and health-promotional programs among the vulnerable minority US adults.

On the measurement of health and its effect on the measurement of health inequality

We examine the extent to which self-reported health measures suffer from income-related reporting heterogeneity and then characterize how this reporting heterogeneity affects the estimation of income-related health inequality. We run a comprehensive set of tests of reporting heterogeneity using several self-reported health measures and several clinical measures of health from the National Health and Nutritional Examination Surveys. We propose the use of a multidimensional measure using clinical indicators of health in the context of measuring income-related health inequality, and we examine the extent of income-related health inequality, as measured by the concentration index, using both self-reported measures of health and the multidimensional clinical measure. Our results confirm the existence of significant, positive, income-related reporting heterogeneity and also suggest that higher income individuals react more strongly to a change in clinical health measures. Using self-assessed health suggests that income-related health inequality is about three times larger than when using more objective, self-reported health measures and ten times larger than when using the multidimensional clinical measure of health.

The role of education in the association between self-rated health and levels of C-reactive protein: a cross-sectional study in rural areas of China

OBJECTIVES

This study aims to examine the association between self-rated health (SRH) and levels of C-reactive protein (CRP) among adults aged 45 to 101 years old in rural areas of China, and to explore the role of education in the association.

DESIGN

Cross-sectional study.

SETTING

The study population was derived from two databases in China: Nanping project (NP) and the China Health and Retirement Longitudinal Study (CHARLS).

PARTICIPANTS

There were 646 participants from a rural area of Nanping (NP) and 8555 rural participants from a national representative sample of China (CHARLS).

METHODS

CRP was measured using a high sensitivity sandwich enzyme immunoassay in the NP and immunoturbidimetric assay in the CHARLS. SRH was assessed by SRH questionnaires and categorised into good and poor. Education was measured by the maximum years of schooling and dichotomised into illiterate and literate. Multivariate linear regression models were used to study the associations.

RESULTS

Compared to people with good SRH, those with poor SRH had higher levels of CRP in NP (β=0.16, 95% CI -0.02 to 0.34) and in CHARLS (β=0.07, 95% CI 0.02 to 0.11) after adjusting for potential confounders. Similar findings were observed in the pooled population (β=0.08, 95% CI 0.03 to 0.12), especially in men (β=0.13, 95% CI 0.06 to 0.20) and in literate people (β=0.12, 95% CI 0.06 to 0.18).

CONCLUSION

Poor SRH may be a predicator of elevated levels of CRP among middle-aged and older people in rural areas, especially in men and literate people.

Gender Minority Stress and Health Perceptions Among Transgender Individuals in a Small Metropolitan Southeastern Region of the United States

Purpose: Transgender individuals continue to face wide-ranging health disparities, which may be due in part to unique and chronic gender identity-related stressors. The present study assessed the relationships between barriers to health care, proximal minority stress related to perceived community safety, and overall health perceptions of transgender individuals living in a small metropolitan region of the Southern United States.

Methods: Participants included 66 transgender individuals who took part in a larger lesbian, gay, bisexual, transgender, and queer (LGBTQ) community needs assessment study. Participants completed measures of barriers to health care, inclusive of medical access barriers, psychosocial needs barriers, and personal resource barriers, perceptions of LGBTQ safety within the region, and overall perceptions of health.

Results: Results revealed that psychosocial needs barriers, personal needs barriers, and perceived lack of community safety were correlated with poorer self-perceptions of overall health, with psychosocial needs barriers and perceived lack of community safety independently predictive of poor health perceptions.

Conclusions: The study demonstrates the need for greater health resources and access to care, as well as improved community conditions for transgender individuals, particularly those in less populated, Southern regions of the United States, to improve health quality and ultimately reduce community health disparities.

Trends in socioeconomic inequalities in self-rated health in Germany: a time-trend analysis of repeated cross-sectional health surveys between 2003 and 2012

OBJECTIVES

This study assessed the extent of educational and income inequalities in self-rated health (SRH) in the German adult population between 2003 and 2012 and how these inequalities changed over time.

DESIGN

Repeated cross-sectional health interview surveys conducted in 2003, 2009, 2010 and 2012.

SETTING AND PARTICIPANTS

The study population was the German adult population aged 25-69, living in private households in Germany. In total 54 197 randomly selected participants (2003: 6890; 2009: 16 418; 2010: 17 145; 2012: 13 744) were included.

MAIN OUTCOME MEASURES

SRH was assessed with one single question. Five answer categories were dichotomised into good ('very good' and 'good') versus poor ('moderate', 'poor', 'very poor') SRH. To estimate the extent of the correlation between absolute and relative inequalities in SRH on the one hand, and income and education on the other; slope indices of inequality (SII) and relative indices of inequality (RII) were estimated using linear probability and log-binomial regression models.

RESULTS

There were considerable and persisting educational and income inequalities in SRH in every survey year. Absolute educational inequalities were largely stable (2003: SII=0.25, 95% CI 0.21 to 0.30; 2012: 0.29, 95% CI 0.25 to 0.33; p trend=0.359). Similarly, absolute income inequalities were stable (2003: SII=0.22, 95% CI 0.17 to 0.27; 2012: SII=0.26, 95% CI 0.22 to 0.30; p trend=0.168). RII by education (2003: 2.53, 95% CI 2.11 to 3.03; 2012: 2.72, 95% CI 2.36 to 3.13; p trend=0.531) and income (2003: 2.09. 95% CI 1.75 to 2.49; 2012: 2.53, 95% CI 2.19 to 2.92; p trend=0.051) were equally stable over the same period.

CONCLUSIONS

We found considerable and persisting absolute and relative socioeconomic inequalities in SRH in the German adult population between 2003 and 2012, with those in lower socioeconomic position reporting poorer SRH. These findings should be a concern for both public health professionals and political decision makers.

The association between self-rated health and underlying biomarker levels is modified by age, gender, and household income: Evidence from Understanding Society - The UK Household Longitudinal Study

The goal of this study was to evaluate how self-rated health (SRH) and objective measures of health (biomarkers) are associated, and if this association varies by gender, age, and socioeconomic position (measured by household income). Data come from the UK Household Longitudinal Study nurse visit (2010–2012), including a representative sample of adults in Great Britain (N = 15 687 maximum sample). SRH was assessed by the question “In general, would you say your health is excellent, very good, good, fair, or poor?” and dichotomized into good or poor. Indices were created for four biomarker categories based on the aspects of health they are likely to reflect, including visible weigh-related, fitness, fatigue, and disease risk biomarkers. Logistic regression models were run with SRH as the outcome and each biomarker index as a predictor, adjusting by gender, age, and income. Further, interaction terms between each biomarker index and gender, age, and income (independently) were added to test for effect modification. All biomarker indices were associated with SRH in expected directions, with the fitness index most strongly predicting SRH. Gender, age, or income modified the associations between SRH and all biomarker indices to different extents. The association between the visible weight-related biomarker index (including body mass/fat variables) and SRH was stronger for women than men and for those in higher income groups than lower income groups. Income also modified the association between SRH and the fitness biomarker index, whereas age modified the association between SRH and the fatigue biomarker index. When using SRH to investigate health inequalities, researchers and policy makers should be clear that different social groups may systematically consider different dimensions of health when reporting their SRH.

•

The association between self-rated global health and underlying objective health as measured by biomarkers varies by type of biomarker, age, sex and socioeconomic status.

•

Biomarkers that measure different aspects of fitness most strongly predicting self-rated health.

•

The association between the visible biomarkers (including body mass/fat variables) and self-rated health was stronger for women than men and for those in higher income groups than lower income groups.

•

Income also modified the association between self-rated health and biomarkers of disease, with a stronger association for higher income groups.

•

When rating own health individuals from different social groups may systematically consider different dimensions of health.

A comparison of health expectancies over 10 years: implications for elderly service needs in Hong Kong

OBJECTIVES

We aimed to estimate health expectancies at age 65 based on physical and cognitive function in 2001-2002 and 2011-2012 and project future needs for carers from 2021 to 2041.

METHODS

Data from the Elderly Health Centres (EHCs) of the Department of Health of the Government of Hong Kong comprising of people aged 65 years or older who enrolled between 2001 and 2002 (EHC 2001-2002) and between 2011 and 2012 (EHC 2011-2012) provided proportion estimates for physical impairment (assessed by independence in activities of daily living) and cognitive impairment (assessed by Abbreviated Mental Test/Mini-Mental Status Examination and self-reported doctor diagnosis of dementia). Health expectancies (years lived with/without physical and/or cognitive impairment) were calculated by Sullivan's method. The proportions of physical and/or cognitive impairment were used to project future needs for carers.

RESULTS

Between 2001-2002 and 2011-2012, years lived without physical/cognitive impairment decreased for men but increased for women, both of which were less than the increases in total life expectancy. Men assessed in 2011-2012 (classified as EHC 2011-2012) lived more years with physical and/or cognitive impairment than those assessed in 2001-2002 (classified as EHC 2001-2002), and women in EHC 2011-2012 lived more years with physical impairment, but fewer years with cognitive impairment than those in EHC 2001-2002, and women enrolled in EHC 2011-2012 lived more years with physical impairment, but fewer years with cognitive impairment than those in EHC 2001-2002. As populations age, the number of carers needed is expected to increase from 344,000 in 2021 to 629,000 by 2041, or an increase of 82.9%. Sensitivity analyses excluding the participants who had been assessed in 2011-2012 from EHC 2001-2002 gave similar estimations.

CONCLUSIONS

Increased life expectancy was not accompanied by an increase in years lived without physical/cognitive impairment. These findings suggest that people will live longer but could be more dependent, which would have considerable implications for elderly service needs in Hong Kong.

Self-Rated Health and Relative Socioeconomic Deprivation in the Palestinian Refugee Communities of Lebanon

Most Palestinian refugees in Lebanon are marginalized as refugees, poor, and targets of discrimination. This study seeks to understand deprivation among these refugees through an exploration of the relationship between indicators of general health and economic deprivation. A nationally representative sample of 2501 Palestinian refugee households were randomly selected and surveyed in 2010. Social workers interviewed the homemaker in each household using a questionnaire on health, economic, and socio-demographic information. This data was analyzed to understand the associations between health and levels of deprivation. 31% of respondents reported poor health and nearly 52% of households had two or more poverty indicators. The logistic regression found each degree of deprivation associated with a 33% increase in poor health (OR 1.33; CI 1.20-1.47). This study suggests understanding deprivation among impoverished communities requires a nuanced approach. Generalizations about experiences of poverty will generate ineffective policy and intervention strategies.

Feeling Better at This Age? Investigating Three Explanations for Self-Rated Health Improvements Among the Oldest-Old

Background and Objectives

Although the majority of individuals in their 80s or 90s do not experience improving health, a significant portion of this age group either (a) subjectively assess their health as improving; or (b) demonstrate self-rated health improvements when comparing consecutive surveys. While there is a body of research that examines self-rated health declines in older ages, much less work has studied possible determinants of self-rated health improvements. This is important, since there is increasing evidence that oldest-old adults have unique health evaluative processes that are not yet well-understood.

Research Design and Methods

Using 21,155 observations from eight waves of the Asset and Health Dynamics survey (the oldest-old portion of the Health and Retirement Study), I use hierarchical linear models to test three explanations as to why the oldest-old may report or demonstrate self-rated health improvements: (a) normalized pre-existing chronic conditions, (b) positive lifestyle changes, and (c) recovery from recent prior health shocks.

Results

Health improvements calculated by comparing consecutive surveys were related to a recovery from four particular serious health diagnoses (cancer, stroke, heart disease, and lung disease). Conversely, explicitly reported health improvements were associated with normalizing pre-existing conditions. Lastly, starting a regular exercise routine was related to both types of health improvements; while the cessation of negative health behaviors (i.e., drinking and smoking) was not related to either type.

Discussion and Implications

These results suggest that while subjective health "improvements" among the oldest-old may be a sign of successful aging, they should be interpreted critically and cautiously.

Self-rated health and its association with all-cause mortality of older adults in Poland: The PolSenior project

OBJECTIVES

Predictive effect of self-rated health (SRH) on mortality in older adults has been observed. The purpose of the study was to analyze this association in Poles aged 65+.

METHODS

Data were obtained from the nationwide, multidisciplinary PolSenior project, conducted in a representative sample of older population. The study group comprised 4049 respondents (48.0% women) without significant cognitive deficit. SRH was measured using Visual Analog Scale. The analysis included selected socio-economic, health status and life-style factors. Mortality data were retrieved from the state registry.

RESULTS

During 5-year period, 414 women (21.4%) and 672 men (31.8%) have died, including 17.5% of women and 26.6% of men with good, 21.6% and 32.9% with fair, 36.2% and 55.3% with poor SRH, respectively. Kaplan-Meier survival curves for SRH revealed significant differences for both genders. Univariate Cox regression analysis revealed significant hazard ratios (HRs) for mortality among women and men with poor compared to good SRH [2.48 (1.83-3.37); 2.62 (2.04-3.36), respectively] and those with fair compared to good SRH [1.29 (1.03-1.60); 1.29 (1.10-1.52), respectively]. Age-adjusted HRs for mortality were significant between groups with poor and good SRH [women: 1.98 (1.46-2.68), men: 2.06 (1.60-2.64)]. Multivariate Cox proportional hazard regression model including revealed significant HRs for mortality between women with poor and good SRH [1.67 (1.06-2.64)].

CONCLUSIONS

SRH was associated with mortality in both genders. After adjustment for age, this relationship was maintained in respondents with poor compared to good SRH. Inclusion of potential confounders demonstrated that SRH was an independent predictor of mortality only in women.

Integrating Biomarkers in Social Stratification and Health Research

This article provides an overview of the integration of biomarkers and biological mechanisms in social science models of stratification and health. The goal in reviewing this literature is to highlight research that identifies the social forces that drive inequalities over the life course and across generations. The article is structured in the following way. First, descriptive background information on biomarkers is presented, followed secondly by a review of the general theoretical paradigms that lend themselves to an integrative approach. Third, the biomarkers used to capture several biological systems that are most responsive to social conditions are described. Fourth, research that explicates how social exposures "get under the skin" to affect physiological functioning and downstream health is discussed, using socioeconomic disadvantage as an illustrative social exposure. The review ends with emerging directions in the use of biomarkers in social science research. This article endeavors to encourage sociologists to embrace biosocial approaches in order to elevate the importance of social factors in biomedical processes and to intervene on the social conditions that create inequities.

From the West Indies to Africa: A universal generational decline in health among blacks in the United States

Research shows that foreign-born blacks have better health profiles than their U.S.-born counterparts. Less is known, however, regarding whether black immigrants' favorable health outcomes persist across generations or whether these patterns differ across the diverse sending regions for black immigrants. In this study, we use data from the 1996-2014 waves of the March Current Population Survey (CPS) to investigate generational differences in self-rated health among blacks with West Indian, Haitian, Latin American, and African ancestry. We show that first-generation black immigrants have a lower probability of reporting fair/poor health than third/higher generation blacks. The health advantage of the first generation over the third/higher generation is slightly more prounced among the foreign-born who migrated to the United States after age 13. Second-generation immigrants with two foreign-born parents are generally less likely to report their health as fair/poor than the third/higher generation. However, we find no evidence that self-reported fair/poor health varies between second-generation immigrants with mixed nativity parents (only one foreign-born parent) and the third/higher generation. These general patterns hold across each of the ancestral subgroups in the study sample. In summary, our findings highlight a remarkable convergence in health across immigrant generations among blacks in the United States.