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Hatton CR, Ettman CK, Gollust S, Abdalla SM, Galea S. Mental Health and U.S. Attitudes Toward Social Determinants of Health Policies. Am J Prev Med 2024; 67:350-359. [PMID: 38810769 DOI: 10.1016/j.amepre.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Research has suggested that individual health may influence policy attitudes, yet the relationship between mental health and policy support is understudied. Clarifying this relationship may help inform policies that can improve the population mental health. To address this gap, this study measures national support for 5 social determinants of health policy priorities and their relation to mental health and political affiliation. METHODS This study assessed support for 5 policy priorities related to the social determinants of health using a nationally representative survey of US adults (n=2,430) conducted in March-April 2023. Logistic regression was used to estimate the predicted probability of identifying each priority as important, test differences in support by self-rated mental health, and evaluate whether partisanship modified these relationships. Analyses were conducted in 2023. RESULTS The majority of US adults, across partisan identities, supported 5 policy priorities related to improving the economy (84%), healthcare affordability (77%), improving K-12 education (76%), housing affordability (68%), and childcare affordability (61%). Worse mental health predicted significantly greater support for addressing housing affordability (73.9% vs 66.2%), and partisanship modified the relationship between mental health and support for improving the economy, improving K-12 education, and housing affordability. CONCLUSIONS In 2023, there was substantial bipartisan support for federal policy action to address the social determinants of health, and worse mental health was related to greater policy support, particularly among Democrats. Federal policymakers have a broad consensus to take action to address the social determinants of health, which may improve the population mental health.
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Affiliation(s)
- C Ross Hatton
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Catherine K Ettman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Salma M Abdalla
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, Massachusetts
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Nehme M, Schrempft S, Baysson H, Pullen N, Rouzinov S, Stringhini S, Guessous I. Associations Between Healthy Behaviors and Persistently Favorable Self-Rated Health in a Longitudinal Population-Based Study in Switzerland. J Gen Intern Med 2024; 39:1828-1838. [PMID: 38528233 PMCID: PMC11282021 DOI: 10.1007/s11606-024-08739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Mayssam Nehme
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Stephanie Schrempft
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Helene Baysson
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nick Pullen
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Serguei Rouzinov
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Silvia Stringhini
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
- School of Population and Public Health and Edwin S.H, Leong Centre for Healthy Aging, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Jaworeck S. Beyond objective metrics: A comparative analysis of health care systems incorporating subjective dimensions to improve comparability of access and equity in healthcare assessments. PLoS One 2024; 19:e0304834. [PMID: 38905262 PMCID: PMC11192299 DOI: 10.1371/journal.pone.0304834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/20/2024] [Indexed: 06/23/2024] Open
Abstract
Comparing health care systems is important for several reasons. E.g. lower-resource health care systems can learn from higher-resource ones, and country-specific progress can be made. Previous rankings of health care systems have been based on objective factors such as the number of available hospital beds or health care spending. An index is considered here that includes a subjective level that is intended to represent access to the health care system. Therefore, this study investigates the divergence between subjective and objective indices related to health care expenditure, with a focus on the influence of involuntary and voluntary payments. Utilizing the Rational Choice Theory as a framework, it explores how individual preferences and perceived benefits affect these indices. The analysis reveals that social insurance contributions, which are mandatory and beyond individual control, are evaluated differently in subjective indices compared to objective indices. This discrepancy is less pronounced for voluntary expenditures, where individuals have decision-making power. The findings highlight significant variations in the correlations between macroeconomic health care indicators and the indices, emphasizing the critical role of autonomy in financial decisions related to health care.
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Affiliation(s)
- Sandra Jaworeck
- Institute for Sociology, Chemnitz University of Technology, Chemnitz, Saxony, Germany
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Bazargan M, Cobb S, Assari S, Bazargan-Hejazi S. Physical and mental health quality of life among underserved African American and Latino older adults. ETHNICITY & HEALTH 2023; 28:217-233. [PMID: 35098826 PMCID: PMC9338176 DOI: 10.1080/13557858.2022.2027886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES There is an increasing amount of research on Health-Related Quality of Life (HRQoL) among older adults in the U.S. However, under-resourced and underserved African American and Latino older adults remain underrepresented in research and interventional studies, resulting in limited data on their quality of life and health promotion practices. This study examined the association between HRQoL and several layers of independent variables, including health conditions, level of pain, sleep disorders, and lifestyle factors, among African American and Latino older adults. DESIGN Nine hundred and five African Americans and Latinos aged 55 years and older from an underserved urban community participated in this face-to-face structured study. Multiple linear regression was performed. RESULTS This study documented that HRQoL among African American and Latino participants was substantially lower compared with their White counterparts reported by other studies. Adjusting for other relevant variables, this study documented an association between: (1) physical HRQoL and financial strain, perceived health, the severity of pain, number of major chronic conditions, smoking, and binge drinking; and (2) mental HRQoL and financial strain, perceived health status, the severity of pain, and sleep disorders. CONCLUSION Significantly lower levels of HRQoL among underserved African American and Latino older adults, compared with their White counterparts, point to another important racial/ethnic disparity in the U.S. geriatric population. The devastating consequences of financial strain, excessive chronic conditions, undiagnosed and untreated pain, and sleep disorders are all experienced by underserved African American and Latino older adults, and these factors directly contribute to a lower quality of life among this segment of our population. Longitudinal multi-faceted, multi-disciplinary, culturally sensitive, both clinic- and community-based participatory interventions are needed to address these factors, particularly pain and sleep disorders, in order to enhance the quality of life among these underserved communities.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA
- Department of Public Health, CDU, Los Angeles, CA
- Physician Assistant Program, CDU, Los Angeles, CA
- Department of Family Medicine, UCLA, Los Angeles, CA
| | | | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA
- Department of Public Health, CDU, Los Angeles, CA
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Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults. J Racial Ethn Health Disparities 2023; 10:205-218. [PMID: 35006585 PMCID: PMC8744566 DOI: 10.1007/s40615-021-01211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study uses a theoretical model to explore (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits among sample of under-resourced African American and Latino older adults. METHODS Nine hundred five African American and Latino older adults from an under-resourced urban community of South Los Angeles participated in this study. Data was collected using face-to-face interviews. Poisson and logistic regression analysis were used to estimate the parameters specified in the Andersen behavioral model. Predictors included predisposing factors, defined as demographic and other personal characteristics that influence the likelihood of obtaining care, and enabling factors defined as personal, family, and community resources that support or encourage efforts to access health services. RESULTS African American older adults have a greater frequency of hospital admissions, ED, and physician visits than their Latino counterparts. About 25%, 45%, and 59% of the variance of the hospital admissions, ED utilization, and physician visits could be explained by predisposing and enabling characteristics. Lower health-related quality of life was associated with a higher number of hospital admissions, ED, and physician visits. Financial strain and difficulty accessing medical care were associated with a higher number of hospital admissions. Being covered by Medicare and particularly Medi-Cal were positively associated with higher hospital admissions, ED, and physician visits. DISCUSSION Compared to African American older adults, Latino older adults show higher utilization of (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits. A wide range of predisposing and enabling factors such as insurance and financial difficulties correlate with some but not other types of health care use. Multi-disciplinary, culturally sensitive, clinic- and community-based interventions are needed to address enabling and predisposing factors that influence ED utilization and hospital admission among African American and Latino older adults in under-resourced communities.
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Health-related quality of life of younger and older lower-income households in Malaysia. PLoS One 2022; 17:e0263751. [PMID: 35134086 PMCID: PMC8824345 DOI: 10.1371/journal.pone.0263751] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background Globally, a lower income is associated with poorer health status and reduced quality of life (QOL). However, more research is needed on how being older may influence QOL in lower-income households, particularly as older age is associated with an increased risk of chronic diseases and care needs. To this end, the current study attempts to determine the health-related QOL (HRQOL) among individuals from lower-income households aged 60 years and over compared to lower-income adults aged less than 60 years. Methods Participants were identified from the Department of Statistics Malaysia sampling frame. Surveys were carried out with individual households aged 18 years and older through self-administered questionnaires. Information was collected on demographics, household income, employment status, number of diseases, and HRQOL assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) tool. Results Out of a total of 1899 participants, 620 (32.6%) were female and 328 (17.3%) were aged 60 years and above. The mean (SD) age was 45.2 (14.1) and mean (SD) household income was RM2124 (1356). Compared with younger individuals, older respondents were more likely to experience difficulties in mobility (32.1% vs 9.7%, p<0.001), self-care (11.6% vs 3.8%, p<0.001), usual activities (24.5% vs 9.1%, p<0.001), pain/discomfort (38.8% vs 16.5%, p<0.001) and anxiety/depression (21.4% vs 13.5%, p<0.001). The mean (SD) EQ-5D index scores were lower among older respondents, 0.89 (0.16) vs 0.95 (0.13), p = 0.001. After adjusting for covariates, age was a significant influencing factor (p = 0.001) for mobility (OR = 2.038, 95% CI:1.439–2.885), usual activities (OR = 1.957, 95% CI:1.353–2.832) and pain or discomfort (OR = 2.241, 95% CI:1.690–2.972). Conclusion Lower-income older adults had poorer HRQOL compared to their younger counterparts. This has important implications concerning intervention strategies that incorporate active ageing concepts on an individual and policy-making level to enhance the QOL and wellbeing, particularly among the older lower-income population.
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Gil-Lacruz M, Gil-Lacruz AI, Navarro-López J, Aguilar-Palacio I. Gender Gap in Self-Rated Health: A Cohort Perspective in Eastern European Countries. Healthcare (Basel) 2022; 10:healthcare10020365. [PMID: 35206979 PMCID: PMC8872258 DOI: 10.3390/healthcare10020365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The relationship between self-rated health and gender differs across countries and generations. The aim of this study is to analyze the effect of socioeconomic conditions on self-rated health from a generational perspective, its differential effect on gender, and its influence on the gender gap in order to explore health diversity using a multidisciplinary approach and considering policy implications in Eastern European countries. Methods: We used data drawn from the European Health Interview Survey for eight Eastern European countries and EUROSTAT from 2006 through to 2009. We conducted multilevel analyses to understand the individual and national health determinants of self-rated health by gender and to determine whether national differences remain after controlling for micro variables. In order to analyze the role of equity (Gini quartile) in gender differences, Oaxaca analyses were used. Results: The self-rated health gender gap increases with age. Individual characteristics, such as educational level or smoking, influence citizens’ perceived health, and have a stronger effect on women than on men. Knowing both the characteristics (endowment effects) and the effects of individual characteristics (coefficient effects) on health is important in order to understand gender gaps among people from the silent generation. Conclusions: Our research indicates that random effects are greater for men than for women. Moreover, random effects might be explained to a certain extent by economic equity (Gini index). The combined effects of gender, cohort, and geographical differences on self-rated health have to be taken into account to develop public health policies.
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Affiliation(s)
- Marta Gil-Lacruz
- Bienestar y Capital Social (BYCS), Department of Psychology and Sociology, Health Science Faculty, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence:
| | - Ana Isabel Gil-Lacruz
- Bienestar y Capital Social (BYCS), Department of Management, School of Engineering and Architecture, University of Zaragoza, 50018 Zaragoza, Spain;
| | - Jorge Navarro-López
- Grupo Decisión Multicriterio Zaragoza (GDMZ), Department of Applied Economics, Faculty of Economics and Business, University of Zaragoza, 50005 Zaragoza, Spain;
| | - Isabel Aguilar-Palacio
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), IIS Aragón, Department of Microbiology, Preventive Medicine and Public Health Medicine Faculty, University of Zaragoza, 50009 Zaragoza, Spain;
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Martikainen A, Svensson Alavi A, Alexanderson K, Farrants K. Associations of sickness absence and disability pension due to mental and somatic diagnoses when aged 60-64 with paid work after the standard retirement age; a prospective population-based cohort study in Sweden. BMC Public Health 2021; 21:2322. [PMID: 34969394 PMCID: PMC8717651 DOI: 10.1186/s12889-021-12382-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background The proportion of people working beyond age 65 is increasing. We aimed to explore whether sickness absence (SA) and disability pension (DP) due to mental, somatic, or both diagnoses when aged 60–64 were associated with being in paid work when aged 66–71. Methods This prospective population-based cohort study included all 98,551 individuals who in 2010 turned 65 years, lived in Sweden, and were in paid work at some point when aged 60–64. Data from three nationwide registers were used with 2010 as baseline, with SA or/and DP as the exposure variables (2005–2009) and paid work as the outcome variable (2011–2016). Logistic regression was conducted to calculate odds ratios (OR) with 95% confidence intervals (CI) for the association between exposures and outcome, controlling for sociodemographic factors. The analyses were also stratified by sex. Results Nearly half were in paid work during follow-up. Those with SA due to mental diagnoses had lower likelihood of being in paid work among both sexes (women OR: 0.76; 95% CI: 0.69–0.84; men 0.74; 0.65–0.84), while this association was smaller for SA due to somatic diagnoses (women 0.87; 0.84–0.91; men 0.92; 0.89–0.96). SA due to both mental and somatic diagnoses was associated with a lower likelihood of paid work for men (0.77; 0.65–0.91), but not women (0.98; 0.88–1.09). Regardless of diagnosis group and sex, DP had the strongest association with not being in paid work (women mental DP 0.39; 0.34–0.45; women somatic DP 0.38; 0.35–0.41; women mental and somatic DP 0.28; 0.15–0.56; men mental DP 0.36; 0.29–0.43; men somatic DP 0.35; 0.32–0.38; men mental and somatic DP 0.22; 0.10–0.51). Combined SA and/or DP demonstrated ORs in-between the diagnosis groups of SA and DP alone (e.g., mental SA and/or DP women and men combined 0.61; 0.57–0.65). Conclusions SA and DP were negatively associated with being in paid work after the standard retirement age of 65. The association was especially strong for DP, irrespective of diagnosis group. Moreover, compared to somatic diagnoses, SA due to mental diagnoses had a stronger association with not being in paid work. More knowledge is needed on how mental SA impedes extending working life.
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Affiliation(s)
- Aleksiina Martikainen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Alice Svensson Alavi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Kristin Farrants
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
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Carcaillon-Bentata L, Soullier N, Beltzer N, Coste J. Alteration in perceived health status of those aged 55 to 65 between 2010 and 2017 in France: role of socioeconomic determinants. BMC Public Health 2021; 21:1804. [PMID: 34620145 PMCID: PMC8499534 DOI: 10.1186/s12889-021-11774-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While life expectancy increases, it is necessary to evaluate whether the additional years are lived in good health, particularly in order to adapt the health care provision and social measures available to support these individuals. Since the 1990s, improvements in perceived health and capacities have been observed among older people, however the changes appear to be far less favourable among the working-age population and, in particular, the generation of people approaching retirement age. The aim of this study was to examine the change in the perceived health status of those aged 55 to 65 in France and investigate the role of socioeconomic factors in this change. METHODS Self-reported health (SRH), chronic condition and activity limitation were assessed in 2010 and in 2017 in the French Health Barometer, a general population phone survey conducted on over 25,000 persons living in the community. The prevalence of all three indicators in 2017, and their evolution between 2010 and 2017 were studied according to the main socioeconomic determinants. RESULTS Between 2010 and 2017, there was a sharp increase in the proportion of individuals aged 55-65 reporting poor SRH, chronic condition or activity limitation. A much more marked deterioration was observed in the three indicators among those aged 55-65 than in older age groups, as well as different changes according to socioeconomic determinants. The category of workers with an average level of education was particularly affected by the deterioration. CONCLUSIONS This study confirms that the generation approaching retirement age presents a more significant deterioration in health status than those of previous generations. The question of how these trends will be reflected in terms of the burden of dependency at later ages remains open and should encourage increased monitoring of and prevention among this population in future years.
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Affiliation(s)
| | - Noémie Soullier
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
| | - Nathalie Beltzer
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
| | - Joël Coste
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
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Sperlich S, Klar MK, Safieddine B, Tetzlaff F, Tetzlaff J, Geyer S. Life stage-specific trends in educational inequalities in health-related quality of life and self-rated health between 2002 and 2016 in Germany: findings from the German Socio-Economic Panel Study (GSOEP). BMJ Open 2021; 11:e042017. [PMID: 33664070 PMCID: PMC7934728 DOI: 10.1136/bmjopen-2020-042017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/30/2020] [Accepted: 01/21/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While evidence suggests persisting health inequalities, research on whether these trends may vary according to different stages of life has rarely been considered. Against this backdrop, we analysed life stage-specific trends in educational inequalities in health-related quality of life (HRQOL) and poor self-rated health (SRH) for individuals in 'later working life' (50-64 years), 'young seniors' (65-79 years) and persons of 'old age' (80+ years). METHODS We used survey data from the German Socio-Economic Panel Study comprising the period from 2002 to 2016. The sample consists of 26 074 respondents (160 888 person-years) aged 50 years and older. Health was assessed using the mental and physical component summary scale (MCS/PCS) of the HRQOL questionnaire (12-Item Short Form Health Survey V.2) and the single item SRH. To estimate educational health inequalities, we calculated the regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII). Time trends in inequalities were assessed by the inclusion of a two-way interaction term between school education and time. RESULTS With increasing age, educational inequalities in PCS and poor SRH decreased whereas they rose in MCS. Over time, health inequalities decreased in men aged 65-79 years (MCSSII=2.76, 95% CI 0.41 to 5.11; MCSRII=1.05, 95% CI 1.01 to 1.10; PCSSII=2.12, 95% CI -0.27to 4.51; PCSRII=1.05, 95% CI 1.00 to 1.11; poor SRHSII=-0.10, 95% CI -0.19 to 0.01; poor SRHRII=0.73, 95% CI 0.48 to 1.13) and among women of that age for MCS (MCSSII=2.82, 95% CI 0.16 to 5.50; MCSRII=1.06, 95% CI 1.01 to 1.12). In contrast, health inequalities widened in the 'later working life' among women (PCSSII=-2.98, 95% CI -4.86 to -1.11; PCSRII=0.94, 95% CI 0.90 to 0.98; poor SRHSII=0.07, 95% CI 0.00 to 0.14) while remained largely stable at old age for both genders. CONCLUSIONS We found distinctive patterns of health inequality trends depending on gender and life stage. Our findings suggest to adopt a differentiated view on health inequality trends and to pursue research that explores their underlying determinants.
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Affiliation(s)
| | | | | | - Fabian Tetzlaff
- Medical Sociology, Hannover Medical School, Hannover, Germany
| | | | - Siegfried Geyer
- Medical Sociology, Hannover Medical School, Hannover, Germany
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Klar MK, Geyer S, Safieddine B, Tetzlaff F, Tetzlaff J, Sperlich S. Trends in healthy life expectancy between 2002 and 2018 in Germany - Compression or expansion of health-related quality of life (HRQOL)? SSM Popul Health 2021; 13:100758. [PMID: 33732863 PMCID: PMC7937823 DOI: 10.1016/j.ssmph.2021.100758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/29/2021] [Accepted: 02/13/2021] [Indexed: 12/29/2022] Open
Abstract
The question of whether rising life expectancy has led to additional life years spent in good health or poor health is of major public health relevance. We tested the theories of compression or expansion of morbidity for Germany with respect to the mental and physical component summary scales (MCS/PCS) of the health-related quality of life (HRQOL) questionnaire (SF-12). Data of 90,758 women and 81,400 men were obtained from the German Socio-Economic Panel between 2002 and 2018. Linear and logistic regression analyses were applied to estimate temporal changes in MCS and PCS in different life stages. The development of healthy life expectancy (H-LE) expressed by life years without severe functional limitations was calculated by applying the Sullivan method. Overall, a significant increase of MCS and PCS was found in both genders. The rise was mainly due to declining proportions of severe limitations (norm values < 40 points) while the proportions of norm values > 60 points did not change substantially. Improvements were most apparent for the 'young seniors' (65-79 years) and at 'old age' (80 years +). In contrast, no improvements in PCS were found for 'later working life' (50-64 years) and decreasing levels were observed for persons of 'middle working age' (30-49 years). During the study period, H-LE at age 50 increased in women/men by 2.93/2.90 years (MCS) and 1.92/2.53 years (PCS), respectively. Our results support the hypothesis of absolute compression of morbidity. However, since consistent improvements were not found for ages below 65 years, it remains open to debate whether the positive health trend will also persist in the future. Our findings suggest that health promotion efforts should be strengthened for people of middle and later working age to support healthy aging.
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Affiliation(s)
| | - Siegfried Geyer
- Hannover Medical School, Medical Sociology, Hannover, Germany
| | | | - Fabian Tetzlaff
- Hannover Medical School, Medical Sociology, Hannover, Germany
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Mahajan S, Caraballo C, Lu Y, Massey D, Murugiah K, Annapureddy AR, Roy B, Riley C, Onuma O, Nunez-Smith M, Valero-Elizondo J, Forman HP, Nasir K, Herrin J, Krumholz HM. Racial and Ethnic Disparities in Health of Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.10.30.20223487. [PMID: 33173885 PMCID: PMC7654876 DOI: 10.1101/2020.10.30.20223487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Thirty-five years ago, the Heckler Report described health disparities among minority populations in the US. Since then, policies have been implemented to address these disparities. However, a recent evaluation of progress towards improving the health and health equity among US adults is lacking. OBJECTIVES To evaluate racial/ethnic disparities in the physical and mental health of US adults over the last 2 decades. DESIGN Cross-sectional. SETTING National Health Interview Survey data, years 1999-2018. PARTICIPANTS Adults aged 18-85 years. EXPOSURE Race/ethnicity subgroups (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic). MAIN OUTCOME AND MEASURES Proportion of adults reporting poor/fair health status, severe psychological distress, functional limitation, and insufficient sleep. We also estimated the gap between non-Hispanic White and the other subgroups for these four outcomes. RESULTS We included 596,355 adults (mean age 46 years, 51.8% women), of which 69.7%, 13.8%, 11.8% and 4.7% identified as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian, respectively. Between 1999 and 2018, Black individuals fared worse on most measures of health, with 18.7% (95% CI 17.1-20.4) and 41.1% (95% CI 38.7-43.5) reporting poor/fair health and insufficient sleep in 2018 compared with 11.1% (95% CI 10.5- 11.7) and 31.2% (95% CI 30.3-32.1) among White individuals. Notably, between 1999-2018, there was no significant decrease in the gap in poor/fair health status between White individuals and Black (-0.07% per year, 95% CI -0.16-0.01) and Hispanic (-0.03% per year, 95% CI -0.07- 0.02) individuals, and an increase in the gap in sleep between White individuals and Black (+0.2% per year, 95% CI 0.1-0.4) and Hispanic (+0.3% per year, 95% CI 0.1-0.4) individuals. Additionally, there was no significant decrease in adults reporting poor/fair health status and an increase in adults reporting severe psychological distress, functional limitation, and insufficient sleep. CONCLUSIONS AND RELEVANCE The marked racial/ethnic disparities in health of US adults have not improved over the last 20 years. Moreover, the self-perceived health of US adults worsened during this time. These findings highlight the need to re-examine the initiatives seeking to promote health equity and improve health.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Dorothy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Oyere Onuma
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Marcella Nunez-Smith
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, TX
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, TX
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
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Gholami A, Jahromi LM, Shams-Beyranvand M, Khazaee-Pool M, Naderimagham S, Mehrizi AA, Amirkalali B, Asadi-lari M. Household Food Insecurity and Health-related Quality of Life in an Urban Adult Population in Iran. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401315666191114142121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The relationship between food insecurity and mental and physical components of health-related quality of life (HRQOL) has been less addressed by healthcare professionals.
Objective:
We aimed to investigate the relationship between household food insecurity and mental
and physical components of HRQOL in a large sample of urban people and to determine whether
household food insecurity has a negative effect on mental and physical components of HRQOL.
Methods:
This cross-sectional study was conducted across twenty-two districts of Tehran (capital of
Iran) during 2011. The participants were selected through multistage cluster random sampling. Two
questionnaires were used to measure household food insecurity and HRQOL in the study population,
while descriptive and inferential statistics were applied to test the relationships between these two parameters.
Results:
The mean age of the study population was 44.5 ± 15.5 years and most were female (64.8%).
The results of this study indicated an independent relationship between household food insecurity
and different subscales of HRQOL (P<0.001). Household food insecurity had a significant negative
relationship with physical (β= -5.93; P<0.001) and mental (β= -6.54; P<0.001) summary scores of
HRQOL. Likewise, average scores on all subscales of HRQOL according to household food security
status were significantly different (P<0.001).
Conclusion:
Food insecurity was associated with mental and physical components of HRQOL
among urban participants and can be considered as a part of comprehensive interventions that target
to improve general health.
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Affiliation(s)
- Ali Gholami
- Department of Epidemiology & Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Leila M. Jahromi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Khazaee-Pool
- Department of Public Health, School of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shohreh Naderimagham
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali A.H. Mehrizi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Bahareh Amirkalali
- Gastrointestinal & Liver Disease Research Center (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-lari
- Oncopathology Research Centre, Iran University of Medical Sciences, Tehran, Iran
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Silveira ML, Dye BA, Iafolla TJ, Adesanya MR, Boroumand S, Youngblood ME, Salazar CR, Finlayson TL, Khambaty T, Beaver SM, Isabel Garcia A. Cultural factors and oral health-related quality of life among dentate adults: Hispanic community health study/study of Latinos. ETHNICITY & HEALTH 2020; 25:420-435. [PMID: 29343079 PMCID: PMC6148392 DOI: 10.1080/13557858.2018.1427219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 12/15/2017] [Indexed: 06/07/2023]
Abstract
Objective: Research on the relationships between acculturation, ethnic identity, and oral health-related quality of life (OHRQOL) among the U.S. Hispanic/Latino population is sparse. The aim of this study is to examine the association between acculturation, ethnic identity, and OHRQOL among 13,172 adults in the 2008-2011 Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Design: Participants self-reported their acculturation (immigrant generation, birthplace, residence in the U.S., language, and social acculturation), ethnic identity (sense of belonging and pride), and four OHRQOL measures. Key socio-demographic, behavioral, and oral health outcomes were tested as potential confounders.Results: Overall, 57% of individuals experienced poor OHRQOL in at least one of the domains examined. In multivariable analyses, some elements of higher acculturation were associated with greater food restriction and difficulty doing usual jobs/attending school, but not associated with pain or difficulty chewing, tasting, or swallowing. While sense of belonging to one's ethnic group was not associated with poor OHRQOL, low sense of pride was associated with food restriction. Socio-behavioral characteristics were significant effect modifiers.Conclusion: This study contributes to the understanding of the role of Hispanic/Latino's cultural factors in OHRQOL perception and can inform targeted strategies to improve OHRQOL in this diverse population.
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Affiliation(s)
- Marushka L. Silveira
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Bruce A. Dye
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Timothy J. Iafolla
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Margo R. Adesanya
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Shahdokht Boroumand
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Marston E. Youngblood
- University of North Carolina at Chapel Hill, Collaborative
Studies Coordinating Center, 123 West Franklin Street, Suite 450, Chapel Hill, NC
– 27516
| | - Christian R. Salazar
- Department of Epidemiology and Health Promotion, New York
University College of Dentistry, 433 1 Ave, 7 floor, New
York, NY 10010
| | - Tracy L. Finlayson
- San Diego State University, Graduate School of Public
Health, 5500 Campanile Drive, San Diego, CA – 92182-4162
| | - Tasneem Khambaty
- University of Maryland, Baltimore County (UMBC), Department
of Psychology, 1000 Hilltop Circle, Math/Psychology 326, Baltimore, MD 21250
| | - Shirley M Beaver
- University of Illinois at Chicago, College of Dentistry,
Department of Periodontics, 801 S. Paulina street, Chicago, IL – 60077
| | - A. Isabel Garcia
- University of Florida, College of Dentistry, Health Science
Center, Room D4-6B, 1395 Center Drive, Gainesville, FL – 32610
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Self-Rated Health: When and How to Use It in Studies Among Older People? INTERNATIONAL HANDBOOK OF HEALTH EXPECTANCIES 2020. [DOI: 10.1007/978-3-030-37668-0_12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Importance US life expectancy has not kept pace with that of other wealthy countries and is now decreasing. Objective To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends. Evidence Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined. Findings Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states. Conclusions and Relevance US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.
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Affiliation(s)
- Steven H Woolf
- Center on Society and Health, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond
| | - Heidi Schoomaker
- Center on Society and Health, Virginia Commonwealth University School of Medicine, Richmond
- Now with Eastern Virginia Medical School, Norfolk
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17
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Greaney ML, Cohen SA, Blissmer BJ, Earp JE, Xu F. Age-specific trends in health-related quality of life among US adults: findings from National Health and Nutrition Examination Survey, 2001–2016. Qual Life Res 2019; 28:3249-3257. [DOI: 10.1007/s11136-019-02280-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/15/2022]
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18
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Trends in good self-rated health in Germany between 1995 and 2014: do age and gender matter? Int J Public Health 2019; 64:921-933. [PMID: 30918976 DOI: 10.1007/s00038-019-01235-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study analyzes longitudinal trends in self-rated health (SRH) by taking age- and gender-specific differences into account. METHODS Data of 29,251 women and 26,967 men were obtained from the German Socio-Economic Panel between 1995 and 2014. Generalized Estimation Equation analysis for logistic regression was used to estimate changes in odds of (very) good SRH over time. Development of (un)healthy life expectancy was calculated by applying the Sullivan method. RESULTS While in women, the odds of good SRH increased significantly over time for the ages 41-50 to 71-80 years, improvements among men were most apparent for the ages 61-70 and 71-80 years. By contrast, for both genders, no improvements in SRH were found in the youngest (31-40 years) and eldest age group (81-90 years) and in men aging 51-60 years. Over time, healthy life expectancy at age 31 increased by 3 years in women and 2 years in men, leading to a reduced but not eliminated gender gap in SRH. CONCLUSIONS Our findings support the hypothesis of relative compression of morbidity. However, trends in SRH differed according to age and gender, calling for health promotion efforts that meet diverse needs at different stages of life.
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19
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Henchoz Y, von Gunten A, Büla C, Seematter-Bagnoud L, Nanchen D, Démonet JF, Blanco JM, Santos-Eggimann B. Do baby boomers feel healthier than earlier cohorts after retirement age? The Lausanne cohort Lc65+ study. BMJ Open 2019; 9:e025175. [PMID: 30782927 PMCID: PMC6368217 DOI: 10.1136/bmjopen-2018-025175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Despite the popular belief that baby boomers are ageing in better health than previous generations, limited scientific evidence is available since baby boomers have turned retirement age only recently. This study aimed to compare self-reported health status at ages 65-70 years among three cohorts of older people born before, during and at the end (baby boomers) of the Second World War. DESIGN Repeated cross-sectional population-based study. SETTING Community in a region of French-speaking Switzerland. PARTICIPANTS Community-dwelling older adults who enrolled in the Lausanne cohort 65+ study at ages 65-70 years in 2004 (n=1561), 2009 (n=1489) or 2014 (n=1678). OUTCOMES Number of self-reported chronic conditions (from a list of 11) and chronic symptoms (from a list of 11); depressive symptoms; self-rated health (very good, good, average, poor or very poor); fear of disease (not afraid at all, barely afraid, a bit afraid, quite afraid or very afraid); self-perception of ageing; disability in basic and instrumental activities of daily living. RESULTS There was no significant difference between cohorts in the number of self-reported chronic conditions and chronic symptoms as well as the presence of difficulty in basic activities of daily living, depressive symptoms, fear of disease and negative self-perception of ageing. In women only, significant differences between cohorts were observed in self-rated health (p=0.005) and disability in instrumental activities of daily living (p=0.003), but these associations did not remain significant in logistic regression models adjusted for sociodemographic characteristics and unhealthy behaviours. CONCLUSIONS Despite important sociodemographic differences between older baby boomers and earlier cohorts, most health indicators did not suggest any trend towards a compression of morbidity. Future studies comparing these three cohorts at more advanced age are required to further investigate whether differences emerge later in life.
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Affiliation(s)
- Yves Henchoz
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Armin von Gunten
- Service of Geriatric Psychiatry, Department of Psychiatry, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Francois Démonet
- Leenaards Memory Centre, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Juan-Manuel Blanco
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
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20
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Ethics and Well-Being: Ages 45-64: 70 is the New 50. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2019; 9:38-50. [PMID: 36819764 PMCID: PMC9930476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The age range 45-64 covers a life-stage when ideally, health status is reasonably manageable. However, this life-stage also poses health risks, which may lead to diseases, illnesses, dysfunctions, disabilities and early death. In fact, over the last three years, life expectancy among non-Hispanic white men has decreased. The opportunity to synergize ethics, health and well-being at the individual and group/community level is also highlighted. Various sphere of ethics and how they impact on individual, group/community well-being strategically, infuses ethics into health and health care conversations. Difficult term to operationalize like well-being, health, ethics and healing are deliberated. The phrase "70 is the new 50" reflects an importance opportunity to discuss what it means to be middle age and be healthy. There are health threats created by social and environment injustices and food deserts which are important considerations influencing health. The concept of Optimal Health, as a group strategy to advance health, particularly for people of African descent, details five group domains: optimal physical, emotional, social-economic, intellectual, and spiritual health. Optimal Health translated into individual behavior also has five health promotion principles that are detailed in the article. Synergizing Optimal Health, at the group/community level, with the five Health Promotion Principles, at the individual level, is the ideal journey toward individual and group/community well-being. Persons ages 45-64 are poised to combine the wisdom gained from their lived experiences, with the knowledge acquired from their positive or negative interfaces with the health delivery system, are generously available to achieve Optimal Health. The article concludes by discussing the Ancient African Imhotep, True Father of Medicine, 2980 B.C.E.
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Muennig PA, Reynolds M, Fink DS, Zafari Z, Geronimus AT. America's Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem. Am J Public Health 2018; 108:1626-1631. [PMID: 30252522 DOI: 10.2105/ajph.2018.304585] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Although recent declines in life expectancy among non-Hispanic Whites, coined "deaths of despair," grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America's health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites. To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity. We show that mortality increases among Whites caused by the opioid epidemic come on the heels of the crack and HIV syndemic among Blacks. Both occurred on top of already higher mortality rates among all Americans relative to people in other nations, and both occurred among declines in measures of well-being. We believe that the attention given to Whites is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans.
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Affiliation(s)
- Peter A Muennig
- Peter A. Muennig is with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Peter A. Muennig and Zafar Zafari are with the Global Research Analytics for Population Health Center, Mailman School of Public Health. Megan Reynolds is with the Department of Sociology, University of Utah, Salt Lake City. David S. Fink is with the Department of Epidemiology, Mailman School of Public Health. Arline T. Geronimus is with Health Behavior and Health Education, School of Public Health and the Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Megan Reynolds
- Peter A. Muennig is with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Peter A. Muennig and Zafar Zafari are with the Global Research Analytics for Population Health Center, Mailman School of Public Health. Megan Reynolds is with the Department of Sociology, University of Utah, Salt Lake City. David S. Fink is with the Department of Epidemiology, Mailman School of Public Health. Arline T. Geronimus is with Health Behavior and Health Education, School of Public Health and the Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - David S Fink
- Peter A. Muennig is with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Peter A. Muennig and Zafar Zafari are with the Global Research Analytics for Population Health Center, Mailman School of Public Health. Megan Reynolds is with the Department of Sociology, University of Utah, Salt Lake City. David S. Fink is with the Department of Epidemiology, Mailman School of Public Health. Arline T. Geronimus is with Health Behavior and Health Education, School of Public Health and the Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Zafar Zafari
- Peter A. Muennig is with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Peter A. Muennig and Zafar Zafari are with the Global Research Analytics for Population Health Center, Mailman School of Public Health. Megan Reynolds is with the Department of Sociology, University of Utah, Salt Lake City. David S. Fink is with the Department of Epidemiology, Mailman School of Public Health. Arline T. Geronimus is with Health Behavior and Health Education, School of Public Health and the Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Arline T Geronimus
- Peter A. Muennig is with the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY. Peter A. Muennig and Zafar Zafari are with the Global Research Analytics for Population Health Center, Mailman School of Public Health. Megan Reynolds is with the Department of Sociology, University of Utah, Salt Lake City. David S. Fink is with the Department of Epidemiology, Mailman School of Public Health. Arline T. Geronimus is with Health Behavior and Health Education, School of Public Health and the Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor
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22
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Choi M, Lee M, Lee MJ, Jung D. Physical activity, quality of life and successful ageing among community-dwelling older adults. Int Nurs Rev 2018; 64:396-404. [PMID: 28837231 DOI: 10.1111/inr.12397] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To identify the relationships between physical activity, quality of life and successful ageing among community-dwelling older adults in South Korea. BACKGROUND With increasing numbers of financially stable and active older adults, it has become imperative to understand successful ageing to promote well-being in this population. METHODS Questionnaire data were collected from senior welfare centres from August to November 2013. Participants were adults aged 65 years or older living in urban areas. Participants were asked to complete self-report questionnaires assessing physical activity, quality of life and successful ageing. Data from 212 participants were analysed using descriptive statistics, independent t-tests, ANOVAs with Scheffe tests and ordinary least square and quantile regression models using STATA 12.0. FINDINGS In the ordinary least square model, the association between physical activity and successful ageing was not statistically significant, whereas quantile regression revealed significant associations within the 75th and 90th percentiles of successful ageing scores. Quality of life was significantly associated with successful ageing in the ordinary least square model and with the median and 75th percentiles of successful ageing in quantile regressions. CONCLUSION Results suggested that physical activity and quality of life were both in part significantly associated with successful ageing among Korean older adults. IMPLICATIONS FOR NURSING AND HEALTH POLICIES Physical activity and quality of life play an important role in enhancing successful ageing. The development of an effective exercise programme advertised towards community-dwelling older adults may be essential for maintaining their successful ageing.
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Affiliation(s)
- M Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - M Lee
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - M-J Lee
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - D Jung
- College of Nursing, Ewha Womans University, Seoul, Korea
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Olfson M, Wall M, Liu SM, Schoenbaum M, Blanco C. Declining Health-Related Quality of Life in the U.S. Am J Prev Med 2018; 54:325-333. [PMID: 29338955 DOI: 10.1016/j.amepre.2017.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/26/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Despite recent declining mortality of the U.S. population from most leading causes, uncertainty exists over trends in health-related quality of life. METHODS The 2001-2002 and 2012-2013 National Epidemiologic Surveys on Alcohol and Related Conditions U.S. representative household surveys were analyzed for trends in health-related quality of life (n=79,402). Health-related quality of life was measured with the Short Form-6 Dimension scale derived from the Short Form-12. Changes in mean Short Form-6 Dimension ratings were attributed to changes in economic, social, substance abuse, mental, and medical risk factors. RESULTS Mean Short Form-6 Dimension ratings decreased from 0.820 (2001-2002) to 0.790 (2012-2013; p<0.0001). In regressions adjusted for age, sex, race/ethnicity, and education, variable proportions of this decline were attributable to medical (21.9%; obesity, cardiac disease, hypertension, arthritis, medical injury), economic (15.6%; financial crisis, job loss), substance use (15.3%; substance use disorder or marijuana use), mental health (13.1%; depression and anxiety disorders), and social (11.2%; partner, neighbor, or coworker problems) risks. In corresponding adjusted models, a larger percentage of the decline in Short Form-6 Dimension ratings of older adults (aged ≥55 years) was attributable to medical (35.3%) than substance use (7.4%) risk factors, whereas the reverse occurred for younger adults (aged 18-24 years; 5.7% and 19.7%) and adults aged 25-44 years (12.7% and 16.3%). CONCLUSIONS Between 2001-2002 and 2012-2013, there was a significant decline in average quality of life ratings of U.S. adults. The decline was partially attributed to increases in several modifiable risk factors, with medical disorders having a larger role than substance use disorders for older adults but the reverse for younger and middle-aged adults.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Michael Schoenbaum
- Office of Science Policy, Planning, and Communications, National Institute of Mental Health, NIH, Bethesda, Maryland
| | - Carlos Blanco
- National Institute on Drug Abuse, Division of Epidemiology, Services, and Prevention Research, Bethesda, Maryland
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Gamble S, Mawokomatanda T, Xu F, Chowdhury PP, Pierannunzi C, Flegel D, Garvin W, Town M. Surveillance for Certain Health Behaviors and Conditions Among States and Selected Local Areas - Behavioral Risk Factor Surveillance System, United States, 2013 and 2014. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2017; 66:1-144. [PMID: 28910267 PMCID: PMC5829867 DOI: 10.15585/mmwr.ss6616a1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PROBLEM Chronic diseases and conditions (e.g., heart diseases, stroke, arthritis, and diabetes) are the leading causes of morbidity and mortality in the United States. These conditions are costly to the U.S. economy, yet they are often preventable or controllable. Behavioral risk factors (e.g., excessive alcohol consumption, tobacco use, poor diet, frequent mental distress, and insufficient sleep) are linked to the leading causes of morbidity and mortality. Adopting positive health behaviors (e.g., staying physically active, quitting tobacco use, obtaining routine physical checkups, and checking blood pressure and cholesterol levels) can reduce morbidity and mortality from chronic diseases and conditions. Monitoring the health risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services at multilevel public health points (states, territories, and metropolitan and micropolitan statistical areas [MMSA]) can provide important information for development and evaluation of health intervention programs. REPORTING PERIOD 2013 and 2014. DESCRIPTION OF THE SYSTEM The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services and practices related to the leading causes of death and disability in the United States and participating territories. This is the first BRFSS report to include age-adjusted prevalence estimates. For 2013 and 2014, these age-adjusted prevalence estimates are presented for all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam, and selected MMSA. RESULTS Age-adjusted prevalence estimates of health status indicators, health care access and preventive practices, health risk behaviors, chronic diseases and conditions, and cardiovascular conditions vary by state, territory, and MMSA. Each set of proportions presented refers to the range of age-adjusted prevalence estimates of selected BRFSS measures as reported by survey respondents. The following are estimates for 2013. Adults reporting frequent mental distress: 7.7%-15.2% in states and territories and 6.3%-19.4% in MMSA. Adults with inadequate sleep: 27.6%-49.2% in states and territories and 26.5%-44.4% in MMSA. Adults aged 18-64 years having health care coverage: 66.9%-92.4% in states and territories and 60.5%-97.6% in MMSA. Adults identifying as current cigarette smokers: 10.1%-28.8% in states and territories and 6.1%-33.6% in MMSA. Adults reporting binge drinking during the past month: 10.5%-25.2% in states and territories and 7.2%-25.3% in MMSA. Adults with obesity: 21.0%-35.2% in states and territories and 12.1%-37.1% in MMSA. Adults aged ≥45 years with some form of arthritis: 30.6%-51.0% in states and territories and 27.6%-52.4% in MMSA. Adults aged ≥45 years who have had coronary heart disease: 7.4%-17.5% in states and territories and 6.2%-20.9% in MMSA. Adults aged ≥45 years who have had a stroke: 3.1%-7.5% in states and territories and 2.3%-9.4% in MMSA. Adults with high blood pressure: 25.2%-40.1% in states and territories and 22.2%-42.2% in MMSA. Adults with high blood cholesterol: 28.8%-38.4% in states and territories and 26.3%-39.6% in MMSA. The following are estimates for 2014. Adults reporting frequent physical distress: 7.8%-16.0% in states and territories and 6.2%-18.5% in MMSA. Women aged 21-65 years who had a Papanicolaou test during the past 3 years: 67.7%-87.8% in states and territories and 68.0%-94.3% in MMSA. Adults aged 50-75 years who received colorectal cancer screening on the basis of the 2008 U.S. Preventive Services Task Force recommendation: 42.8%-76.7% in states and territories and 49.1%-79.6% in MMSA. Adults with inadequate sleep: 28.4%-48.6% in states and territories and 25.4%-45.3% in MMSA. Adults reporting binge drinking during the past month: 10.7%-25.1% in states and territories and 6.7%-26.3% in MMSA. Adults aged ≥45 years who have had coronary heart disease: 8.0%-17.1% in states and territories and 7.6%-19.2% in MMSA. Adults aged ≥45 years with some form of arthritis: 31.2%-54.7% in states and territories and 28.4%-54.7% in MMSA. Adults with obesity: 21.0%-35.9% in states and territories and 19.7%-42.5% in MMSA. INTERPRETATION Prevalence of certain chronic diseases and conditions, health risk behaviors, and use of preventive health services varies among states, territories, and MMSA. The findings of this report highlight the need for continued monitoring of health status, health care access, health behaviors, and chronic diseases and conditions at state and local levels. PUBLIC HEALTH ACTION State and local health departments and agencies can continue to use BRFSS data to identify populations at risk for certain unhealthy behaviors and chronic diseases and conditions. Data also can be used to design, monitor, and evaluate public health programs at state and local levels.
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Affiliation(s)
- Sonya Gamble
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Tebitha Mawokomatanda
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Pranesh P. Chowdhury
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Carol Pierannunzi
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - William Garvin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Machell Town
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Põld M, Pärna K, Ringmets I. Trends in self-rated health and association with socioeconomic position in Estonia: data from cross-sectional studies in 1996-2014. Int J Equity Health 2016; 15:200. [PMID: 27931236 PMCID: PMC5146881 DOI: 10.1186/s12939-016-0491-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 12/01/2016] [Indexed: 01/09/2023] Open
Abstract
Background Self-rated health (SRH) and socioeconomic position (SEP) as important determinants of health differences are associated with health and economic changes in society. The objectives of this paper were (1) to describe trends in SRH and (2) to analyze associations between SRH and SEP among adults in Estonia in 1996–2014. Methods The study was based on a 25–64-year-old subsample (n = 18757) of postal cross-sectional surveys conducted every second year in Estonia during 1990–2014. SRH was measured using five-point scale and was dichotomized to good and less-than-good. Standardized prevalence of SRH was calculated for each study year. Poisson regression with likelihood ratio test was performed for testing trends of SRH over study years. Age, nationality, marital status, education, work status and income were used to determine SEP. Logistic regression analysis was used to assess association between SRH and SEP. Results The prevalence of dichotomized good self-rated health increased significantly over the whole study period with slight decrease in 2008–2010. Until 2002, good SRH was slightly more prevalent among men, but after that, among women. Good SRH was significantly associated with younger age, higher education and income and also with employment status among both, men and women. Good SRH was more prevalent among Estonian women and less prevalent among single men. Conclusions There was a definite increase of good SRH over two decades in Estonia following economic downturn between 2008 and 2010. Good SRH was associated with higher SEP over the study period. Further research is required to study the possible reasons behind increase of good SRH, and it’s association with SEP among adults in Estonia.
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Affiliation(s)
- Mariliis Põld
- Estonian Health Insurance Fund, Lastekodu 48, 10144, Tallinn, Estonia.
| | - Kersti Pärna
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Inge Ringmets
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411, Tartu, Estonia
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Muennig PA, Mohit B, Wu J, Jia H, Rosen Z. Cost Effectiveness of the Earned Income Tax Credit as a Health Policy Investment. Am J Prev Med 2016; 51:874-881. [PMID: 27614902 DOI: 10.1016/j.amepre.2016.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 05/24/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Lower-income Americans are suffering from declines in income, health, and longevity over time. Income and employment policies have been proposed as a potential non-medical solution to this problem. METHODS An interrupted time series analysis of state-level incremental supplements to the Earned Income Tax Credit (EITC) program was performed using data from 1993 to 2010 Behavioral Risk Factor Surveillance System surveys and state-level life expectancy. The cost effectiveness of state EITC supplements was estimated using a microsimulation model, which was run in 2015. RESULTS Supplemental EITC programs increased health-related quality of life and longevity among the poor. The program costs about $7,786/quality-adjusted life-year gained (95% CI=$4,100, $13,400) for the average recipient. This ratio increases with larger family sizes, costing roughly $14,261 (95% CI=$8,735, $19,716) for a family of three. CONCLUSIONS State supplements to EITC appear to be highly cost effective, but randomized trials are needed to confirm these findings.
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Affiliation(s)
- Peter A Muennig
- Mailman School of Public Health, Columbia University, New York, New York.
| | - Babak Mohit
- Mailman School of Public Health, Columbia University, New York, New York
| | - Jinjing Wu
- Mailman School of Public Health, Columbia University, New York, New York
| | - Haomiao Jia
- School of Nursing. Columbia University, New York, New York
| | - Zohn Rosen
- Mailman School of Public Health, Columbia University, New York, New York
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Goins RT, John R, Hennessy CH, Denny CH, Buchwald D. Determinants of Health-Related Quality of Life Among Older American Indians and Alaska Natives. J Appl Gerontol 2016. [DOI: 10.1177/0733464805283037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
During the past decade, health-related quality of life (HRQoL) has been recognized in both clinical and community health research as an important health outcome and a needed supplement to conventional health outcomes. The authors provide a profile of HRQoL and examine its determinants among American Indians and Alaska Natives aged 50 or older. Multivariate analyses of cross-sectional survey data from the 1996-1998 Centers for Disease Control Behavioral Risk Factor Surveillance System were conducted. Thirty-four percent of the sample reported fair or poor self-rated health. The mean number of poor health days in the past month ranged from 4 to 6 on different measures. Age, sex, education, annual household income, employment status, hypertension, and obesity were associated with aspects of HRQoL. Further research aimed at eliminating health disparities among this population should focus on identifying additional indicators of poor HRQoL and on understanding variables that mediate the relationship between disease and HRQoL.
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Affiliation(s)
| | - Robert John
- University of Oklahoma Health Sciences Center
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Quality of urban life among older adults in the world major metropolises: a cross-cultural comparative study. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16000957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThe concept of quality of urban life (QoUL) can be interpreted quite differently across different cultures. Little evidence has shown that the measure of QoUL, which is based on Western culture, can be applied to populations cross-culturally. In the current study, we use data from the 2006 Assessing Happiness and Competitiveness of World Major Metropolises study to identify underlying factors associated with QoUL as well as assess the consistency of the QoUL measurement among adults, aged 60 and older, in ten world major metropolises (i.e. New York City, Toronto, London, Paris, Milan, Berlin, Stockholm, Beijing, Tokyo and Seoul). Exploratory factor analysis and multiple-group confirmatory factor analysis (CFA) are used to analyse the data. Findings of the study suggest that the measure of QoUL is sensitive to socio-cultural differences. Community factor and intrapersonal factor are two underlying structures that are related to QoUL among older adults in ten metropolises cross-culturally. Results from the CFA indicate that Toronto is comparable with Beijing, New York City, Paris, Milan and Stockholm in QoUL, while other cities are not. The results provide insights into the development of current urban policy and promotion of quality of life among older residents in major metropolitan areas. Future researchers should continue to explore the relationship between QoUL and socio-cultural differences within international urban settings, while remaining cautious when making cross-cultural comparisons.
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Crews JE, Chou CF, Zack MM, Zhang X, Bullard KM, Morse AR, Saaddine JB. The Association of Health-Related Quality of Life with Severity of Visual Impairment among People Aged 40-64 Years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System. Ophthalmic Epidemiol 2016; 23:145-53. [PMID: 27159347 DOI: 10.3109/09286586.2016.1168851] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years. METHODS We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001). CONCLUSION Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years.
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Affiliation(s)
- John E Crews
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Chiu-Fang Chou
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Matthew M Zack
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Xinzhi Zhang
- b University of Alabama at Birmingham , Birmingham , AL , USA
| | - Kai McKeever Bullard
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | | | - Jinan B Saaddine
- a National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Altman CE, Van Hook J, Hillemeier M. What Does Self-rated Health Mean? Changes and Variations in the Association of Obesity with Objective and Subjective Components Of Self-rated Health. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:39-58. [PMID: 26811364 PMCID: PMC5191852 DOI: 10.1177/0022146515626218] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There are concerns about the meaning of self-rated health (SRH) and the factors individuals consider. To illustrate how SRH is contextualized, we examine how the obesity-SRH association varies across age, periods, and cohorts. We decompose SRH into subjective and objective components and use a mechanism-based age-period-cohort model approach with four decades (1970s to 2000s) and five birth cohorts of National Health and Nutrition Examination Survey data (N = 26,184). Obese adults rate their health more negatively than non-obese when using overall SRH with little variation by age, period, or cohort. However, when we decomposed SRH into objective and subjective components, the obesity gap widened with increasing age in objective SRH but narrowed in subjective SRH. Additionally, the gap narrowed for more recently born cohorts for objective SRH but widened for subjective SRH. The results provide indirect evidence that the relationship between obesity and SRH is socially patterned according to exposure to information about obesity and the availability of resources to manage it.
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Dong WL, Li YC, Wang ZQ, Jiang YY, Mao F, Qi L, Dong JQ, Wang LM. Self-rated health and health-related quality of life among Chinese residents, China, 2010. Health Qual Life Outcomes 2016; 14:5. [PMID: 26753922 PMCID: PMC4709902 DOI: 10.1186/s12955-016-0409-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 01/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-rated health (SRH) and health-related quality of life (HRQOL) are two outcome measures used to assess health status. However, little is known about population-based SRH and HRQOL in China. METHODS Data from the 2010 China Chronic Disease and Risk Factor Surveillance, a nationally representative sample of 98,658 adults (≥18-year-old) residing in China, were analyzed. SRH was assessed by asking "Would you say that, in general, your health is very good, good, general, poor, or very poor?" HRQOL was assessed by asking "For about how many days during the past 30 days was your health not good due to physical illnesses, injuries, or mental unhealthy?". RESULTS Overall, 6.3 % of participants rated their health as poor or very poor. The prevalence of poor/very poor health increased with advancing age ranging from 2.0 % in the 18-24 year-olds to 14.9 % in those ≥75 years-old, while it decreased with education levels from 13.0 % in illiterates/those with some primary school education to 2.2 % in college graduates or above. Additionally, women were more likely than men to rate their health as poor or very poor (7.2 % vs. 5.4 %). The reported rate of poor/very poor health was higher in western region residents compared to those in the east (7.4 % vs. 5.3 %). The mean numbers of self-reported physically unhealthy days, injury-caused unhealthy days, or mentally unhealthy days during the past 30 days were 1.48, 0.20, and 0.54, respectively. Older adults had more physically unhealthy days than the younger ones ranging from 2.92 days in those ≥ 75 year-old to 0.95 days in 18-24 year-olds. Women had more physically unhealthy days and mentally unhealthy days than men (1.72 vs. 1.23; 0.62 vs. 0.46, respectively). The highest mean number of physically unhealthy days (2.32) was reported by illiterates or those with some primary school education. The highest mean number of mentally unhealthy days (0.86) reported by college graduates or above. CONCLUSIONS Substantial variations existed in SRH and HRQOL among age groups, gender groups, education groups, and across regions in China. Considering these disparities will be important when developing health policies and allocating resources.
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Affiliation(s)
- Wen-Lan Dong
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China. .,Chinese Field Epidemiology Training Program, Beijing, 100050, People's Republic of China.
| | - Yi-Chong Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China.
| | - Zhuo-Qun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China.
| | - Ying-Ying Jiang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China.
| | - Fan Mao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China.
| | - Li Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China.
| | - Jian-Qun Dong
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China.
| | - Li-Min Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, 100050, People's Republic of China.
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Piatt JA, Van Puymbroeck M, Zahl M, Rosenbluth JP, Wells MS. Examining How the Perception of Health Can Impact Participation and Autonomy Among Adults with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2016; 22:165-172. [PMID: 29339858 PMCID: PMC4981011 DOI: 10.1310/sci2203-165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Studies examining participation as defined by the International Classification of Functioning, Disability and Health (ICF) as well as autonomy among the spinal cord injury population (SCI) are only starting to emerge. Little research has looked at how this population perceives their health status and the role this plays in active participation within their lives. Objective: This exploratory study was developed to determine whether the perception of health has an impact on participation and autonomy among adults with SCI. Methods: A convenience sample of adults with SCI currently receiving outpatient services from a rehabilitation hospital completed the online questionnaire. Forty-two subjects responded and were categorized into 2 groups: Group 1, positive perceived health, and Group 2, negative perceived health. The sample completed the Impact on Autonomy and Participation (IPA) that has 5 subscales (autonomy indoors, family role, autonomy outdoors, social life, and work/education) and demographic questions. Results: Multivariate analysis of variance (MANOVA) revealed that perceived health had a significant impact on family roles, autonomy outdoors, social life, and work/education. Perceived health did not have a significant impact on autonomy indoors. Conclusion: The perception of health may have an impact on participation and autonomy within the areas of family role, outdoors, work/education, and social life. Implications for rehabilitation are included.
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Yang SE, Park YG, Han K, Min JA, Kim SY. Dental pain related to quality of life and mental health in South Korean adults. PSYCHOL HEALTH MED 2015; 21:981-92. [PMID: 26456324 DOI: 10.1080/13548506.2015.1098781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
High levels of stress, anxiety and depression have been reported in patients with orofacial pain. Dental pain has the potential to reduce quality of life (QOL), and pain relief is important aspect of QOL. The purpose of this study was to assess the relationships of dental pain with QOL and mental health using a nationally representative, population-based study. This study analyzed data from the 2012 Korea National Health and Nutrition Examination Survey (N = 5469). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Health-related QOL (HRQOL) was evaluated using EQ-5D and EQ-VAS, and mental health was evaluated by questionnaires. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Among 5469 adults, 1992 (36.42%) presented self-reported dental pain. Participants with anxiety/depression or pain/discomfort, and participants with stress, melancholy, suicidal thought or depression showed significantly higher prevalence of dental pain. After adjusting for covariates, five aspects of QOL and five aspects of mental health were related with dental pain. The AORs (95% CI) for dental pain were 1.39 (1.06-1.81) for mobility, 1.77 (1.19-2.63) for self-care, 1.38 (1.02-1.85) for usual activities, 1.73 (1.43-2.09) for pain/discomfort and 1.50 (1.13-1.98) for anxiety/depression. For mental health status factors, the AORs (95% CI) for dental pain were 1.29 (1.11-1.51) for stress, 1.37 (1.09-1.74) for melancholy, 1.26 (1.01-1.58) for suicidal thoughts, 1.43 (.93-2.19) for consultation to psychiatrist and 1.53 (1.07-2.19) for depression. This study showed that dental pain has an association with lower HRQOL and worse mental health status in South Korean adults.
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Affiliation(s)
- Sung-Eun Yang
- a Department of Conservative Dentistry , Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Yong-Gyu Park
- b Department of Biostatistics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Kyungdo Han
- b Department of Biostatistics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Jung-Ah Min
- c Department of Psychiatry , Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Sin-Young Kim
- a Department of Conservative Dentistry , Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
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Lee H, Cho SH, Kim JH, Kim YK, Choo HI. [Influence of self efficacy, social support and sense of community on health-related quality of life for middle-aged and elderly residents living in a rural community]. J Korean Acad Nurs 2015; 44:608-16. [PMID: 25608539 DOI: 10.4040/jkan.2014.44.6.608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationship between self-efficacy, social support, sense of community and health-related quality of life (HRQoL), including the direct and indirect effects of the variables on HRQoL. METHODS A cross-sectional survey was conducted with a convenience sample of 249 middle-aged and elderly residents living in a rural community in A-County, K Province. The structured questionnaire included 4 scales from the Euro Quality of life-5 Dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), and measures of General Self-Efficacy, Social Support, and Sense of Community. Data were analyzed using SPSS WIN 20.0 and AMOS 21.0 program. RESULTS The mean HRQoL score for the participants was 0.87±0.13. Self-efficacy (β=.13, p=.039) and age (β= -.38, p<.001) were significantly associated with HRQoL, explaining 21% of the variance. In the path analysis, self-efficacy showed a significant direct effect on HRQoL (β=.14, p=.040) and significantly mediating relationships between both social support (β=.05, p=.030) and sense of community (β=.02, p=.025) and HRQoL. CONCLUSION Although self-efficacy was found to be the main predictor for HRQoL, the findings imply that social environmental factors such as social support and sense of community need to be considered when developing interventions to increase HRQoL in middle-aged and elderly residents in rural communities.
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Affiliation(s)
| | - Sung Hye Cho
- College of Nursing, Yonsei University, Seoul, Korea.
| | - Jung Hee Kim
- Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Yune Kyong Kim
- Department of Nursing, Masan University, Changwon, Korea
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A multilevel cross-lagged structural equation analysis for reciprocal relationship between social capital and health. Soc Sci Med 2015; 142:1-8. [DOI: 10.1016/j.socscimed.2015.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/28/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022]
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Mcbean AL, Schlosnagle L. Sleep, health and memory: comparing parents of typically developing children and parents of children with special health-care needs. J Sleep Res 2015; 25:78-87. [PMID: 26238150 DOI: 10.1111/jsr.12329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Amanda L. Mcbean
- The Center for Excellence in Disabilities; West Virginia University; Morgantown WV USA
| | - Leo Schlosnagle
- The Center for Excellence in Disabilities; West Virginia University; Morgantown WV USA
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Blue Bird Jernigan V, Peercy M, Branam D, Saunkeah B, Wharton D, Winkleby M, Lowe J, Salvatore AL, Dickerson D, Belcourt A, D'Amico E, Patten CA, Parker M, Duran B, Harris R, Buchwald D. Beyond health equity: achieving wellness within American Indian and Alaska Native communities. Am J Public Health 2015; 105 Suppl 3:S376-9. [PMID: 25905823 DOI: 10.2105/ajph.2014.302447] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Valarie Blue Bird Jernigan
- Valarie Blue Bird Jernigan and Alicia L. Salvatore are with the College of Public Health, University of Oklahoma Health Sciences Center, Tulsa. Michael Peercy and Bobby Saunkeah are with the Health Services Division, Chickasaw Nation of Oklahoma, Ada. Dannielle Branam and David Wharton are with the Health Services Division, Choctaw Nation of Oklahoma, Talihina. Marilyn Winkleby is with the Stanford Prevention Research Center, Stanford School of Medicine, Stanford, CA. John Lowe is with the Christine E. Lynn College of Nursing, Florida Atlantic University, Gainesville. Daniel Dickerson is with the Integrated Substance Abuse Programs, University of California School of Medicine, Los Angeles. Annie Belcourt is with the Department of Health Services, University of Montana, Missoula. Elizabeth D'Amico is with the RAND Corporation, Santa Monica, CA. Christi A. Patten is with the Mayo Clinic, Rochester, MN. Myra Parker and Bonnie Duran are with the Indigenous Wellness Research Institute, University of Washington, Seattle. Raymond Harris and Dedra Buchwald are with the Partnerships for Native Health, University of Washington
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Badley EM, Canizares M, Perruccio AV, Hogg-Johnson S, Gignac MAM. Benefits gained, benefits lost: comparing baby boomers to other generations in a longitudinal cohort study of self-rated health. Milbank Q 2015; 93:40-72. [PMID: 25752350 PMCID: PMC4364431 DOI: 10.1111/1468-0009.12105] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
UNLABELLED POLICY POINTS: Despite beliefs that baby boomers are healthier than previous generations, we found no evidence that the health of baby boomers is substantially different from that of the previous or succeeding cohorts. The effects of increased education, higher income, and lower smoking rates on improving self-rated health were nearly counterbalanced by the adverse effect of increasing body mass index (BMI). Assumptions that baby boomers will require less health care as they age because of better education, more prosperity, and less propensity to smoke may not be realized because of increases in obesity. CONTEXT Baby boomers are commonly believed to be healthier than the previous generation. Using self-rated health (SRH) as an indicator of health status, this study examines the effects of age, period, and birth cohort on the trajectory of health across 4 generations: World War II (born between 1935 and 1944), older baby boomers (born between 1945 and 1954), younger baby boomers (born between 1955 and 1964), and Generation X (born between 1965 and 1974). METHODS We analyzed Canada's longitudinal National Population Health Survey 1994-2010 (n = 8,570 at baseline), using multilevel growth models to estimate the age trajectory of SRH by cohort, accounting for period and incorporating the influence of changes in education, household income, smoking status, and body mass index (BMI) on SRH over time. FINDINGS SRH worsened with increasing age in all cohorts. Cohort differences in SRH were modest (p = 0.034), but there was a significant period effect (p = 0.002). We found marked cohort effects for increasing education, income, and BMI, and decreasing smoking from the youngest to the oldest cohorts, which were much reduced (education and smoking) or removed (income and BMI) once period was taken into account. At the population level, multivariable analysis showed the benefits of increasing education and income and declines in smoking on the trajectory of improving SRH were almost counterbalanced by the effects of increasing BMI (obesity). CONCLUSIONS We found no evidence to support the expectation that baby boomers will age more or less healthily than previous cohorts did. We also found that increasing BMI has likely undermined improvements in health that might have otherwise occurred, with possible implications for the need for health care. Period effects had a more profound effect than birth cohort effects. This suggests that interventions to improve health, such as reducing obesity, can be targeted to the entire, or a major portion of the, population and need not single out particular birth cohorts.
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Affiliation(s)
- Elizabeth M Badley
- Toronto Western Research Institute, University Health Network; Dalla Lana School of Public Health, University of Toronto
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Silva LS, Assunção AÁ. Health‐related quality of life and working conditions on public transport workers in the Metropolitan Region of Belo Horizonte, Brazil, 2012. J Occup Health 2015; 57:39-50. [DOI: 10.1539/joh.14-0049-oa] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Johansson SE, Midlöv P, Sundquist J, Sundquist K, Calling S. Longitudinal trends in good self-rated health: effects of age and birth cohort in a 25-year follow-up study in Sweden. Int J Public Health 2015; 60:363-73. [PMID: 25650292 DOI: 10.1007/s00038-015-0658-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/16/2015] [Accepted: 01/22/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Although average life expectancy has increased considerably in Sweden, there is less evidence for improved self-rated health (SRH). We analyzed longitudinal trends in SRH between 1980/1981 and 2004/2005 in age and birth cohort subgroups. METHODS 2,728 males and 2,770 females, aged 16-71 years, were interviewed every eighth year. Mixed models with random intercepts were used to estimate changes in SRH within different age groups and birth cohorts, adjusting for potential confounders. RESULTS During the 25-year follow-up, SRH improved in individuals aged ≥48 years, but became poorer or was unchanged in those aged 16-47 years. All birth cohorts showed poorer SRH with increasing age, with an adjusted odds ratio (95% confidence interval) of 0.94 (0.93-0.95) in males and 0.92 (0.91-0.93) in females. CONCLUSIONS While SRH in the older age groups improved, SRH became poorer in the youngest. Poorer SRH is deeply worrying for the affected individuals, and may also have a negative impact on the health care system. Although mental illness, socioeconomic factors, and lifestyle may be potential mechanisms, future studies are needed to investigate the reasons behind this trend.
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Affiliation(s)
- Sven-Erik Johansson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Levinson D, Kaplan G. What does Self Rated Mental Health Represent. J Public Health Res 2014; 3:287. [PMID: 25553310 PMCID: PMC4274494 DOI: 10.4081/jphr.2014.287] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 11/21/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unlike the widely used self rated health, the self rated mental health was found unsuitable as a proxy for mental illness. This paper analyses the relationships between the self ratings of physical health, mental health and overall health, and their association of with the objective indicators for physical and mental health. DESIGN AND METHODS The study is a secondary analysis of data from a nationwide representative sample of the non-institutionalized adult residents of Israel in 2003 that was collected via computer-assisted personal interview methods [n=4859]. RESULTS The self rated physical health and the self rated mental health were strongly related to each other yet the self rated mental health was not related to chronic physical conditions and the self rated physical health was not related to mental disorders. In a multiple logistic regression analysis, those with positive self rated mental health had 93 times the odds of reporting positive overall health whereas those with positive self rated physical health had 40 times the odds of reporting positive overall health. CONCLUSIONS The self rating of mental health presents a qualitatively different dimension from mental illness. The self rated mental health is two times more important than the self rated physical health in predicting the self rated overall health Significance for public healthThe present study is an original study on the self rated physical, mental and overall health measures. Because of the wide range of associations with other health indicators, and the simplicity with which they are collected, self-rated health measures are widely used in large population surveys.The present study questions the automatic assumption that the self rated mental health functions as a proxy measure of psychiatric morbidity, and suggests that the self rated mental health is more closely related to subjective well-being. The results show that self rated mental health predicts self rated general health better than self rated physical health.
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Affiliation(s)
| | - Giora Kaplan
- Certner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel
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Crews JE, Chou CF, Zhang X, Zack MM, Saaddine JB. Health-related quality of life among people aged ≥65 years with self-reported visual impairment: findings from the 2006-2010 behavioral risk factor surveillance system. Ophthalmic Epidemiol 2014; 21:287-96. [PMID: 24955821 PMCID: PMC4924345 DOI: 10.3109/09286586.2014.926556] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years. METHODS We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart attack, body mass index, leisure time activity, smoking, and medical care cost concerns) and comparing to those with no self-reported visual impairment, people reporting a little visual impairment were more likely to have fair/poor health (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1-1.3), life dissatisfaction (OR 1.6, 95% CI 1.3-2.0), and disability (OR 1.5, 95% CI 1.3-1.6), and those with self-reported moderate/severe visual impairment had more fair/poor health (OR 1.8, 95% CI 1.6-2.0), life dissatisfaction (OR 2.3, 95% CI 1.8-2.9), and disability (OR 2.0, 95% CI 1.8-2.2). They also had more frequent physically unhealthy days (OR 1.9, 95% CI 1.7-2.1), mentally unhealthy days (OR 1.8, 95% CI 1.5-2.1), and activity limitations days (OR 1.9, 95% CI 1.6-2.2). CONCLUSION Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years.
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Affiliation(s)
- John E Crews
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, GA , USA
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Audureau E, Rican S, Coste J. Worsening trends and increasing disparities in health-related quality of life: evidence from two French population-based cross-sectional surveys, 1995-2003. Qual Life Res 2014; 22:13-26. [PMID: 22298202 DOI: 10.1007/s11136-012-0117-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2012] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate time trends in health-related quality of life (HRQoL) in France and to report existing and changing demographic, socioeconomic, and geographic disparities. METHODS Data were drawn from two independent national cross-sectional surveys conducted in 1995 and 2003, including 3,243 individuals aged 18–84 in 1995 and 22,743 in 2003. HRQoL was measured with the 8 subscales of the French version of the SF-36. RESULTS After multiple linear regression, a significant decrease was observed between 1995 and 2003 in all scales scores, from −0.11 adjusted standard deviations for Social Functioning (95% CI: −0.15 to −0.08) to −0.23 for Vitality (−0.26 to −0.19). Increasing age, female gender, divorce/widowhood, lowest educational levels, chronic conditions, and living in the Northern region were identified as independent predictors of lower HRQoL scores. Testing interactions showed significantly greater differences between 1995 and 2003 for subjects aged 75–84 and for least educated subjects (Physical Functioning, General Health). The Gini index increased for all scales. CONCLUSIONS We report evidence of worsening trends and possibly increasing demographic, socioeconomic, and regional disparities in HRQoL between 1995 and 2003 in France. Monitoring HRQoL in populations can provide unique and sensitive data, complementary to classical indicators based on mortality and morbidity.
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Affiliation(s)
- Etienne Audureau
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, Nancy-Université, Université Paris-Descartes, Université Metz Paul Verlaine, Research Unit APEMAC, EA 4360, 1 place du Parvis Notre-Dame, 75181 Paris Cedex 4, France.
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Beck AN, Finch BK, Lin SF, Hummer RA, Masters RK. Racial disparities in self-rated health: trends, explanatory factors, and the changing role of socio-demographics. Soc Sci Med 2014; 104:163-77. [PMID: 24581075 PMCID: PMC4002582 DOI: 10.1016/j.socscimed.2013.11.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/07/2013] [Accepted: 11/12/2013] [Indexed: 11/18/2022]
Abstract
This paper uses data from the U.S. National Health Interview Surveys (N = 1,513,097) to describe and explain temporal patterns in black-white health disparities with models that simultaneously consider the unique effects of age, period, and cohort. First, we employ cross-classified random effects age-period-cohort (APC) models to document black-white disparities in self-rated health across temporal dimensions. Second, we use decomposition techniques to shed light on the extent to which socio-economic shifts in cohort composition explain the age and period adjusted racial health disparities across successive birth cohorts. Third, we examine the extent to which exogenous conditions at the time of birth help explain the racial disparities across successive cohorts. Results show that black-white disparities are wider among the pre-1935 cohorts for women, falling thereafter; disparities for men exhibit a similar pattern but exhibit narrowing among cohorts born earlier in the century. Differences in socioeconomic composition consistently contribute to racial health disparities across cohorts; notably, marital status differences by race emerge as an increasingly important explanatory factor in more recent cohorts for women whereas employment differences by race emerge as increasingly salient in more recent cohorts for men. Finally, our cohort characteristics models suggest that cohort economic conditions at the time of birth (percent large family, farm or Southern birth) help explain racial disparities in health for both men and women.
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Affiliation(s)
- Audrey N Beck
- San Diego State University, San Diego, CA 92123, USA.
| | | | - Shih-Fan Lin
- San Diego State University, San Diego, CA 92123, USA
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Schnittker J, Bacak V. The increasing predictive validity of self-rated health. PLoS One 2014; 9:e84933. [PMID: 24465452 PMCID: PMC3899056 DOI: 10.1371/journal.pone.0084933] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 11/20/2013] [Indexed: 11/18/2022] Open
Abstract
Using the 1980 to 2002 General Social Survey, a repeated cross-sectional study that has been linked to the National Death Index through 2008, this study examines the changing relationship between self-rated health and mortality. Research has established that self-rated health has exceptional predictive validity with respect to mortality, but this validity may be deteriorating in light of the rapid medicalization of seemingly superficial conditions and increasingly high expectations for good health. Yet the current study shows the validity of self-rated health is increasing over time. Individuals are apparently better at assessing their health in 2002 than they were in 1980 and, for this reason, the relationship between self-rated health and mortality is considerably stronger across all levels of self-rated health. Several potential mechanisms for this increase are explored. More schooling and more cognitive ability increase the predictive validity of self-rated health, but neither of these influences explains the growing association between self-rated health and mortality. The association is also invariant to changing causes of death, including a decline in accidental deaths, which are, by definition, unanticipated by the individual. Using data from the final two waves of data, we find suggestive evidence that exposure to more health information is the driving force, but we also show that the source of information is very important. For example, the relationship between self-rated health and mortality is smaller among those who use the internet to find health information than among those who do not.
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Affiliation(s)
- Jason Schnittker
- University of Pennsylvania, Department of Sociology, Philadelphia, Pennsylvania, United States of America
| | - Valerio Bacak
- University of Pennsylvania, Department of Sociology, Philadelphia, Pennsylvania, United States of America
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Lee JA, Kim SY, Kim Y, Oh J, Kim HJ, Jo DY, Kwon TG, Park JH. Comparison of Health-related Quality of Life Between Cancer Survivors Treated in Designated Cancer Centers and the General Public in Korea. Jpn J Clin Oncol 2013; 44:141-52. [DOI: 10.1093/jjco/hyt184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Objectives: This is the first analysis that demonstrates empirically the likely tie between activities (time spent) and disability (health-related difficulty in activities). We compare trends in activities and disability for Americans ages 55 to 69 in recent years, and assess cross-sectional linkages of activities and disability. Methods: Data are from the Health and Retirement Study, a longitudinal survey of community-dwelling U.S. adults. Trends are estimated by mixed-effects regression models (MRMs) with time, age, and time–age interaction predictors. Links of activities and disability also use MRM. Results: For midlife adults, hobbies/leisure and sports/exercise increased, repairs/yard decreased, and several activities had convex patterns; by contrast, disability prevalence was stable. Personal care hours rise with disability, but most activities decline. Discussion: Activities are more dynamic than disability, and time use is associated with disability. Taken together, the results encourage broader activities in disability measures to capture better disability’s scope and dynamics.
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Affiliation(s)
| | - Xian Liu
- DoD Deployment Health Clinical Center, Walter Reed National Military Medical Center, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Stewart ST, Cutler DM, Rosen AB. US trends in quality-adjusted life expectancy from 1987 to 2008: combining national surveys to more broadly track the health of the nation. Am J Public Health 2013; 103:e78-87. [PMID: 24028235 PMCID: PMC3828687 DOI: 10.2105/ajph.2013.301250] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used data from multiple national health surveys to systematically track the health of the US adult population. METHODS We estimated trends in quality-adjusted life expectancy (QALE) from 1987 to 2008 by using national mortality data combined with data on symptoms and impairments from the National Medical Expenditure Survey (1987), National Health Interview Survey (1987, 1994-1995, 1996), Medical Expenditure Panel Survey (1992, 1996, 2000-2008), National Nursing Home Survey (1985, 1995, and 1999), and Medicare Current Beneficiary Survey (1992, 1994-2008). We decomposed QALE into changes in life expectancy, impairments, symptoms, and smoking and body mass index. RESULTS Years of QALE increased overall and for all demographic groups-men, women, Whites, and Blacks-despite being slowed by increases in obesity and a rising prevalence of some symptoms and impairments. Overall QALE gains were large: 2.4 years at age 25 years and 1.7 years at age 65 years. CONCLUSIONS Understanding and consistently tracking the drivers of QALE change is central to informed policymaking. Harmonizing data from multiple national surveys is an important step in building this infrastructure.
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Affiliation(s)
- Susan T Stewart
- Susan T. Stewart is with the National Bureau of Economic Research (NBER), Cambridge, MA; she also performed this research in previous positions with the Harvard University Interfaculty Program for Health Systems Improvement (PHSI), and the Harvard Initiative for Global Health, Cambridge. David M. Cutler is with the Department of Economics, Harvard University, Harvard PHSI, and the NBER. Allison B. Rosen is with the Department of Quantitative Health Sciences and Meyer's Primary Care Institute, University of Massachusetts Medical School, Worcester, and the NBER
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Karcharnubarn R, Rees P, Gould M. Healthy life expectancy changes in Thailand, 2002-2007. Health Place 2013; 24:1-10. [PMID: 23999577 DOI: 10.1016/j.healthplace.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 07/19/2013] [Accepted: 08/01/2013] [Indexed: 11/16/2022]
Abstract
We investigate links between increasing longevity and health status in Thailand. Using data from 2002 and 2007 national surveys of the elderly, healthy life expectancies at older ages were estimated. Change depended on health indicator, gender and age. Self-reported health and self-care disability showed expansion of morbidity. Mobility disability change indicated compression but a wording change means this may be an artefact. We compare these findings with the 1990 and 2010 results of the Global Burden of Disease study. Using HLE based on disease prevalence, the GBD found that Thailand experienced small longevity gains and morbidity compression. Our findings suggest these results should be treated with caution, as, since 2000, Thailand has introduced universal health care.
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Affiliation(s)
- Rukchanok Karcharnubarn
- College of Population Studies, Chulalongkorn University, Visid Prachuabmoh Building, Bangkok 10330, Thailand.
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Jia H, Zack MM, Thompson WW, Dube SR. Quality-adjusted life expectancy (QALE) loss due to smoking in the United States. Qual Life Res 2013; 22:27-35. [PMID: 22350530 PMCID: PMC4590979 DOI: 10.1007/s11136-012-0118-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Estimate quality-adjusted life expectancy (QALE) loss due to smoking and examine trends and state differences in smoking-related QALE loss in the U.S. METHODS Population health-related quality of life (HRQOL) scores were estimated from the Behavioral Risk Factor Surveillance System. This study constructed life tables based on U.S. mortality files and the mortality linked National Health Interview Survey and calculated QALE for smokers, non-smokers, and the total population. RESULTS In 2009, an 18-year-old smoker was expected to have 43.5 (SE = 0.2) more years of QALE, and a non-smoker of the same age was expected to have 54.6 (SE = 0.2) more years of QALE. Therefore, smoking contributed 11.0 (SE = 0.2) years of QALE loss for smokers and 4.1 years (37%) of this loss resulted from reductions in HRQOL alone. At the population level, smoking was associated with 1.9 fewer years of QALE for U.S. adults throughout their lifetime, starting at age 18. CONCLUSIONS This study demonstrates an application of a recently developed QALE estimation methodology. The analyses show good precision and relatively small bias in estimating QALE--especially at the individual level. Although smokers may live longer today than before, they still have a high disease burden due to morbidities associated with poor HRQOL.
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, 617 West 168th Street, New York, NY 10032, USA.
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