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

Built environment and its association with self-rated health in Brazilian elderly: National Health Survey 2013

The present study aims to investigate the association between the built environment and positive self-rated health among older adults from Brazilian capitals. It is a cross-sectional population-based study, which collected data from the National Health Survey 2013 and the Observatório das Metrópoles. The outcome was a positive self-rated health. The built environment was investigated by the Urban Wellbeing Index (IBEU, in Portuguese). Analyses were performed by multilevel logistic regression (95%CI). Among the 4,643 elderly individuals evaluated in this study, 51.5% reported a positive self-rated health (95%CI: 50.0-52.9). Elderly people living in capitals with higher IBEU terciles were more likely to have a positive self-rated health (OR: 1.42; 95%CI: 1.08-1.86 (T2); OR: 1.78; 95%CI: 1.35-2.33 (T3)). As for the dimensions of the IBEU, the following were associated with the outcome: urban infrastructure (OR: 1.56; 95%CI: 1.13-2.16), urban environmental conditions (OR: 1.49; 95%CI: 1.10-2.04), urban housing conditions (OR: 1.45; 95%CI: 1.05-1.99), and urban collective services (OR: 1.72; 95%CI: 1.30-2.27). A positive association was found between better conditions of the built environment and one's perception of health, regardless of individual characteristics. Promoting changes in the built environment can be effective in improving health levels, thus favoring healthy aging.

Social environment characteristics are related to self-rated health in four Latin America countries: Evidence from the SALURBAL Project

We investigated the associations of social and built environment and demographic features of urban areas with self-rated health among adults living in four Latin American countries. We estimated multilevel models with harmonized data from 69,840 adults, nested in 262 sub-cities and 112 cities, obtained from the Salud Urbana en América Latina project. Poor self-rated health was inversely associated with services provision score at the sub-city-level and with social environment index at the city-level. We did not identify associations of built environment and demographic features with self-rated health. Approaches and policies to improve health in Latin American should be urban context-sensitive.

Neighbourhood Socioeconomic Processes and Dynamics and Healthy Ageing: A Scoping Review

Elderly citizens are concentrated in urban areas and are particularly affected by the immediate residential environment. Cities are unequal and segregated places, where there is an intensification of urban change processes such as gentrification and displacement. We aimed to understand how neighbourhood socioeconomic processes and dynamics influence older people’s health. Three bibliographic databases—PubMed, Web of Science, and Scopus—were used to identify evidence of the influence of neighbourhood socioeconomic deprivation, socio-spatial segregation, urban renewal, and gentrification on healthy ageing. We followed the method of Arksey and O’Malley, Levac and colleagues, the Joanna Briggs Institute, and the PRISMA-ScR. The included studies (n = 122) were published between 2001 and 2021. Most evaluated neighbourhood deprivation (n = 114), followed by gentrification (n = 5), segregation (n = 2), and urban renewal (n = 1). Overall, older people living in deprived neighbourhoods had worse healthy ageing outcomes than their counterparts living in more advantaged neighbourhoods. Older adults pointed out more negative comments than positive ones for gentrification and urban renewal. As to segregation, the direction of the association was not entirely clear. In conclusion, the literature has not extensively analysed the effects of segregation, gentrification, and urban renewal on healthy ageing, and more quantitative and longitudinal studies should be conducted to draw better inferences.

The Effects of Urban Neighborhood Environmental Evaluation and Health Service Facilities on Residents' Self-Rated Physical and Mental Health: A Comparative and Empirical Survey

(1) Background: The neighborhood environment has been shown to be an essential factor affecting residents’ quality of life and health, but the relationship between the characteristics of health service facilities and health levels is rarely known. (2) Methods: This study used a representative sample (n = 591, 303 women; 288 men, age 18–85 years, lived in Chengdu for an extensive time) of residents living in Chengdu City, China, and took spatial point data and empirical research data to construct an ordered logistic regression model. We contrastively analyzed the influence of different variables in the neighborhood environment and health service facilities on self-rated physical health (SRPH) and self-rated mental health (SRMH). (3) Results: The frequency of use and accessibility of multiple facilities in the health service facilities were significantly associated with self-rated health (SRH). Significant differences occurred between residents’ perceived accessibility and actual accessibility of facilities in SRH. Comparing the results of SRPH and SRMH revealed that the influencing factors that affect the two vary. The factors that significantly affect SRMH include neighborhood physical environment evaluation; social environmental evaluation; the frequency of use of the parks and squares, and sports zones; and the accessibility of parks and squares, specialized hospitals, community hospitals, and pharmacies. However, the factors that significantly affect SRPH include the frequency of use of sports venues, general hospitals, and pharmacies and the accessibility of general hospitals. The social environment of the neighborhood is also a non-negligible part, and its interaction with the physical environment of the neighborhood affects the outcome of SRH. (4) Conclusions: Neighborhood environmental characteristics and the layout of health service facilities have significant differential effects on people’s physical and psychological health, and this information is of great value in promoting healthy city development and improving the quality of life of urban populations around the world.

The Good Old Days: how Older Adults in Present-Day Ghana Compare themselves to Older Adults in Past Generations

This study explores nostalgia among older adults in present-day Ghana by investigating how they subjectively compare themselves to older adults in the past. A purposive sample of 23 older adults provided data through semi-structured face-to-face interviews and data analysis employed a general inductive approach, with a focus on content and thematic analytic procedures. The findings show an overall theme of 'the good old days', how participants compare themselves negatively to older adults in their past, believing and feeling that older adults in the past enjoyed better health and longevity and had more care and respect. While participants generally praise the past for its perceived virtue and vitality, they scold the present for a perceived degeneration. Findings of this study support theoretical descriptions and empirical research conclusions on nostalgia as: an emotionally invested remembrance of the past; a yearning to relive the past or reconnect with people and things past, or to return to places in the past; and an evocation of the beauty of the past in contrast to the ugliness of the present. Consonant with this, the study shows how participants evoke the beauty of the past, where, comparatively, older adults enjoyed a life of dignity. In what is characteristic of nostalgic evocations, participants reclaim the lost beautiful past, where people ate natural - healthy - foods, engaged in physically active work, and were stronger into late adulthood. Again, consonant with nostalgia as a discourse of critique of the present with the past as yardstick, participants express disenchantment with the present for a perceived steady degradation of the values of care, respect, and obedience to elders, which made older adults in past generations a privileged class. To this end, we may conclude that nostalgia not only speaks to the present from the past, it seeks to recreate the past in the future.

Understanding the Wellbeing of the Oldest-Old in China: A Study of Socio-Economic and Geographical Variations Based on CLHLS Data

Empirical studies of the socio-economic determinants of the wellbeing of the oldest-old in China including the role of geography and spatial factors are rare. This paper applies binary logistic regression analysis to data on the oldest-old aged 80 years old and higher from the 2011 Chinese Longitudinal Healthy Longevity Study (CLHLS). Socioeconomic determinants of the self-reported quality of life (QoL) and self-reported health (SRH) of the oldest-old population are explored, with special attention paid to the role of residence and region. The results indicate that, after controlling for individual demographic and health behavior variables, both economic status and social welfare have a significant effect on self-reported QoL and SRH. There are also significant differences in self-reported QoL among cities, towns and rural areas, with the oldest-old respondents living in Central rural, Western town and Western rural areas being significantly less likely to report good QoL, compared to the oldest-old living in Eastern cities. Significant differences in SRH exist among Eastern China, Western China and Northeastern China, with the oldest-old from Western towns being significantly less likely to report good health, and the oldest-old from Northeastern cities being significantly more likely to report good health than those from Eastern cities. The results of this study indicate that socioeconomic factors that explain self-reported QoL and SRH of the older population are in general factors that explain the self-reported QoL and SRH of the oldest-old cohorts. The interaction effect of residence and region matters more than each of the individual factors, in providing us with more detailed information on the role of geography in explaining QoL and health of the oldest-old. At a time when the oldest-old cohorts in China are at the beginning of their projected growth, these findings are vital for providing policy makers with more information on the urgency of making more geographically targeted policy to improve more effectively the self-reported QoL and SRH of the oldest-old population.

Pain and self-rated health among middle-aged and older Canadians: an analysis of the Canadian community health survey-healthy aging

Background

Pain is an important health problem adversely affecting functionality and quality of life. Though self- rated health (SRH) is a major predictor of mortality, its relationship with pain is not well understood. We explore 1) how pain and age interact to influence SRH, and 2) provincial variations in SRH across Canada.

Methods

We analyzed cross-sectional data from Statistics Canada’s Canadian Community Health Survey-Healthy Aging (n = 30,685), which targeted those 45 years and older and was conducted from 2008 to 12-01 to 2009–11-30. The response rate was 74.4%.The topics covered included socio-demographics, well-being and chronic diseases. We performed both bivariate and multivariate analyses between each predictor and SRH; unadjusted and adjusted odds ratios and 95% confidence intervals are reported. Two-level logistic regression mixed model was used to account for provincial differences. An intraclass correlation coefficient was also computed.

Results

Slightly more than half of respondents (56.40%) were female. In bivariate analyses, those experiencing pain had an odds ratio of 0.20. Which means that the odds of reporting good self-rated health are 4 to 5 times lower for those with pain, compare to the odds of reporting good self-rated health among those without pain (p < 0.001). In multivariate analyses the highly educated, female gender, the never married or single and households with high yearly income were predictors of good health (p < 0.001). Those who reported depressive symptoms, the lonely, the obese, daily smokers and/or the stressed were less likely to rate their health as good (p < 0.001). The influence of pain on SRH was stronger among younger age groups (45–54 years) compared to older age groups (75-84 years, with an odds ratio of 3.53 [p < 0.001] versus 3.14 [p < 0.001]).

Conclusions

Pain, among other determinants, is associated with SRH. Individuals in rating their health may consider a variety of factors, some of which may not be apparent to health providers. We found that those who reported depressive symptoms, were daily smokers, the obese, the lonely, and/or having a stressful life were less likely to rate their health as good. No significant provincial variations in SRH in Canada was observed in this study.

Focusing neighborhood context and self-rated health in the Pró-Saúde Study

The influence of neighborhood characteristics on self-rated health has been little studied. A multilevel approach using hierarchical models was applied to analyze the relationship between the socioeconomic characteristics in 621 neighborhoods (level 2) in the city of Rio de Janeiro, Brazil, and the self-rated health of 3,054 university employees (level 1) from the baseline of the Pró-Saúde Study. Neighborhoods were created using the SKATER algorithm (Spatial ‘K’luster Analysis by Tree Edge Removal) to cluster census tracts according to four indicators and a minimum population of 5,000 people. After adjustment for individual factors (per capita income, schooling, age, sex, ethnicity, health-related behavior and chronic diseases), low level of neighborhood income and higher numbers of members per household were significantly associated with poor self-rated health. Participants living in medium income-level neighborhoods were 34% more likely to self-rate their health as being poor. Those living in areas with a higher density of members per household were 50% more likely to present poor self-rated health. Neighborhood context influences self-rated health, beyond the effect of individual factors. Worsening neighborhood socioeconomic conditions affect health adversely, which in turn increasing the chance of poor self-rated health.

Are area-level and individual-level socioeconomic factors associated with self-rated health in adult urban citizens? Evidence from Slovak and Dutch cities

Background

Evidence shows that living in disadvantaged areas is associated with poor health. This may be due to the socioeconomic (SE) characteristics of both these residents and the areas where they live. Evidence regarding this on Central European (CE) countries is scarce. Our aim was to assess whether the prevalence of poor self-rated health (SRH) was higher in deprived urban areas, whether this can be explained by individual SE status (SES) and whether this differed between Slovakia and the Netherlands per age group. We examined the association of urban-level data and individual-level SE factors from different urban areas in different countries (Slovakia, the Netherlands) using comparable urban health indicators and area indicators. We also obtained unique data from the EU-FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that poor SRH was associated with area deprivation in both countries. Regarding age by country, poor SRH occurred more frequently in the more deprived areas for the younger age group (≤64) in the Netherlands but for the older age group (≥65 years) in Slovakia. Moreover, Slovak citizens reported poor SRH significantly more often than Dutch residents. Individual SES was significantly associated with poor SRH in both age groups and both countries for most area-level SE measures. Individual SES is associated with SRH more strongly than area deprivation. Therefore, it is important to account for relative deprivation at an individual level when considering health-enhancing activities. Moreover, the effect of urban-area deprivation seems to differ between CE and WE countries.

Associations between neighborhood effects and physical activity, obesity, and diabetes: The Jamaica Health and Lifestyle Survey 2008

OBJECTIVE

To examine the impact of neighborhood disorder, perceived neighborhood safety, and availability of recreational facilities on prevalence of physical activity (PA), obesity, and diabetes mellitus (DM).

STUDY DESIGN AND SETTING

Multilevel analyses were conducted among 2,848 respondents from the 2007-08 Jamaica Health and Lifestyle Survey. Neighborhood effects were based on aggregated interviewer responses to systematic social observation questions. Mixed-effect logistic regression models were created to assess the relationship between neighborhood indicators and DM and the modifiable risk factors PA and overweight/obesity.

RESULTS

There was significant clustering in PA levels of 20 minutes at least once per week (intraclass correlation coefficient [ICC] = 10.7%), low/no PA (ICC = 7.22%), diabetes (ICC = 5.44%), and obesity (ICC = 3.33%) across neighborhoods. Greater levels of neighborhood disorder, home disorder, and counterintuitively recreational space availability were associated with higher levels of low/no PA among women. There was significant interaction by sex between neighborhood infrastructure and overweight/obesity with a significant association in men (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.05, 1.28) but not women (OR = 1.01; 95% CI = 0.95, 1.07).

CONCLUSION

Differences in PA and obesity-related outcomes among Jamaicans may be partially explained by characteristics of the neighborhood environment and differ by sex. Future studies must be conducted to determine the mechanistic pathways through which the neighborhood environment may impact such outcomes to better inform prevention efforts.

Does Social Context Matter? Income Inequality, Racialized Identity, and Health Among Canada's Aboriginal Peoples Using a Multilevel Approach

OBJECTIVES

Debates surrounding the importance of social context versus individual level processes have a long history in public health. Aboriginal peoples in Canada are very diverse, and the reserve communities in which they reside are complex mixes of various cultural and socioeconomic circumstances. The social forces of these communities are believed to affect health, in addition to individual level determinants, but no large scale work has ever probed their relative effects. One aspect of social context, relative deprivation, as indicated by income inequality, has greatly influenced the social determinants of health landscape. An investigation of relative deprivation in Canada's Aboriginal population has never been conducted. This paper proposes a new model of Aboriginal health, using a multidisciplinary theoretical approach that is multilevel.

METHODS

This study explored the self-rated health of respondents using two levels of determinants, contextual and individual. Data were from the 2001 Aboriginal Peoples Survey. There were 18,890 Registered First Nations (subgroup of Aboriginal peoples) on reserve nested within 134 communities. The model was assessed using a hierarchical generalized linear model.

RESULTS

There was no significant variation at the contextual level. Subsequently, a sequential logistic regression analysis was run. With the sole exception culture, demographics, lifestyle factors, formal health services, and social support were significant in explaining self-rated health.

CONCLUSIONS

The non-significant effect of social context, and by extension relative deprivation, as indicated by income inequality, is noteworthy, and the primary role of individual level processes, including the material conditions, social support, and lifestyle behaviors, on health outcomes is illustrated. It is proposed that social structure is best conceptualized as a dynamic determinant of health inequality and more multilevel theoretical models of Aboriginal health should be developed and tested.

Moving toward a holistic conceptual framework for understanding healthy aging among gay men

In the last four decades, we have witnessed vast and important transitions in the social, economic, political, and health contexts of the lived experiences of gay men in the United States. This dynamic period, as evidenced most prominently by the transition of the gay rights movement to a civil rights movement, has shifted the exploration of gay men's health from one focusing primarily on HIV/AIDS into a mainstream consideration of the overall health and wellbeing of gay men. Against this backdrop, aging gay men in the United States constitute a growing population, for whom further investigations of health states and health-related disparities are warranted. In order to advance our understanding of the health and wellbeing of aging gay men, we outline here a multilevel, ecosocial conceptual framework that integrates salient environmental, social, psychosocial, and sociodeomgraphic factors into sets of macro-, meso-, and micro-level constructs that can be applied to comprehensively study health states and health care utilization in older gay men.

Neighbourhood immigrant concentration and hospitalization: a multilevel analysis of cardiovascular-related admissions in Ontario using linked data

OBJECTIVE

To assess the influence of neighbourhood immigrant concentration on cardiovascular-disease-related hospitalizations in Canada (CVDH), while adjusting for individual-level immigrant status and socio-economic indicators at individual and neighbourhood levels.

METHODS

Data were from the 2006 Canadian Census linked to the hospital Discharge Abstract Data (DAD) for the province of Ontario. Adults (n=1,459,950) aged ≥18 years at baseline and grouped by place of birth (Canada, China, South Asia, Europe, and other) were followed between Census Day May 16, 2006 and March 31, 2008. Information on CVDH was obtained from the DAD, while that on immigration and socio-economic indicators was obtained from the Census. The analysis used multilevel logistic regression.

RESULTS

Unadjusted results showed that CVDH was significantly lower among people living in neighbourhoods with medium and high immigrant concentration. Neighbourhood immigrant concentration tended to have no independent effect on CVDH after adjustment for individual-level immigrant status. Immigrants were less likely to experience CVDH irrespective of their country of birth. However, cross-level interaction showed that neighbourhood immigrant concentration provided additional protection to individual-level immigrant status against CVDH for most female immigrant groups, but only for South Asian males.

CONCLUSION

This study resulted from the first-ever linkage of census data to hospitalization data in Canada. It is also the first Canadian study to report on neighbourhood variation and the effect of immigrant concentration on CVDH. The study shows that understanding immigrant health requires both individual and neighbourhood approaches, and a consideration of country of origin.

Assistive technology and self-rated health in comparison with age peers: a longitudinal study in 55-64-year-olds

PURPOSE

To determine changes in self-rated health in comparison with age peers (SRH-AP) among 55-64-year-olds, as affected by (1) initiating, (2) ceasing, and (3) prolonging the use of assistive technology (AT).

METHODS

Data included two national cohorts of 55-64-year-olds from the Longitudinal Aging Study Amsterdam (total N = 1968), with baseline cycles in 1992-93 and 2002-03 and 3-year follow-ups. The effect of AT use on SRH-AP was studied in analyses of variance for repeated measurements, adjusting for age and self-reported disability.

RESULTS

Respondents using AT reported poorer SRH-AP than respondents not using AT. Over time disability increased for respondents prolonging and initiating AT use and decreased for respondents ceasing AT use. No major changes were seen in SRH-AP over time, except for a small improvement for respondents prolonging AT use.

CONCLUSIONS

AT use had a negative influence on SRH-AP, but this influence subsided over time for prolonged AT use. Despite longitudinal changes in disability, there was a marked stability of SRH-AP over time which may be attributed to AT use. Implications for Rehabilitation Both the proportion of 55-64-year-olds using AT and the proportion reporting disability was significantly higher in the recent cohort as compared to the early cohort. 55-64-Year-olds not using AT rated their health compared with age peers (SRH-AP) better than those using AT. 55-64-Year-olds who prolonged the use of AT reported the poorest ratings of SRH-AP, but also showed the clearest improvement in SRH-AP, suggesting that the initial negative influence of AT use on SRH-AP may subside over time.

Poorer self-rated health in residential areas with limited healthcare supply

AIMS

The aim of this study was to explore differences in self-rated health and physician-diagnosed disease across geographical regions in Iceland to better understand regional requirements for health services.

METHODS

Data on self-rated health and diagnosed disease from a 2007 national health survey (n=5909; response rate 60.3%) across geographic regions were analysed. Area of residence was classified according to distance from the Capital Area (CA) and availability of local health services. We used regression models to calculate crude and multivariable adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95% CI) of self-rated health and diagnosed diseases by area of residence. Models were adjusted for age, gender, education, civil status, and income.

RESULTS

Residents in rural areas with no local health service supply rated their physical health worse than residents of areas with diverse supply of specialised services (aOR 1.40, 95% CI 1.21-1.61). Residents outside the CA rate both their physical (aOR 1.35, 95% CI 1.23-1.50) and mental (aOR 1.17, 95% CI 1.06-1.30) health worse than residents in the CA. In contrast, we observed a lower prevalence of several diagnosed chronic diseases, including cancers (aOR 0.78, 95% CI 0.60-0.99) and cardiovascular disease (aOR 0.77, 95% CI 0.62-0.95) outside the CA.

CONCLUSIONS

These findings from a national survey of almost 6000 Icelanders indicate that self-rated health is related to regional healthcare supply. The findings have implications for national planning of health services aiming at equality both in health and access to health services.

Smoking in context: a multilevel analysis of 49,088 communities in Canada

BACKGROUND

The extent to which the prevalence of smoking in Canada varies across geographic areas independently of individual characteristics has not been quantified.

PURPOSE

To estimate the extent and potential sources of geographic variation in smoking among communities, health regions, and provinces/territories in Canada.

METHODS

Data are from the Canadian Community Health Surveys conducted between 2001 and 2008 (n=461,709). Current cigarette smoking among adults (aged ≥18 years) was the primary outcome. Individual-level markers of SES were education, household income, and occupation. Contextual variables potentially related to smoking considered were provincial cigarette taxes, workplace smoking bans, and collective family norms discouraging smoking in communities. A multilevel logistic regression analysis was conducted to model variation in smoking at the geographic scale of communities, health regions, and provinces.

RESULTS

Overall, the contribution of geography as a percentage of the total variation in smoking was 8.4%, with 2.4% attributable to provinces, 1.2% attributable to health regions, and 4.8% attributable to communities after adjusting for age, gender and survey period. In models that accounted for socioeconomic and demographic characteristics in addition to age and gender, the contribution of geography to the total variation in smoking was attenuated to 4.1%; with 2.0% at the province level, 0.4% at the health region level, and 1.7% at the community level. Within provinces/territories, the community variation in smoking ranged from 2.4% in Prince Edward Island to 9.1% in British Columbia. Nationally, 71% of community and 21% of provincial differences in smoking were explained by individual, socioeconomic, and demographic factors alone; the inclusion of contextual covariates explained an additional 27% of the variation among communities. Collective family norms discouraging smoking in a community was the strongest contextual predictor of individual smoking; provincial cigarette taxes and workplace bans were only modestly related to individual smoking behavior.

CONCLUSIONS

Geographic variation in smoking remained after accounting for individual, socioeconomic, and demographic characteristics, suggesting the importance of place, at the level of provinces and communities in Canada. Remaining community variation in smoking was largely attenuated after accounting for collective family norms discouraging smoking. Area-level influences such as the social and/or environmental conditions of provinces and communities may be important sources of variation in smoking and therefore need to be considered if rates of smoking are to be modified.

Understanding the non-stationary associations between distrust of the health care system, health conditions, and self-rated health in the elderly: a geographically weighted regression approach

The goals of this study are to explore whether health condition is an antecedent extraneous factor for the relationship between health care system distrust and self-rated health among the elderly, and to investigate if the associations among these variables are place-specific. We used logistic geographically weighted regression to analyze data on an elderly sample residents in the Philadelphia metropolitan area. We found that the health conditions of the elderly account for the association between high distrust and poor/fair self-rated health and that the distrust/self-rated health relationship varied spatially. This finding suggests that a place-centered perspective can inform distrust/self-rated health research.