Sociodemographics, self-rated health, and mortality in the US

The Concealment of Health Information at the Intersection of Sexual Orientation and Race

Purpose: Sexually and racially minoritized people often have mistrust toward the healthcare system due to both perceived and actual experiences of discrimination. This may result in increased privacy concerns and a reluctance to share health-related information with health care providers. Drawing upon minority stress and an intersectionality framework, this study examines how rates of concealing health information differ between non-Hispanic White heterosexual people, non-Hispanic White lesbian, gay, and bisexual (LGB) people, racially minoritized heterosexual people, and those who are both sexually and racially minoritized. Methods: Using nationally representative cross-sectional data from the Health Information National Trends Survey from 2017 and 2018 (n = 4575), we fit logistic regression models to examine (1) whether sexually and racially minoritized people conceal health information from their providers more than their counterparts and (2) whether this tendency increases for those with multiple marginalized identities. Furthermore, we fit linear regression models to examine whether and how concealing health information from providers are linked to health outcomes. Results: Sexually and racially minoritized people had higher odds of concealing health information from providers than their counterparts. Those with multiple marginalized identities had even higher odds of withholding health information than other groups. Finally, we found a significant negative association between concealing health information and mental health. Conclusion: Our findings underscore the need to consider how the intersection of multiple marginalized identities shape health experiences and concerns over privacy in health care matters. We call for further research to better understand the complex dynamics of patient-provider relationships for marginalized populations.

Longitudinal associations between socioeconomic position and overall health of children with chronic kidney disease and their carers

BACKGROUND

Disadvantaged socioeconomic position (SEP) is an important predictor of poor health in children with chronic kidney disease (CKD). The time course over which SEP influences the health of children with CKD and their carers is unknown.

METHODS

This prospective longitudinal study included 377 children, aged 6-18 years with CKD (stages I-V, dialysis, and transplant), and their primary carers. Mixed effects ordinal regression was performed to assess the association between SEP and carer-rated child health and carer self-rated health over a 4-year follow-up.

RESULTS

Adjusted for CKD stage, higher family household income (adjusted odds ratio (OR) (95% CI) 3.3, 1.8-6.0), employed status of primary carers (1.7, 0.9-3.0), higher carer-perceived financial status (2.6, 1.4-4.8), and carer home ownership (2.2, 1.2-4.0) were associated with better carer-rated child health. Household income also had a differential effect on the carer's self-rated health over time (p = 0.005). The predicted probabilities for carers' overall health being 'very good' among lower income groups at 0, 2, and 4 years were 0.43 (0.28-0.60), 0.34 (0.20-0.51), and 0.25 (0.12-0.44), respectively, and 0.81 (0.69-0.88), 0.84 (0.74-0.91), and 0.88 (0.76-0.94) for carers within the higher income group.

CONCLUSIONS

Carers and their children with CKD in higher SEP report better overall child and carer health compared with those in lower SEP. Carers of children with CKD in low-income households had poorer self-rated health compared with carers in higher-income households at baseline, and this worsened over time. These cumulative effects may contribute to health inequities between higher and lower SEP groups over time. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Self-rated health according to sex and associated factors in Manaus, Brazil, 2019: a population-based cross-sectional study

OBJECTIVE

To assess the prevalence and factors associated with poor self-rated health according to respondents' sex in Manaus, Brazil.

METHODS

This was a cross-sectional population-based study with adults in Manaus in 2019. Adjusted prevalence ratios and 95% confidence intervals (95%CI) were calculated using Poisson regression following a hierarchical model.

RESULTS

Poor self-rated health occurred in 35.2% (95%CI 33.3;37.2) of the 2,321 participants and was higher in females (PR = 1.27; 95%CI 1.13;1.43). In the general population, among both sexes, poor self-rated health was higher among the oldest, those with moderate and severe food insecurity and with chronic diseases (p-value < 0.05). Among females, poor health was also higher among the evangelical and those with mild food insecurity. Among males, self-rated health was also poorer among the retired and those with education below elementary level (p-value < 0.001).

CONCLUSION

The female sex had the poorest health rating, influenced by morbidity and access to food.

Self-rated health among adolescents from vulnerable areas and their sociodemographic, lifestyle and contextual factors: A multilevel analysis

PURPOSE

Understanding self-rated health in young people can help orient global health actions, especially in regions of social vulnerability. The present study analysed individual and contextual factors associated with self-rated health in a sample of Brazilian adolescents.

DESIGN AND METHODS

Cross-sectional data from 1272 adolescents (aged 11-17; 48.5% of girls) in low human development index (HDI) neighbourhoods were analysed (HDI from 0.170 to 0.491). The outcome variable was self-rated health. Independent variables relating to individual factors (biological sex, age and economic class) and lifestyle (physical activity, alcohol, tobacco consumption and nutritional state) were measured using standardised instruments. The socio-environmental variables were measured using neighbourhood registered data where the adolescents studied. Multilevel regression was used to estimate the regression coefficients and their 95% confidence intervals (CI).

RESULTS

Good self-rated health prevalence was of 72.2%. Being male (B: -0.165; CI: -0.250 to -0.081), age (B: -0.040; CI: -0.073 to -0.007), weekly duration of moderate to vigorous physical activity (B: 0.074; CI: 0.048-0.099), body mass index (B: -0.025; CI: -0.036 to -0.015), number of family healthcare teams in the neighbourhood (B: 0.019; CI: 0.006-0.033) and dengue incidence (B: -0.001; CI: -0.002; -0.000) were factors associated with self-rated health among students from vulnerable areas.

CONCLUSIONS/PRACTICAL IMPLICATIONS

Approximately three in every 10 adolescents in areas of social vulnerability presented poor self-rated health. This fact was associated with biological sex and age (individual factors), physical activity levels and BMI (lifestyle) and the number of family healthcare teams in the neighbourhood (contextual).

Perceived Racial/Ethnic Discrimination, Citizenship Status, and Self-Rated Health Among Immigrant Young Adults

Both racial/ethnic discrimination and citizenship status are manifestations of racism. Few empirical studies have examined the role of multiple stressors and how both stressors are interlinked to influence health among immigrant young adults. Informed by the theory of stress proliferation, the current study seeks to examine the interplay between perceived racial/ethnic discrimination and citizenship status on health. We used the third wave of the Children of Immigrants Longitudinal Study (CILS) to examine the influence of perceived racial/ethnic discrimination and citizenship status on self-rated health (SRH) among immigrant young adults (N = 3344). Perceived racial/ethnic discrimination was initially associated with SRH. After adjusting for both predictors, those experiencing perceived racial/ethnic discrimination and non-citizen youth were less likely to report better health than youth who did not report perceived racial/ethnic discrimination or citizen youth. In fully adjusted multivariate regression models, racial/ethnic discrimination remained significant, while citizenship status was no longer associated with SRH. To test stress proliferation, an interaction term was included to assess whether the relationship between perceived racial/ethnic discrimination and SRH varied by citizenship status. The interaction term was significant; non-citizen young adults who experienced racial/ethnic discrimination were less likely to report better health in comparison to citizen young adults and those who did not report perceived racial/ethnic discrimination. Results suggest that the interplay between perceived racial/ethnic discrimination and citizenship status may be influential for health among immigrant young adults. These findings underscore the need for further assessment of the role of stress proliferation on immigrant young adults' health.

Self-assessed health status and obesity vulnerability in rural Louisiana: A cross-sectional analysis

Rural communities are resource-constrained and at higher risk of obesity and obesity-related conditions. Thus, studying self-assessed health status and underlying vulnerabilities is critical to provide insights to the program planners for effective and efficient planning of obesity prevention programs. This study aims to investigate the correlates of self-assessed health status and subsequently determine the obesity vulnerability level of residents in rural communities. Randomly sampled data were obtained from in-person community surveys in three rural Louisiana counties-East Carroll, Saint Helena, and Tensas-in June 2021. The association of social-demographic factors, grocery store choice, and exercise frequency with self-assessed health was investigated using the ordered logit model. An obesity vulnerability index was constructed using the weights obtained from the principal component analysis. The results show that gender, race, education, possession of children, exercise frequency, and grocery store choice significantly influence self-assessed health status. Around 20% of respondents fall into the most-vulnerable segment and 65% of respondents are vulnerable to obesity. The obesity vulnerability index ranged from -4.036 to 4.565, indicating a wide heterogeneity in the vulnerability level of rural residents. The findings show that the self-assessed health status of rural residents is not promising along with a high level of vulnerability to obesity. The findings from this study could serve as a reference in the policy discussion regarding an effective and efficient suite of interventions in rural communities to address obesity and promote well-being.

The relationship between political efficacy and self-rated health: An analysis of Mexican, Puerto Rican, and Cuban subgroups compared to non-Latinx whites in the United States

Latinx represent a growing population in the United States (US) that continue to experience a disproportionate burden of disease. However, health disparities vary across Latinx subgroups, including Mexican, Puerto Rican, and Cuban communities, particularly when assessing self-rated health. Given the nature of political exclusion in the US, these differences may be associated with underexplored political factors, or political determinants of health, within the social environment that distinctly shape health among racial and ethnic minorities. To explore potential pathways that connect the political environment to individual-level health outcomes among Latinx subgroups, political efficacy (or one's perceptions about one's power to influence political affairs) was assessed as a correlate of self-rated health. We used secondary data from the 2016 Collaborative Multiracial Post-election Survey to conduct ordered logistic regression analysis to determine whether two domains of political efficacy, internal and external political efficacy, were correlates of self-rated health among Mexican, Puerto Rican, and Cuban subgroups as compared to non-Latinx whites in the US. We also tested for differential associations across Latinx subgroups as compared to non-Latinx whites. The sample consisted of 3156 respondents (1486 Mexicans, 484 Puerto Ricans, 159 Cubans and 1027 non-Latinx whites). Among Puerto Ricans, results revealed that lower levels of internal political efficacy were associated with higher levels of self-rated health. Conversely, among other subgroups, positive associations between internal political efficacy and self-rated health were observed. This study provides empirical evidence of a relationship between internal political perceptions and health perceptions that has not previously been established within the Latinx health disparities literature. Future investigations should continue to examine pathways that connect political determinants to individual-level health outcomes, particularly among communities that disproportionately experience political exclusion.

Pre- and Early Peri-menopausal Physical Function and Risk of Cardiovascular Events: The Study of Women's Health Across the Nation

OBJECTIVES

To determine whether physical function (PF) before menopause is related to cardiovascular disease (CVD) risk.

METHODS

Participants were N = 2950 pre-/early peri-menopausal women (median age 46, (25th-75th percentile: 43-48 years). Physical function was assessed at baseline using the Physical Function subscale of the SF-36 and scores were trichotomized (no, some, or substantial limitations). Clinical CVD events were ascertained at annual/biennial clinical assessments through the 15th follow-up visit. Risk of CVD was determined with Cox proportional hazards models. Results: Women were followed for a median of 19.1 years, during which 220 women had a CVD event. In fully adjusted models, women with substantial limitations at baseline had higher CVD risk compared to women with no limitations (hazards ratio [HR] = 1.55, 95% confidence interval [CI]: 1.12-2.33). Discussion: Substantial PF limitations in pre- and early peri-menopausal women are associated with higher risk of clinical CVD events, consistent with literature in older adults.

Racial disparities in visitation and health among older adults incarcerated in prison

OBJECTIVES

I sought to identify racial disparities in visitation and health between Non-White and White older adults incarcerated in prison and to examine the contribution of visitation to health among this vulnerable population.

METHODS

Descriptive and bivariate statistics were calculated to describe the cross-sectional sample and relationships between visitation and health. Independent t-tests, Chi-square tests, and effect sizes were used to identify racial disparities in measures of and relationships between visitation and health. Hierarchical multiple linear regression was used to examine the contribution of visitation to physical functioning, chronic disease, and mental health.

RESULTS

Older adults rated their physical functioning higher than their mental health. Over 70% of older adults received zero visits during their current incarceration (∼13 years) and White older adults received 10 times the number of visits than Non-White older adults. Increased visitation related to decreased physical functioning among Non-White older adults, a relationship distinct from that of White older adults (z=-3.14, p<.001) and visitation contributed to variation in older adults' mental health.

CONCLUSION

Future scholars are encouraged to examine factors associated with visitation and the quality of such visits for older adults. Further, visitation policies warrant amendment to increase visits and to enhance social support for older adults.

A study on the equity of self-rated health of older adults at the family level

BACKGROUND

The self-rated health of older adults (SHOA) plays an important role in enhancing their medical service utilization and quality of life. However, the determinants and magnitude variations in SHOA at the family level (SHOAFL) remain unknown. The purpose of this study was to assess the status and equitable level of SHOAFL in China, as well as to analyze the influencing factors and the precise nature and scope of their impacts.

METHODS

This study analyzed the data from the "Chinese residents' health service needs survey in the New Era", and included a total of 1413 families with older adults. The status and influencing factors of SHOAFL were analyzed using mean comparison and Logistic regression (LR) models. The Concentration Index method was used to explore the equity of the distribution of SHOAFL. The relationship between differences in personal characteristics among family members and differences in SHOA was determined by the method of Coupling Coordination Degree (CCD).

RESULTS

The total score of SHOAFL was 66.36 ± 15.47, and LR results revealed that the factors with a significant impact on SHOAFL were number of people living in family, distance to the nearest medical service institution, travel time to the nearest medical service institution, annual family income, yearly family medical and health expenditures, average age, and residence (all P < 0.05). The Concentration index of SHOAFL ranged from -0.0315 to 0.0560. CCD of the differences between SHOA and medical insurance and smoking status were 0.9534 and 0.7132, respectively.

CONCLUSION

The SHOAFL was found to be generally but more inclined towards urban families with high incomes and a short time to medical service institution. The observed disparities in SHOA among family members were mostly attributable to differences in health insurance and pre-retirement occupations. The status and equality of SHOAFL may be improved if policymakers prioritize making services more accessible to older rural residents with low incomes. Concurrently, reducing the existing discrepancy in health insurance coverage between older couples may also enhance their health.

The spiral of disadvantage: Ethnolinguistic discrimination, acculturative stress and health in Nahua indigenous communities in Mexico

OBJECTIVES

The aim of this study was to test the hypothesis that ethnic and ethnolinguistic discrimination, and Post-Traumatic Stress Disorder (PTSD) related to being Indigenous as well as different aspects of acculturative stress, are associated with poorer health and higher levels of depression among the Nahua Indigenous communities.

MATERIALS AND METHODS

Our quantitative survey was carried out in four different regions inhabited by the Nahua people in Mexico. Self-rated health and depression, the symptoms of PTSD, two facets of acculturative stress and ethnolinguistic discrimination were assessed by questionnaires. The data were analyzed using binary logistic regression models.

RESULTS

The symptoms of PTSD and acculturative stress experienced in the workplace were significantly associated with a higher risk of poor self-rated health, adjusted for various socio-demographic characteristics. Acculturative stress, discouragement of language use, language avoidance and ethnolinguistic discrimination were related to a higher risk of depression and PTSD.

DISCUSSION

Our research implies that ethnic and linguistic discrimination, acculturative stress and the memory of harm linked to being Indigenous reflected in the symptoms of PTSD, are important predictors of poorer health and depression among Nahua groups in Mexico. These adverse effects could be significantly counteracted by effective dealing with stigmatization and discrimination against Indigenous people in Mexico and by replacing strong assimilation pressures with integrational approaches that respect ethnolinguistic diversity and reduce socioeconomic marginalization.

Longitudinal Associations Between Loneliness and Self-Rated Health Among Black and White Older Adults

OBJECTIVES

This study examined the longitudinal association between loneliness and self-rated health (SRH), and whether there were race differences between non-Hispanic Black and White adults in these associations.

METHOD

A total of 1,407 participants were drawn Social Relations Study, a regional study of social relations across the life span with 3 waves of data collection in 1992, 2005, and 2015 (Wave 1, W1: Mage = 50.28, 28% Black, 59% women). Cross-lagged structural equation models examined the association between loneliness and SRH over 3 waves. We adjusted for baseline age, gender, social network size, and depressive symptoms.

RESULTS

There were no race differences in loneliness at any wave. Loneliness W1 was associated with Loneliness W2; Loneliness W2 was associated with Loneliness W3. We had similar findings for associations among SRH. However, only one of the cross-lagged paths was significant. Worse SRH W2 was associated with more Loneliness W3. The only path that varied across race was in the association between SRH W2 and Loneliness W3, and this path was significant only in Whites.

DISCUSSION

Findings indicate that worse SRH at later midlife may increase risk for loneliness in later life, particularly for Whites. As a valid indicator of health, SRH can be used in the body of research on health correlates of loneliness as adults age. Use of the current sample of Black and White adults provides nuanced understanding in the ways in which racially diverse adults experience loneliness and should be useful in refining and developing culturally competent interventions for older adults.

Social media links with social capital to trust in healthcare facilities: empirical evidence from Bangladesh

Purpose

The paper aims to investigate the most influential social media information sources to trust in healthcare facilities. The article shows a valuable point of reference for understanding how social media becomes the casting of social capital.

Design/methodology/approach

This paper has taken 660 responses from the people who used social media for healthcare information in the mid of 2020 during the pandemic. The people were approached through different social media groups. The paper conducted structural equation modelling (SEM). The result has shown that with the instigating power of social capital where people put trust in social media information during pandemics.

Findings

The findings demonstrated that personal sources, government organisations and healthcare professionals are the most influential sources of social media. In order to effectively ensure the encompassing provision of COVID-19 health services, this article argues that social capital considerations establish trust between healthcare facilities seeking community to healthcare information providers.

Research limitations/implications

This research has signified that social cohesion and concern for community welfare instigated people to engage in social media communication. The inherent social capital belongings influence people to trust the sources of health information from selected sources that appear on social media.

Practical implications

Healthcare policymakers may utilise this intense feeling of belongingness and cohesion of social capital and use social media platforms to spread health-related information.

Originality/value

The study shows social capital has the strength to entice people into healthcare-seeking behaviour. In this era, social capital is reformulated to digital social capital through social media and strongly affects people's trust.

The Mediation Effect of Perceived Attitudes toward Medical Service on the Association between Public Satisfaction with the Overall Medical Service and Self-Rated Health among the General Population in China: A Cross-Sectional Study

This study aimed to examine the association between public satisfaction with the overall medical service and individuals' self-rated health among 18,852 Chinese adults aged 16-60 years by using data from the 2018 China Family Panel Studies. We further test whether such an association is mediated by perceived attitudes toward the medical service. The logistic regression model is used to explore the association between public satisfaction with the overall medical service and individuals' self-rated health (SRH) outcomes. Mediation analysis was conducted by using the Karlson-Holm-Breen (KHB) method. We found that public satisfaction with the overall medical service was associated with good SRH. Additional results indicated that the association between public satisfaction with the overall medical service and SRH was significantly mediated by perceived attitudes toward the medical service. The degree of mediation is much larger for individuals' satisfaction with the level of medical expertise than for trusting in doctors, attitudes toward medical service problems, and the attitude toward the level of the hospital. Targeted medical policy interventions are designed to promote individuals' perceived attitudes toward the medical service, which might help to improve individuals' health benefits.

A test of the predictive validity of relative versus absolute income for self-reported health and well-being in the United States

BACKGROUND

A classic debate concerns whether absolute or relative income is more salient. Absolute values resources as constant across time and place while relative contextualizes one's hierarchical location in the distribution of a time and place.

OBJECTIVE

This study investigates specifically whether absolute income or relative income matters more for health and well-being.

METHODS

We exploit within-person, within-age, and within-time variation with higher-quality income measures and multiple health and well-being outcomes in the United States. Using the Panel Study of Income Dynamics and the Cross-National Equivalent File, we estimate three-way fixed effects models of self-rated health, poor health, psychological distress, and life satisfaction.

RESULTS

For all four outcomes, relative income has much larger standardized coefficients than absolute income. Robustly, the confidence intervals for relative income do not overlap with zero. By contrast, absolute income mostly has confidence intervals that overlap with zero, and its coefficient is occasionally signed in the wrong direction. A variety of robustness checks support these results.

CONCLUSIONS

Relative income has far greater predictive validity than absolute income for self-reported health and well-being.

CONTRIBUTION

Compared to earlier studies, this study provides a more rigorous comparison and test of the predictive validity of absolute and relative income that is uniquely conducted with data on the United States. This informs debates on income measurement, the sources of health and well-being, and inequalities generally. Plausibly, these results can guide any analysis that includes income in models.

Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles

BACKGROUND

A growing body of research suggests that financial difficulties could weaken the protective effects of socioeconomic status (SES) indicators, including education and income, on the health status of marginalized communities, such as African Americans.

AIM

We investigated the separate and joint effects of education, income, and financial difficulties on mental, physical, and oral self-rated health (SRH) outcomes in African American middle-aged and older adults.

METHODS

This cross-sectional study enrolled 150 middle-aged and older African Americans residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics (education, income, and financial difficulties), and self-rated health (mental, physical, and oral health) were collected. Three linear regression models were used to analyze the data.

RESULTS

Higher education and income were associated with a lower level of financial strain in a bivariate analysis. However, according to multivariable models, only financial difficulties were associated with poor mental, physical, and oral health. As similar patterns emerged for all three health outcomes, the risk associated with financial difficulties seems robust.

CONCLUSIONS

According to our multivariable models, financial strain is a more salient social determinant of health within African American communities than education and income in economically constrained urban environments such as South Los Angeles. While education and income lose some protective effects, financial strain continues to deteriorate the health of African American communities across domains.

Childhood deprivations predict late-life cognitive impairment among older adults in India

Large population-based studies on the associations of childhood factors with late-life cognition are lacking in many low and middle income countries including India. In this study, we assessed the prevalence of late-life cognitive impairment and examined the associations of childhood socioeconomic status (SES) and health conditions with cognitive impairment among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India conducted in 2017–18. The effective sample size was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five global domains (memory, orientation, arithmetic function, executive function, and object naming). The overall score ranged between 0 and 43, and the score was reversed indicating cognitive impairment. Descriptive statistics along with mean scores of cognitive impairment were presented. Additionally, moderated multivariable linear regression models were employed to examine the association between explanatory variables, including childhood SES and health conditions and late-life cognitive impairment. The mean score of cognitive functioning among the study participants was 21.72 (CI 2.64–21.80). About 15% of older adults had poor health conditions, and 44% had lower financial status during their childhood. Older adults who had a fair health during their childhood were more likely to suffer from cognitive impairment in comparison to older adults who had good health during their childhood (Coef: 0.60; CI 0.39, 0.81). In comparison to older adults who had good childhood financial status, those who had poor childhood financial status were more likely to suffer from cognitive impairment (Coef: 0.81; CI 0.56, 1.07). Older adults who had fair childhood health status and poor childhood financial status were more likely to suffer from cognitive impairment in comparison to older adults who had good childhood health and good financial status (Coef: 1.26; CI 0.86, 1.66). Social policies such as improving educational and financial resources in disadvantaged communities and socioeconomically poor children and their families, would help to enhance a better cognitive ageing and a healthy and dignified life in old age.

Neighborhood Disadvantage and Poor Health: The Consequences of Race, Gender, and Age among Young Adults

The objective of this study is to examine the relationship between neighborhood disadvantage and poor self-rated health for a nationally representative sample of Blacks and Whites in young adulthood, 18 to 30 years old. Data were from 16 waves (1997–2013) of the National Longitudinal Survey of Youth 1997 cohort (N = 6820 individuals; observations = 58,901). Utilizing the stress process model and generalized estimating equations to account for the correlated nature of multiple responses over time, results show that neighborhood disadvantage increases the odds of poor health for all groups. This positive association is strongest in the most disadvantaged neighborhoods and is heightened as young adults age. There are also notable race and gender differences. For example, Blacks, who live in the most highly disadvantaged neighborhoods, seem to be somewhat shielded from the most deleterious effects of poor neighborhood conditions compared to their White counterparts. Despite greater proportions of Blacks residing in harsh neighborhood environments, Black men experience better health than all other groups, and the health of Black women is no worse compared to White men or women. Limitations and directions for future research are discussed.

Predictive capacity of self-rated health on all-cause mortality in Spain: differences across sex, age and educational level

BACKGROUND

Published evidence on self-rated health's capacity to predict mortality and its variability across subpopulations lacks consistency. Our objective is to evaluate this predictive association and whether/how it varies by sex, age and educational attainment at the population level in Spain.

METHODS

Data came from a prospective longitudinal study based on 42 645 individuals aged ≥15 years who participated in the 2011-2012 and 2014 Spanish Health Surveys. Median follow-up time for mortality was 5.4 years. Cox proportional hazards models adjusted for sociodemographic, lifestyle and chronic disease variables were used to estimate the predictive capacity of self-rated health on mortality.

RESULTS

Self-rated health was associated with mortality with a dose-response effect (p value for linear trend <0.001). Compared with respondents who rated their health as very good, those rating it as very poor presented an HR of 3.33 (95% CI 2.50 to 4.44). Suboptimal self-rated health was a stronger predictor of mortality among 15-44 year-olds (HR 2.87; 95% CI 1.59 to 5.18), compared with the estimate for 45-64 year-olds (HR 1.86; 95% CI 1.45 to 2.39) (p value for interaction=0.001) and for those 65 and older (HR 1.51; 95% CI 1.36 to 1.68) (p value for interaction <0.001). Regarding educational attainment, the association was stronger for individuals with university studies (HR 2.51; 95% CI 1.67 to 3.76) than for those with only primary or no studies (HR 1.31; 95% CI 1.17 to 1.48) (p value for interaction=0.010). No statistically significant differences were observed between men and women.

CONCLUSIONS

Self-rated health may be considered a good predictor of all-cause mortality in the population of Spain, although the magnitude of this predictive association varies by age and educational level.

Exploring the most important factors related to self-perceived health among older men in Sweden: a cross-sectional study using machine learning

OBJECTIVE

To evaluate which factors are the most strongly related to self-perceived health among older men and describe the shape of the association between the related factors and self-perceived health using machine learning.

DESIGN AND SETTING

This is a cross-sectional study within the population-based VAScular and Chronic Obstructive Lung disease study (VASCOL) conducted in southern Sweden in 2019.

PARTICIPANTS

A total of 475 older men aged 73 years from the VASCOL dataset.

MEASURES

Self-perceived health was measured using the first item of the Short Form 12. An extreme gradient-boosting model was trained to classify self-perceived health as better (rated: excellent or very good) or worse (rated: fair or poor) using self-reported data on 19 prevalent physician-diagnosed health conditions, intensity of 9 symptoms and 9 demographic and lifestyle factors. Importance of factors was measured in SHapley Additive exPlanations absolute mean and higher scores correspond to greater importance.

RESULTS

The most important factors for classifying self-perceived health were: pain (0.629), sleep quality (0.595), breathlessness (0.549), fatigue (0.542) and depression (0.526). Health conditions ranked well below symptoms and lifestyle variables. Low levels of symptoms, good sleep quality, regular exercise, alcohol consumption and a body mass index between 22 and 28 were associated with better self-perceived health.

CONCLUSIONS

Symptoms are more strongly related to self-perceived health than health conditions, which suggests that the impacts of health conditions are mediated through symptoms, which could be important targets to improve self-perceived health. Machine learning offers a new way to assess composite constructs such as well-being or quality of life.

Self-rated health, socioeconomic status and all-cause mortality in Chinese middle-aged and elderly adults

Our study aims to investigate the association between SRH and all-cause mortality, and to investigate whether the SRH-mortality association varies across different socioeconomic status (SES) groups among middle-aged and older Chinese adults. We used data from China Health and Retirement Longitudinal Study (CHARLS), including 11,762 participants for the final analysis. Cox proportional hazards regression was conducted to investigate the association between SRH status and subsequent mortality. There were 724 death events occurred. The results were shown that fair/poor SRH participants tend to die than better SRH peers (HR 1.46, 95% CI 1.12–1.91). The association only occurred in those with rural residency (HR 1.46, 95% CI 1.05–2.04), those who were literate (HR 1.65, 95% CI 1.17–2.33), those with above-average household income (HR 1.95, 95% CI 1.15–3.29) and those working in agriculture and below (HR 1.38, 95% CI 1.02–1.88). In conclusion, worse SRH may be a predictor of all-cause mortality among middle-aged and elderly Chinese, especially in people with rural residency, literacy, above-average household income and working in agriculture and below.

Interrelationships between self reported physical health and health behaviors among healthy US adults: From the NHANES 2009-2016

Objectives

Individuals who engage in regular physical activity, consume a healthy diet, have a normal body mass index (BMI), as well as avoid smoking and heavy alcohol consumption have lower risks of morbidity and mortality. While self-reported health is a strong predictor of morbidity and mortality, data are sparse about the interrelationship of concurrent healthy behaviors and self-reported health.

Study design

Cross-sectional study design.

Methods

The sample included 7,267 individuals aged 30-50 years without diabetes, heart failure, cancer, myocardial infarction, stroke and emphysema from 2009 to 2016 of the National Health and Nutrition Examination Survey (NHANES). We used latent class analyses to identify concurrent healthy behaviors and explore interrelationships of class membership with self-reported health after adjusting for covariates using SAS® 9.4 software.

Results

Two mutually exclusive classes were found, "fewer healthy behaviors" and "more healthy behaviors". "Fewer healthy behaviors" class members were less adherent to healthy guidelines while "more healthy behaviors" class members were more adherent. The two classes varied by smoking status, diet, and physical activity but not by BMI or alcohol consumption. Individuals in the "more healthy behaviors" class were associated with self-assessments of good (OR: 2.08; 95% CI: 1.15-3.79), very good (OR: 3.22; 95% CI: 1.78-3.79) and excellent (OR: 4.09; 95% CI: 2.11-7.94) health compared to those in the "fewer healthy behavior" class.

Conclusions

We revealed two mutual exclusive classes with differing patterns of healthy behavior adherence. The class of individuals with more concurrent healthy behavior recommendations were more likely to self-assess their health more favorably.

The Relative Contribution of Social Determinants of Health Among Health Resources and Services Administration-Funded Health Centers

Frameworks for identifying and assessing social determinants of health (SDOH) are effective for developing long-term societal policies to promote health and well-being, but may be less applicable in clinical settings. The authors compared the relative contribution of a specific set of SDOH indicators with several measures of health status among patients served by health centers (HCs). The 2014 Health Center Patient Survey was used to identify a sample of HC patient adults 18 years and older that reported the HC as their usual source of care (n = 5024). The authors examined the relationship between SDOH indicators organized in categories (health behaviors, access and utilization, social factors, economic factors, quality of care, physical environment) with health status measures (fair or poor health, diabetes, hypertension, cardiovascular disease, depression, or anxiety) using logistic regressions and predicted probabilities. Findings indicated that access to care and utilization indicators had the greatest relative contribution to all health status measures, but the relative contribution of other SDOH indicators varied. For example, access indicators had the highest predicted probability in the model with fair or poor health as the dependent variable (72.4%) and the model with hypertension as the dependent variable (47.4%). However, the second highest predicted probability was for social indicators (54.1%) in the former model and physical environment (44.7%) indicators in the latter model. These findings have implications for HCs that serve as the primary point of access to medical care in underserved communities and to mitigate SDOH particularly for patients with diabetes, depression, or anxiety.

Self-Rated Health and Socioeconomic Status in Old Age: The Role of Gender and the Moderating Effect of Time and Welfare Regime in Europe

Research has shown that health status and self-rated health (SRH) are correlated not only with age and gender but also with socioeconomic determinants, such as income, education, and employment status, in the course of life and in late life. Much less investigated, however, are gender differences in the association between socioeconomic factors and SRH and how the connection differs among the European welfare state regimes. This study examines the association between SRH and socioeconomic status in later life and in relation to gender and welfare state regime characteristics. Using SHARE data, it builds an analytical sample of respondents aged 60–70 (1275 men, 1544 women) who participated in Wave 1 and, ten years later, in Wave 6. The analysis regresses SRH by gender on socioeconomic status, controlling for various sociodemographic, health, and socioeconomic variables, as well as welfare regime indicators, at two points in time. Past health variables are also controlled for in order to evaluate their effect on SRH at the time of the investigation. A significant gender gap in SRH is found from childhood to late life. The association of socioeconomic status with poorer SRH is significant over time and within welfare state regimes. Consequently, the relationship between gender and SRH, and the extent to which it varies by socioeconomic position, does appear to differ across welfare state regimes. In all regimes and all points in time, including retrospective childhood SRH, women report poorer health than men. The analysis underscores the association between SRH and socioeconomic status in relation to gender in late life and finds that it correlates differently for men and women. The odds of women experiencing poorer SRH are higher, although they become more moderate over time. Even under the most egalitarian welfare regimes, gender differences in the nexus of SRH and socioeconomic status do not favor women.

Effects of Serving as a State Functionary on Self-Rated Health: Empirical Evidence From China

Purpose

There is a strong link between occupation and self-rated health. Existing research has revealed the effects of occupation on self-rated health outcomes and the corresponding mechanisms. However, there is a lack of research on the effects of state services on self-rated health in China. Therefore, this study focuses on exploring the effects of serving as a state functionary in China on self-rated health to enrich research in related fields.

Method

Based on the data of 14,138 individuals collected from the 2016 China Labour-Force Dynamics Survey, the logit model was used to investigate the effects of serving as a state functionary on self-rated health and the difference in the effects across different populations.

Results

The results show that (1) serving as a state functionary has a significant positive effect on self-rated health; (2) self-rated health of elderly state functionaries is higher than that of younger state functionaries; (3) self-rated health of state functionaries in non-eastern regions is higher than that of state functionaries in eastern regions; and (4) state functionaries with lower education have higher self-rated health than highly-educated state functionaries; (5) Higher self-rated health of state functionaries is achieved primarily through better work time, better work environment and lower relative deprivation.

Conclusion

Serving as a state functionary in China has a significant positive correlation with self-rated health, with differences across populations of state functionaries. This study expands the current literature on the effects of occupation on self-rated health in the context of China.

Autoavaliação ruim do estado de saúde: prevalência e fatores associados em mulheres privadas de liberdade

Resumo Objetivo Verificar a prevalência da autoavaliação ruim do estado de saúde em mulheres encarceradas e analisar os fatores associados. Método Trata-se de estudo transversal, realizado entre os anos de 2019 e 2020, por meio de censo, com participação de 99 mulheres. A análise dos fatores associados ao desfecho foi conduzida a partir de um modelo teórico de determinação com três blocos hierarquizados de variáveis. As variáveis foram ajustadas entre si dentro de cada bloco. Aquelas com nível de significância ≤ 0,20 foram incluídas no modelo de regressão de Poisson e ajustadas ao nível superior ao seu, considerando o nível de 5% de significância. Resultados A prevalência da autoavaliação ruim da saúde foi de 31,3% (IC95% = 22,8%–40,9%). Morbidade referida, presença de sintomas de ansiedade e a pior perspectiva em relação às condições de saúde pós-encarceramento foram as variáveis associadas com o desfecho. Considerações finais e implicações para a prática Os fatores associados à ocorrência do evento investigado poderão direcionar medidas que visem à redução dos impactos à saúde durante o período de encarceramento.

The Prospective Association of Patient Hospitalization with Spouse Depressive Symptoms and Self-Reported Heath

After hospital discharge, patients experience a period of generalized risk for adverse mental and physical health outcomes (post-hospital syndrome [PHS]). Hospital stressors can explain these effects in patients (e.g., sleep disruption, deconditioning). Patients' partners also experience adverse outcomes following patient hospitalization, but mechanisms of these effects are unknown. The purpose of this study was to test whether greater times and nights of patient hospitalization (proxies for partner exposure to hospital stressors) are prospectively associated with greater increases in partner depression and in partner self-reported poor health. Participants were 7,490 married couples (11,208 individuals) enrolled in the Health and Retirement Study. Outcomes were prospective changes in depressive symptoms and self-reported poor health, and primary predictors were spouse hospitalization over the past two years (yes/no), spouse hospitalized ≥ two times (yes/no), and spouse spent ≥ eight nights in-hospital (yes/no). Covariates included age, gender, race, ethnicity, income, own hospitalization experiences during the past 12 months, and one's own and spouse comorbidities. Having a spouse who experienced two or more hospitalizations was associated with an increase in one's own depression over time, as was having a spouse who spent eight or more nights in-hospital. Spouse hospitalization was not associated with prospective changes in self-reported health. Results suggest that PHS mechanisms may account for adverse post-hospitalization outcomes in patients' partners.

Association between socioeconomic status and academic performance in children and adolescents with chronic kidney disease

BACKGROUND

Lower socioeconomic status (SES) is associated with lower academic achievement; however, this relationship is understudied in children with chronic kidney disease (CKD). This study examined the relationship between SES and academic performance in children and adolescents with CKD.

METHODS

A total of 377 participants aged 6-18 years with CKD stages 1-5 (n = 199), on dialysis (n = 43) or with a kidney transplant (n = 135) were recruited. Five SES measures and a composite SES index were examined for associations with parent-rated average or above average academic performance in numeracy and literacy using multivariable logistic regression.

RESULTS

Participants' median age was 12.6 years (IQR 8.9-15.5). Adjusted odds ratios (aOR) (95%CI) for better performance in numeracy and literacy, respectively, were 0.71 (0.44-1.15) and 0.75 (0.45-1.23) for children whose caregivers had lower educational attainment; 0.46 (0.26-0.80) and 0.53 (0.30-0.93) for lower household income; 0.52 (0.32-0.85) and 0.44 (0.26-0.73) for caregivers who were unemployed; 0.68 (0.41-1.12) and 0.59 (0.35-1.00) for caregivers with poor self-rated financial status; and 0.93 (0.53-1.64) and 1.00 (0.56-1.79) for caregivers who did not own their own home. Compared with the highest SES index quartile, the aORs for better performance by SES quartile in descending order were 1.24 (0.60-2.54), 0.76 (0.37-1.58), and 0.39 (0.18-0.86) for numeracy and 0.88 (0.41-1.85), 0.77 (0.35-1.66), and 0.32 (0.14-0.72) for literacy. No interactions were identified between SES and CKD stage, child age, or gender.

CONCLUSIONS

Across all CKD stages, children from lower SES families are less likely to perform well in literacy and numeracy than those from higher SES households. A higher resolution version of the Graphical abstract is available as Supplementary information.

Nonlinear Associations between Medical Expenditure, Perceived Medical Attitude, and Sociodemographics, and Older Adults’ Self-Rated Health in China: Applying the Extreme Gradient Boosting Model

Background: although China’s total health expenditure has been dramatically increased so that the country can cope with its aging population, inequalities among individuals in terms of their medical expenditures (relative to their income level) have exacerbated health problems among older adults. This study aims to examine the nonlinear associations between each of medical expenditure, perceived medical attitude, and sociodemographics, and older adults’ self-rated health (SRH); it does so by using data from the 2018 China Family Panel Studies survey. Method: we used the extreme gradient boosting model to explore the nonlinear association between various factors and older adults’ SRH outcomes. We then conducted partial dependence plots to examine the threshold effects of each factor on older adults’ SRH. Results: older adults’ medical expenditure exceeded their overall income. Body mass index (BMI) and personal health expenditure play an essential role in predicting older adults’ SRH outcomes. We found older adult age, physical exercise status, and residential location to be robust predictors of SRH outcomes in older adults. Partial dependence plots of the results visualized the nonlinear association between variables and the threshold effects of factors on older adults’ SRH outcomes. Conclusions: findings from this study underscore the importance of medical expenditure, perceived medical attitudes, and BMI as important predictors of health benefits in older adults. The potential threshold effects of medical expenditure on older adults’ SRH outcomes provide a better understanding of the formation of appropriate medical policy interventions by balancing the government and personal medical expenditure to promote health benefits among older adults.

What influences individual perception of health? Using machine learning to disentangle self-perceived health

Self-perceived health is a subjective health outcome that summarizes all the health conditions and is widely used in population health studies. Yet, despite its well-known relationship with survival, it is still unclear as to which health conditions are actually taken into account when making an individual assessment of one's own health. The aim of this paper is to assess the influence of four objective health conditions - IADLs, ADLs, chronic diseases, and depression - in predicting self-perceived health among Europeans by age group (50-64 and 65-79) and by sex. Classification trees (J48 algorithm), which pertains to the emerging Machine Learning techniques, were applied to predict self-perceived health according to the four abovementioned objective health conditions of European individuals in the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 55,611). The four variables present different degrees of relevance in establishing predictions of self-perceived health values by age and by sex. Before the age of 65, chronic diseases have the greatest importance, while IADL limitations are more important in the 65-79 age group. Likewise, ADL limitations are more important for women free of chronic diseases in the 50-64 age group; however, these differences disappear among women in the older group. There is an evident degree of interplay between the objective health indicators of chronic diseases, ADLs, IADLs, and depression when predicting self-perceived health with a high level of accuracy. This interplay implies that self-perceived health summarizes different health conditions depending on age. Gender differences are only evident for the younger age group, whereas construction of self-perceived is the same for women and men among the older group. Therefore, none of these four indicators on its own is able to totally substitute self-perceived health.

The Health Impact of Household Cooking Fuel Choice on Women: Evidence from China

In order to achieve sustainable development, the world is experiencing a profound energy transition from traditional biomass through fossil fuel to clean and renewable energy. As women are the primary undertakers of cooking in developing countries, they are more vulnerable to household air pollution caused by solid fuel combustion. Although women can benefit from clean fuel switching for household cooking, its influence on women’s health is still not well understood. Using the longitudinal data from China Family Panel Studies in 2014 and 2018, this study adopts panel data models to investigate the impact of household cooking fuel choice on women’s health from multiple dimensions in China, including self-rated health, others-rated health, and instrumental activities of daily living, aiming at shedding light on energy transition and health improvement for developing countries. It is found that household cooking fuel switching from solid fuel to clean fuel improves women’s self-rated and others-rated health but has no significant impact on women’s abilities of independence in daily activities. Specifically, each level of household cooking fuel increases respondents’ self-rated and others-rated health by 0.009 and 0.043, respectively. Moreover, further investigation of the impact of household cooking fuel switching on the health status of women from different groups found: (1) the health effect of clean cooking fuel switching on women aged 46 and above is more significant than that on women aged 45 and below, (2) there are significant differences between urban and rural areas in the impact of household cooking fuel switching on women’s health, and (3) uneducated women benefit more than educated women from clean cooking fuel switching. Finally, this study provides some policy implications to promote the energy transition and improve women’s health in China and other developing countries.

Utilisation of community care services and self-rated health among elderly population in China: a survey-based analysis with propensity score matching method

Background

Elderly care and elderly health are the enormous challenges in such an aging society as China. Community care services have been developing rapidly in recent years in China as an increasingly mainstream care resource to promote elderly health. The purpose of this study is to examine the association between using community care services and self-rated health among Chinese elderly.

Methods

A cross-sectional survey was conducted in 2019 and 612 elderly people from China’s Shaanxi province were enrolled. The binary logistic regression was first employed to explore the association between community care services utilisation and elderly health. Given the potential selection bias issue, the propensity score matching method was hired to generate comparable samples between participants who used these services and participants who didn’t, and further examine the health benefits of using four types of services.

Results

The results of the binary logistic regression showed that the use of community care services predicted a better health status of elderly individuals. Overall, the results of the propensity score matching method showed the similar results. Specifically, with the nearest neighbors matching algorithm, using daily care services was significantly associated with a 0.246 increase in the self-rated health of the elderly (T = 1.83). For medical care services, the mean of self-rated health of elderly individuals who used these services was 3.542, significantly higher than those who didn’t (T = 2.15). For spiritual comfort services, elderly individuals using these services showed a significant increase by 0.280 in the self-rated health (T = 1.82). For social and recreational services, the result of the nearest neighbor matching method was not statistically significant, while the results of kernel matching method and the mahalanobis matching method showed a significant increase in the self-rated health among elderly individuals using these services (T = 2.03, T = 2.03, respectively). All the estimated results passed the Rosenbaum bounds analysis and were not sensitive to hidden bias.

Conclusions

Using community care services improved the self-rated health of the elderly. More effective measures may be implemented to increase access to care resources for senior citizens, and further improve their health status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11989-x.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

Area- and Individual-Level Correlates of Self-Rated Health: Implications for Geographic Health Disparities

BACKGROUND

Self-rated health (SRH) is a common measure of overall health. However, little is known about multilevel correlates of physical and mental SRH.

METHODS

Patients attending primary care clinics completed a survey before their appointment, which we linked to community data from American Community Survey and other sources (n = 455). We conducted multilevel logistic regression to assess correlates of excellent/very good versus good/fair/poor physical and mental SRH.

RESULTS

43.9% of participants had excellent/very good physical SRH, and 55.2% had excellent/very good mental SRH. Physical SRH was associated with age (odds ratio[OR] = 0.82 per 10 years; 95% confidence interval[CI] = 0.72-0.93) and community correlates, including retail establishment density (OR = 0.94, 95% CI = 0.90-0.99) and percent of students eligible for free/reduced lunch (OR = 1.60, 95% CI = 1.08-2.38) (all P < .05). Mental SRH was not associated with any characteristics.

CONCLUSIONS

Practitioners in public health, social work, and medicine could use zip codes to intervene in patients and communities to improve physical SRH.

Trajectories of Subjective Health: Testing Longitudinal Models for Self-rated Health From Adolescence to Midlife

Self-rated health (SRH) is ubiquitous in population health research. It is one of the few consistent health measures in longitudinal studies. Yet, extant research offers little guidance on its longitudinal trajectory. The literature on SRH suggests several possibilities, including SRH as (1) a more fixed, longer-term view of past, present, and anticipated health; (2) a spontaneous assessment at the time of the survey; (3) a result of lagged effects from prior responses; (4) a function of life course processes; and (5) a combination of the preceding. Different perspectives suggest different longitudinal models, but evidence is lacking about which model best captures SRH trajectory. Using data from the National Longitudinal Study of Adolescent to Adult Health and the National Longitudinal Survey of Youth, we employ structural equation modeling to correct for measurement error and identify the best-fitting, theoretically guided models describing SRH trajectories. Results support a hybrid model that combines the lagged effect of SRH with the enduring perspectives, fitted with a type of autoregressive latent trajectory (ALT) model. This model structure consistently outperforms other commonly used models and underscores the importance of accounting for lagged effects combined with time-invariant effects in longitudinal studies of SRH. Interestingly, comparisons of this latent, time-invariant autoregressive model across gender and racial/ethnic groups suggest that there are differences in starting points but less variability in SRH trajectories from early life into adulthood.

Are long-term care jobs harmful? Evidence from Germany

Like many OECD countries, Germany is currently facing a shortage of long-term care (LTC) workers. This situation is concerning in the context of the ageing of the German population. A potential reason why Germany fails to recruit and retain LTC workers is that LTC jobs are particularly demanding (physical and psychological strain) which may be harmful to health. However, there is a lack of empirical evidence demonstrating this effect. This article fills the gap in the literature by exploring to what extent LTC jobs reduce workers' health over time. We estimate a dynamic panel data model on the German Socio-Economic Panel (v.35; 1984-2018), which allows adressing selection issues into occupations. Our paper provides innovative findings on the impact of LTC occupations on workers' health. We confirm that LTC jobs have a negative impact on self-reported health. Our results have strong policy implications: we emphasize the need to provide sufficient assistance to LTC workers, who are at risk of facing more health issues than other workers. This issue is key to increase the attractiveness of LTC jobs and reduce turnover in the LTC workforce.

Subjective Successful Aging: Measurement Invariance Across 12-Years

BACKGROUND AND OBJECTIVES

Debates about how to define successful aging have dominated gerontology for over 60 years. Regardless of how successful aging is conceptualized, in order to accurately understand how the construct changes over time and how it differs between people of varying ages, successful aging must be measured with instruments that are valid, reliable, and have measurement invariance. These analyses focus on subjective successful aging and examine the extent to which a reliable, valid, three-item scale has measurement invariance across 12-years for individuals aged 50-86.

RESEARCH DESIGN AND METHODS

We analyzed five waves of data collected from a panel of 5,688 community-dwelling people aged 50-74 when recruited in 2006. We tested measurement invariance using the four nested steps delineated by Widaman and Reiss (1997), introducing increasing parameter constraints at each step. Analyses were conducted using Mplus 7.

RESULTS

Analyses revealed that the three-item scale measuring subjective successful aging has adequate measurement invariance across time. We demonstrated that the scale has configural, metric, and scalar invariance by most standard metrics. Only residual invariance was not supported. However, because residuals are not part of the latent factor, invariance of the item residuals is inconsequential to interpretation of latent mean differences.

DISCUSSION AND IMPLICATIONS

Findings provide the foundation needed for researchers to examine change in subjective successful aging over time, differences in subjective successful aging between people of varying ages, and predictors of subjective successful aging, confident that the scale has adequate measurement invariance.

White and Black Differences in Perceived Access to Health and Community Services and Self-Rated Health in an Age-Friendly Community Assessment

OBJECTIVES

This study sought to identify the race differences in perceived access to health and community services and self-rated health (SRH) among White and Black older adult participants of an age-friendly community assessment.

METHODS

Responses (n = 313) to a baseline assessment of Columbus, Ohio, residents aged ≥50 years were analyzed.

RESULTS

Significant differences were found between White and Black older adults regarding SRH, with Black older adults reporting lower SRH. Black older adults reported significantly lower perceived access to 11 out of the 13 health and community services. There were no significant differences by race regarding ratings of Columbus and personal neighborhoods as a place for people to live as they age. Regression analyses found income was a significant predictor of SRH for both White and Black older adults.

DISCUSSION

Opportunities to increase perceived access and knowledge of health and community services for older adults through targeted, equitable interventions are warranted.

Impact of self-assessed health status and physical and functional limitations on healthcare utilization and mortality among older cancer survivors in US

PURPOSE

The purpose of this study was to examine the impact of physical limitations, functional limitations and self-assessed health status on mortality and healthcare utilization among older cancer survivors.

METHODS

National Medicare Current Beneficiary Survey (MCBS) cost and use data from 2008 to 2013 were used for analysis. Physical limitations, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) were assessed on multiple questions, and self-assessed health was measured on a five-point scale (1-5: Excellent-Poor). Multivariable logistic regression and Poisson regression models were used for hospitalization, re-hospitalization and mortality rates based on three follow up years.

RESULTS

This study included 17,715 cancer patients with a mean age of 75 years and 57% females. Cancer survivors with poor self-assessed health had a higher rate of hospitalizations (adjusted Odds Ratio: aOR: 1.60, 95% Confidence Interval: CI: 1.47-1.72, p < 0.001) relative to non-cancer participants. Compared to participants with no history of cancer, cancer survivors with IADL (aOR: 1.41, 95% CI: 1.25-1.58, p < 0.001) or with poor self-assessed health (aOR: 1.39, 95% CI: 1.21-1.60, p < 0.001) were more likely to have a higher number of hospital readmissions within 30 days of a prior hospitalization. Three-year mortality rate was significantly higher among cancer survivors with poor self-assessed health (Hazard Ratio: 2.81, 95% CI: 2.81-2.82, p < 0.001).

CONCLUSION

Self-assessed health and physical and functional limitations significantly and independently impact healthcare utilization and mortality among older cancer survivors. Healthcare providers should incorporate formal assessments of both self-assessed health and functional status among older cancer survivors in their clinical practice.

IMPLICATION FOR CANCER SURVIVORS

Self-reported health status is a valuable and independent predictor of healthcare utilization and mortality among cancer survivors.

Comparing the Self-Reported Health, Happiness, and Marital Happiness of a Multinational Sample of Consensually Non-Monogamous Adults with Those of the U.S. General Population: Additional Comparisons by Gender, Number of Sexual Partners, Frequency of Sex, and Marital Status

The primary objective of this cross-sectional study was to examine the associations of self-reported health, happiness, marital happiness, frequency of sexual activity, and number of partners from a multinational survey of individuals who are consensually non-monogamous (CNM) or open to being CNM, completed in 2012 with 4062 respondents. We compared data from this survey with the 2010-2014 US General Social Surveys (GSS). This study explored these variables and their predictors by gender (including 612 non-binary-gendered CNM individuals), marital status, number of partners, sexual frequency, age, education, and income and were broken down by behavioral sexual orientation, marital status, and other relevant categories. Respondents in our CNM sample generally reported being as healthy (sometimes healthier; e.g., all respondents M-W Z = 7.66, p < .001, η² = 0.007), happy (frequently happier; e.g., multiple-partnered Z = 15.43, p < .001, η² = 0.069), happy in their marriages (in some cases happier; e.g., multiple-partnered females Z = 2.61, p = .009, η² = 0.067), and reported having more frequent sexual activity (e.g., all Z = 29.54, p < .001, η² = 0.094) with more partners (e.g., all Z = 60.75, p < .001, η² = 0.393) compared to corresponding individuals within the GSS. This study contributes to knowledge about commonalities and differences between the general population and those who are CNM regarding health, happiness, and happiness in marriage, including differences in optimal number of sexual partners and sexual frequency.

Subjective health in adolescence: Comparing the reliability of contemporaneous, retrospective, and proxy reports of overall health

Self-rated health (SRH) is one of the most important social science measures of health. Yet its measurement properties remain poorly understood. Most studies ignore the measurement error in SRH despite the bias resulting from even random measurement error. Our goal is to estimate the measurement reliability of SRH in contemporaneous, retrospective, and proxy indicators. We use the National Longitudinal Study of Adolescent to Adult Health to estimate the reliability of SRH relative to proxy assessments and respondents' recollections of past health. Even the best indicators - contemporaneous self-reports - have a modest reliability of ~0.6; retrospective and proxy assessments fare much worse, with reliability less than 0.2. Moreover, not correcting for measurement error in SRH leads to a ~20-40% reduction in its correlation with other measures of health. Researchers should be skeptical of analyses that treat these subjective reports as explanatory variables and fail to take account of their substantial measurement error.

Help me quit smoking but don't make me sick! The controversial effects of electronic cigarettes on tobacco smokers

Despite its increasing use, little is known about the effect of electronic cigarette. This study estimates the impact of the use of electronic cigarettes on tobacco smoking and health among tobacco smokers, using French panel data derived from the Health, Health Care, and Insurance Survey for 2010-2014. We use a difference-in-differences propensity score matching approach to identify the effect of electronic cigarette use on a sample of 982 smokers. We show that the use of electronic cigarettes increases the probability of quitting smoking and reduces the number of regular cigarettes smoked per day. However, we also find evidence that electronic cigarette users have a higher probability of reporting poor health status and suffering from a chronic disease compared with those who only smoke regular cigarettes. Overall, our results do not support the use of electronic cigarettes for tobacco smokers.

The Roles of Marital Dissolution and Subsequent Repartnering on Loneliness in Later Life

OBJECTIVES

Loneliness in later life is associated with poorer health and higher risk of mortality. Our study assesses whether gray divorced adults report higher levels of loneliness than the widowed and whether social support or repartnership offset loneliness.

METHOD

Using data from the 2010 and 2012 Health and Retirement Study, we estimated ordinary least squares regression models for women (n = 2,362) and men (n = 1,127) to examine differences in loneliness by dissolution pathway (i.e., divorce versus widowhood), accounting for social support and repartnership.

RESULTS

Divorced men were lonelier than their widowed counterparts. Although social support reduced loneliness among men, the difference between the divorced and widowed persisted. Repartnership assuaged men's loneliness and reduced the variation between divorced and widowed men. Among women, the results did not reveal differences in loneliness for the divorced and widowed although social support and repartnership linked to less loneliness.

DISCUSSION

Later-life marital dissolutions increasingly occur through divorce rather than spousal death. Some older adults go on to form new partnerships. Our findings demonstrate the importance of gerontological research widening the lens beyond widowhood to consider the ramifications of later-life divorce and repartnership for well-being.

Self-Rated Health by Sexual Orientation Among Middle-Aged and Older Adults in Canada

OBJECTIVES

This article examines patterns of self-rated physical and mental health by sexual orientation among middle-aged and older adults in Canada, a rapidly growing subpopulation shown to be at risk of poor health.

METHOD

We use the Canadian Community Health Survey (CCHS 2015-2016) to estimate logit models predicting fair/poor self-rated physical and mental health by sexual orientation among middle-aged and older adults, stratifying by sex and age group.

RESULTS

We find no differences in physical health for gay men and lesbian women compared with their heterosexual counterparts. However, middle-aged gay men are disadvantaged in terms of mental health, but not women. Bisexual women are disadvantaged in terms of physical health, and for mental health in some model specifications. Respondents who did not know their sexual orientation have poorer health across some measures of health and age groups.

DISCUSSION

Our findings add to the paucity of research on older sexual minorities in Canada. They highlight the importance of separating out sexual minority groups because bisexual women have distinct health profiles. In addition, this is the first study to examine the health of respondents who "do not know" their sexual orientation, and future research should distinguish between different explanations for their poor health.

Self-rated health status in relation to aircraft noise exposure, noise annoyance or noise sensitivity: the results of a cross-sectional study in France

BACKGROUND

Noise is a major public health issue because of its negative impacts on health, including annoyance, sleep disturbance, cardiovascular diseases and altered cognitive performance among children. Self-rated health status (SRHS) can be considered as a reliable indicator of quality of life, morbidity and mortality but few studies have considered SRHS in relation to aircraft noise exposure. The present study aims to investigate the association between this exposure and SRHS of people living near airports in France, and to consider the mediating or moderating role of aircraft noise annoyance and noise sensitivity in this association.

METHODS

This cross-sectional study included 1242 participants older than 18 and living near three major French airports. Information on their SRHS, aircraft noise annoyance, noise sensitivity and demographic, socioeconomic and lifestyle factors was collected during a face-to-face interview performed at home. Outdoor aircraft noise levels were estimated for each participant's home address using noise maps. Logistic regressions with adjustment for potential confounders were used. The moderating and mediating effects of aircraft noise annoyance and noise sensitivity were investigated following Baron and Kenny's recommendations.

RESULTS

A significant association was shown between aircraft noise levels and a fair/poor SRHS, only in men (OR=1.55, 95%CI 1.01-2.39, for a 10 dB(A)-increase in L_den). This relationship was higher in men highly sensitive to noise (OR=3.26, 95%CI 1.19-8.88, for a 10 dB(A)-increase in L_den). Noise sensitivity was associated with a fair/poor SRHS significantly in women (OR=1.74, 95%CI 1.12-2.68) and at the borderline of significance in men (OR=1.68, 95% CI 0.94-3.00), whereas aircraft noise annoyance was associated with a fair/poor SRHS only in men (OR=1.81, 95%CI 1.00-3.27).

CONCLUSION

The present study confirms findings in the small number of available studies to date suggesting a positive association between aircraft noise levels and a fair/poor SRHS. These results also support the hypothesis that noise sensitivity would moderate this association. However, a mediating effect of annoyance cannot be excluded.

Prevalence and characteristics of antidepressant prescribing in adults with comorbid depression and type 2 diabetes mellitus: A systematic review and meta-analysis

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Antidepressant gender disparity less in type 2 diabetes than general population

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No evidence of ethnic disparity in antidepressant prescribing in type 2 diabetes

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No evidence of disparity in antidepressant prescribing for insulin users

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Considerable evidence gaps for antidepressant prescribing in type 2 diabetes

Background

Treatment guidelines do not provide specific recommendations for antidepressant prescribing in people with type 2 diabetes mellitus (T2DM). It is important to understand the prevalence of antidepressant prescribing and associated patient characteristics, to recognise safety issues or inequalities related to treatment access.

Methods and Results

Seven databases were searched using terms related to depression, T2DM and antidepressant medication. From 14,389 reports retrieved, 9 met inclusion criteria. The prevalence of antidepressant prescribing varied considerably between studies from 18% to 87%. Where meta-analyses were possible, the pooled odds ratio for receiving an antidepressant were 1.52 (95% confidence intervals (CIs) 1.28 – 1.82) in women compared to men, 0.53 (95% CIs 0.23-1.20%) in Black and Ethnic Minorities compared to White ethnicity and 1.29 (95% CIs 0.92-1.80) in insulin users compared to individuals with non-insulin controlled T2DM.

Conclusions

Antidepressant prescribing is more common in women with T2DM compared to men, however, the difference is less than in the general population. Insulin users, representing individuals with more advanced T2DM, were as likely to be prescribed antidepressants as those who did not use insulin. There is a gap in the literature concerning which antidepressant agents are being prescribed, and alongside which concurrent medications and comorbidities.