Concepts of self-rated health: specifying the gender difference in mortality risk

Self-Rated Health and Medically Diagnosed Chronic Disease Association among Adults in Puerto Rico

Introduction

Latinos report lower self-rated health (SRH) than non-Hispanic White persons. However, the association between SRH and medically diagnosed chronic diseases (MDCDs) remains understudied in Latino populations. This study assessed the relationship between a single-item SRH indicator and MDCD status among predominantly Latino adults in Puerto Rico.

Methods

Participants (30-75 years; n=965) of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) reported SRH (excellent/very good, good, or fair/poor) and MDCD (ever vs never). We performed multivariate logistic regressions to evaluate the association between SRH and MDCD, which adjusted for key socioeconomic, demographic, and behavioral confounders.

Results

Twenty-seven percent of participants reported excellent/very good SRH, 39% good, and 34% fair/poor. Participants with fair/poor SRH (vs excellent/very good) were more likely to report MDCD for painful inflammation (odds ratio [OR]=4.95 [95% CI, 3.27-7.48]), kidney disease (4.64 [2.16-9.97]), sleep disorder (4.47 [2.83-7.05]), migraine headaches (4.07 [2.52-6.58]), overweight/obesity (3.84 [2.51-5.88]), depression (3.61 [2.28-5.74]), hypertension (3.59 [2.43-5.32]), high blood sugar (3.43 [2.00-5.89]), cardiovascular disease (3.13 [2.01-4.87]), anxiety (2.87 [1.85-4.44]), arthritis (2.80 [1.83-4.30]), diabetes (2.46 [1.57-3.83]), respiratory problems (2.45 [1.59-3.79]), stomach problems (2.44 [1.57-3.81]), eye disease (2.42 [1.44-4.06]), gallbladder disease (2.34 [1.35-4.05]), liver disease (2.26 [1.38-3.70]), heartburn (2.25 [1.55-3.26]), hyperlipidemia (2.10 [1.44-3.06]), and thyroid conditions (2.04 [1.30-3.21]).

Conclusions

SRH may reflect MDCD burden and serve as a valid screener to efficiently identify Latino individuals in high need of clinical services. This is relevant in Puerto Rico, where chronic disease rates remain high amid limited, disparate access to health care.

Women with cirrhosis have lower self-rated health than men

BACKGROUND

Women systematically experience lower rates of liver transplantation (LT) and higher rates of waitlist mortality than men. Self-rated health has been associated with patient outcomes in the global population. We, therefore, assessed gender differences in self-rated and clinician-rated health among LT candidates.

METHODS

Ambulatory LT candidates without hepatocellular carcinoma were enrolled from 2012 to 2018. Participants and their hepatologists were asked separately to rate the participant's overall general health on a 6-point scale (0="excellent" to 5="very poor"). Logistic regression was used to assess the associations between covariates and superior self-assessment, defined as 1 SD above the mean self-assessment score.

RESULTS

Of 855 participants, the median (interquartile range) self-rated health score was 2 (1-3); 156 (18%) were categorized as superior self-rated health. The correlation between self-rated and clinician-rated health was positive (Spearman's rho 0.3, P<0.001). In univariate analysis, being a woman was associated with lower odds of superior self-rated health (OR 0.7, 95% CI 0.5-1.0, P=0.04), which persisted on multivariable analysis (aOR 0.7, 95% CI 0.4-1.0, P=0.05), controlling for race, frailty, work status, comorbidities, Model for End-Stage Liver Disease-Na, hepatic encephalopathy, and ascites.

CONCLUSION

These findings highlight the need for well-designed quality-based research to determine how our patients perceive health to highlight opportunities to offer more comprehensive, quality-based care.

Women suffer but men die: survey data exploring whether this self-reported health paradox is real or an artefact of gender stereotypes

BACKGROUND

Despite consistently reporting poorer health, women universally outlive men. We examine whether gender differences in lived circumstances considered, and meaning attributed to SRH by women and men might explain this paradox.

METHODS

In an online survey 917 adults rated their health (SRH) and mental health (SRMH) and reflected upon what life experiences they considered in making their ratings. Descriptive findings were sex-disaggregated. The multiple experiences listed were then subject to factor analyses using principal components methods and orthogonal rotation.

RESULTS

Women reported poorer SRH and SRMH. They considered a wider range of circumstances, weighing all but self-confidence and behaviors as more important to SRH than did men. Two underlying components, psychosocial context and clinical status were identified overall. Physical health and pain were more important elements of men's clinical status and behaviors. Comparisons with others of the same age played a larger role in male psycho-social context. Two components also underpinned SRMH. These were clinical problems and psycho-social circumstances for which self-confidence was only important among men.

CONCLUSIONS

Women's and men's common interpretation of measures like SRH suggests that women's health disadvantage is neither artefactual nor determined by gendered meanings of measures and does not explain the paradox. SRH and SRMH captured social circumstances for all. Convergence of characteristics women and men consider as central to health is evidence of the dynamism of gender with evolving social norms. The remaining divergence speaks to persisting traditional male stereotypes.

Impact of urban green space on self-rated health: Evidence from Beijing

As a crucial component of urban green space (UGS), urban parks have been found to be closely associated with the health of urban residents. Drawing on a large-scale survey, "International First-class Harmonious and Livable Capital", in Beijing conducted in 2018, this paper examines the impact of subjective and objective characteristics of UGS on residents' self-rated health (SRH) by using a binary logistic regression model. The results indicate that the overall SRH status of urban residents in Beijing is relatively good, with 73.8% of the respondents reporting good SRH. The perceived quality of UGS and objectively measured accessibility to UGS are positively associated with residents' SRH, but the subjective indicator of UGS has a greater impact on SRH than the objective indicator of UGS. In terms of influencing mechanisms, social interaction and air quality perception were the two major mediators of UGS that affected residents' SRH. The heterogeneity analysis suggests that objective accessibility to different types of urban parks has mixed effects on residents' SRH. Access to high-quality parks is positively associated with residents' SRH, whereas access to common parks has a negative impact on residents' SRH. Our findings provide important policy implications for optimizing urban park design and improving the quality of urban park provision according to human needs in the Beijing Metropolitan Area.

Association between multimorbidity, self-rated health and life satisfaction among independent, community-dwelling very old persons in Japan: longitudinal cohort analysis from the Kawasaki Ageing and Well-being Project

OBJECTIVE

This study aimed to identify associations between multimorbidity and subjective health outcomes among the very old persons, after adjusting for coexisting conditions such as frailty and depression.

STUDY SETTING AND PARTICIPANTS

This was an observational cross-sectional study involving 1012 independent, community-dwelling very old persons (507 men, 505 women; aged 85-89 years) in Kawasaki city, Japan.

OUTCOME MEASURES

The primary outcome was the cross-sectional associations between multimorbidity and poor self-rated health (SRH) and life satisfaction using binary logistic regression. The secondary outcome was the association of subjective health with each chronic condition.

RESULTS

The prevalence of multimorbidity (≥2 conditions) was 94.7%, and the average number of chronic conditions was 4.47±1.9. Multimorbidity was significantly associated with poor SRH in the adjusted model only when six or more chronic conditions were present (OR 4.80; 95% CI 1.34 to 17.11; p=0.016). Cerebrovascular disease, heart disease, respiratory disease, connective tissue disease and arthritis showed significant associations with poor SRH after multivariate adjustment. Sex-specific analysis replicated associations between multimorbidity with six or more conditions and SRH in both men and women, while the diseases with the greatest impact on SRH differed between men and women. Most conditions were not associated with low satisfaction with life scale, with the exception of arthritis (OR 1.92, 95% CI 1.32 to 2.78, p=0.001).

CONCLUSIONS

Multimorbidity is prevalent in the independent, community-dwelling very old persons and is associated with poor SRH when six or more conditions are present; conditions causing mobility limitations, such as cerebrovascular disease, connective tissue disease and arthritis, have a negative impact on SRH.

TRIAL REGISTRATION NUMBER

UMIN000026053.

Self-reported health status and mortality from all-causes of death, cardiovascular disease and cancer in an older adult population in Spain

Aim

To assess the association between self-reported health (SRH) and mortality from all-causes, cardiovascular disease (CVD) and cancer, in adults 65 years and older in Spain.

Methods

We analysed data of 894 adults (504 women, 390 men) aged 65 years and above from two population-based studies, the EUREYE-Spain study and the Valencia Nutritional Survey (VNS). SRH was assessed at baseline using a single question which is widely used in epidemiological studies: “Overall, how would you consider your health at present?” and the response options were: 1. Very good, 2. Good, 3. Fair, 4. Poor, 5. Very poor. Deaths were ascertained during a 12-year follow-up period, and we used Cox proportional hazards regression models to obtain adjusted hazard ratios (HR).

Results

During the 12 years of follow-up (8566.2 person-years), we observed 400 deaths, 158 (39.5%) due to CVD and 89 (22.3%) due to cancer. Fair and poor/very poor SRH were significantly associated with higher all-cause mortality after 12-years of follow-up, HR = 1.29 (95% CI, 1.03–1.61) and HR 1.53 (95% CI, 1.09–2.15), respectively. We observed evidence of higher CVD mortality among those who reported fair and poor/very poor SRH, although the association was attenuated and lost statistical significance in the fully adjusted models.

Conclusion

This study suggests that a poor SRH status is associated with a higher all-cause mortality risk among older adults in Spain. Checking SHR status may be useful to plan health care in older adults.

[Self-perceived health in Spanish and Portuguese young seniors after the great recession according to the European Health Survey: A cross-sectional study]

OBJECTIVE

The aim of this study is to describe self-perceived health (SPH) in Spanish and Portuguese population aged between 65 and 74years old and to analyze other associated factors measured in the European Health Interview Survey (EHIS) in 2014.

DESIGN

Retrospective secondary data analysis from EHIS 2014.

SETTING

Community based.

PARTICIPANTS

Young seniors, people aged 65-74years old surveyed and with available data from two countries.

MAIN MEASUREMENTS

For each country and sex, SPH, sociodemographic variables, clinical chronic conditions, lifestyles and utilization of health care resources were described. A multiple logistic regression (very good or good SPH versus remaining levels) with robust estimators was used to assess the country effect adjusted by sociodemographic factors, clinical factors and/or lifestyles.

RESULTS

Good SPH showed variation by country (52.9% Spain vs. 19% Portugal; P<.001) and gender (44% men vs. 31.3% women; P<.001). Both countries had high prevalence of multimorbidity (64.7% Spain vs. 76.3% Portugal; P<.001) and the distribution of chronic diseases was similar with the only exception of depression (13.2% Spain vs. 20.3% Portugal; P<.001). Regarding individual factors related with good SPH we found Spanish nationality (OR: 4.52; 95%CI: 4.05-5.04), male gender (OR: 1.10; 95%CI: 1.101-2.21), education level, completing primary school (OR: 1.28; 95%CI: 1.24-1.31) or achieving tertiary level (OR: 2.43; 95%CI: 1.14-5.17) and physical activity of two or more days per week (OR: 1.87; 95%CI: 1.39-2.5). Factors with a negative impact on SPH were multimorbidity (OR: 0.19; 95%CI: 0.12-0.31) and depression (OR: 0.32; 95%CI: 0.25-0.41).

DISCUSSION

Good SPH is higher in Spanish young seniors compared to Portuguese. Having higher level of education achieved and practicing regular physical exercise were two most important factors increasing good SPH.

How the Labor Market Affects the Self-Perceived Health of Older Workers. The Evidence From Central and Eastern European Countries (CEECs)

Background: The paper aims to analyze the impact of key labor market indicators on the self-assessed health of the population of older workers (aged 55-64). Methods: Authors build the econometric models where the dependent variable is the self-perceived health status (for women and men separately). Explanatory variables are selected key indicators of the labor market, covering unemployment, including long-term, inactivity, or under-employment. The average household income is used to control the effect of wealth. Additionally, the models incorporate the variable describing the proximity of retirement. The research sample consists of nine countries of Central and Eastern Europe: Poland, Czech Republic, Slovakia, Hungary, Lithuania, Latvia, Estonia, Bulgaria, and Romania. Results and Conclusions: The study confirms that in the group of elderly workers, the perceived state of health is influenced by long-term unemployment, inactivity, and, in the case of women, time-related underemployment.

A Space-Time Analysis of Rural Older People's Outdoor Mobility and Its Impact on Self-Rated Health: Evidence from a Taiwanese Rural Village

With the aggravation of rural aging, the well-being and self-rated health level of older people in rural communities are significantly lower than those in urban communities. Past studies hold that mobility is essential to the quality of life of the elderly, and well-being depends on their own adaptation strategies in the built environment. Therefore, this study combines three key factors related to active aging: environment, health and mobility, and assumes that the elderly with good health status will have environmental proactivity and a wider range of daily mobility in a poor rural built environment. This study attempts to track daily mobility by using a space-time path method in time geography and then to explore the relationship between outdoor mobility and older people's self-rated health. A 1-week mobility path survey for 20 senior citizens of Xishi Village, a typical rural village in Taiwan, was conducted by wearing a GPS sports watch. A questionnaire survey and in-depth interviews were done to provide more information about the seniors' personal backgrounds and lifestyles. The results show that when the built environment is unfit to the needs of daily activities, half of the participants can make adjustment strategies to go beyond the neighborhoods defined by administrative units. Correlation analysis demonstrated that mental health is associated with daily moving time and distance. In addition, men have higher self-rated health scores than women, and there are significant statistical differences between married and widowed seniors in daily outing time and distance. This exploratory study suggests that in future research on rural health and active aging in rural areas, understanding the daily outdoor mobility of the elderly can help to assess their health status and living demands and quickly find out whether there is a lack of rural living services or environmental planning.

Volunteering Served as a Transitional Role That Enhances the Well-Being and Cognitive Health Among Older Adults With Cognitive Impairments

OBJECTIVES

We examined whether volunteering among older adults with cognitive impairments serves as a transitional role that can enhance these older persons' well-being and cognitive health.

METHODS

Using data from the Health and Retirement Study, we selected older adults with cognitive impairments (N = 472) and developed linear mixed models to assess associations between volunteering and health outcomes.

RESULTS

Volunteers in our sample were mostly females, non-Hispanic whites, those with higher income, and those with a high-school diploma. Volunteering was associated with higher levels of self-rated health, and consistent participation in volunteer work was related to stronger feelings of purpose in life. Cognitive health slightly improved over time only among those who volunteered.

DISCUSSION

We demonstrate that cognitive impaired older adults' participation in the volunteer role can benefit cognitive health while strengthening their late life resilience.

Longitudinal Twin Study of Subjective Health: Differences in Genetic and Environmental Components of Variance Across Age and Sex

OBJECTIVE

The current analysis examines sex differences in longitudinal changes in genetic and environmental influences on three measures of subjective health (SH).

METHOD

Sample includes 7,372 twins (mean intake age = 73.22) with up to 8 waves of measurement (mean = 3.1). Three SH items were included: general self-rated health (SRH), health compared to age peers (COMP), and impact of health on activities (ACT) which previous research shows capture different frames of reference.

RESULTS

Latent growth curve modeling indicated significant differences across gender and frame of reference in trajectories of change with age and in genetic and environmental contributions to change. Men have higher mean scores on all three SH measures, indicating better SH, but there were no sex differences in pattern of change with age. Accelerating declines with age were found for SRH and ACT, whereas COMP improved with age. Results indicated more genetic variance for women than men, but declining genetic variance for both after age 70. Increasing shared environmental variance with increasing age was also found for both sexes.

DISCUSSION

As aging triggers a re-evaluation of the meaning of "good health," physical aspects of health may become less important and shared cultural conceptions of health may become more relevant. This change in conceptions of good health may reflect both aging and the change in composition of the elderly population as a result of selective survival.

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

OBJECTIVES

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

DESIGN

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

SETTING AND PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Gender-Specific Relationship Between Executive Function and Self-Rated Health

Objectives

Self-rated health is a comprehensive measure of health. As gender difference in self-rated health is found, identifying gender-specific factors related to self-rated health is important. Poor executive functioning negatively affects an individual’s independence and healthy lifestyle, but it is unknown relationships between executive function and self-rated health and gender differences in these relationships. Therefore, gender differences were examined in the relationship between executive function and self-rated health in the community.

Methods

Individuals completed questionnaires about their health status and subjective decline in executive function. Neuropsychological tests were also performed to assess objective executive functioning. Two separate multivariable linear regression analyses were conducted by gender.

Results

Better objective executive function was related to greater self-rated health scores (better self-rated health) in men alone (βs = 0.341), while better subjective executive function was significantly associated with greater self-rated health scores in both men and women (βs = 0.385 and 0.443, respectively).

Conclusion

Gender differences are important when reporting perceived health status, in particular the different effects of subjective and objective executive function on self-rated health across genders. Clinicians need to be aware of the potential value of subjective executive function complaints when evaluating health status.

The Change of Self-Rated Health According to Working Hours for Two Years by Gender

OBJECTIVE

The aim of this study was to confirm the association between working hours and self-rated health, and to find the degree of changes in health level by working hours according to gender.

METHODS

This study was based on the 929 workers (571 men and 358 women) from the Korean Labor and Income Panel Study during 2004⁻2006. To minimize the healthy worker effects, the study subjects included only those who did not have any chronic diseases, and who answered their health status as "moderate" or above in the baseline. Logistic regression analysis was used to confirm the associations between working hours and self-rated health.

RESULTS

In men, working hours per week of 47⁻52 h, 53⁻68 h, and >68 h were associated with 1.2, 1.3, and 1.1 times increases, respectively, in the odds ratio on worsened self-rated health, compared with the reference group (40⁻46 h). On the other hand, the risks were 1.0, 2.2, and 2.6 times increases in women. However, the results were different according to gender in the group with less than 40 h. The men with less than 40 h had a 0.9 times odds ratio on worsened self-rated health. For the women with less than 40 h, the odds ratio on self-rated health was 5.4 times higher than the reference group.

CONCLUSIONS

Working more than 52 h per week had a negative effect on health, regardless of gender. However, in the group with less than 40 h, the negative association between working hours and self-rated health were shown only in women. Health outcomes due to working hours may differ by gender. Therefore, further studies are needed to explore the causes of these results.

Peer effects in health valuation: the relation between rating of contemporaries' health and own health

Background

Most health valuation studies assume that individuals’ health valuations do not depend on social comparisons. However, there is some evidence that this assumption is not satisfied in practice. This paper tests whether self-rated health by means of a Visual Analogue Scale (VAS) is related to how one perceives the health of one’s contemporaries, while accounting for one’s health as classified by the EQ-5D classification system.

Methods

In a large sample (n = 1500), representative of the general public, we use a VAS to rate respondents’ own health and their assessment of their contemporaries’ health. In addition, we directly ask them whether they perceive their health to be better, the same, or worse than their contemporaries, and we measure their own health according to the EQ-5D-5 L.

Results

We find a positive relationship between own health rating and contemporaries’ health rating, after controlling for the respondents’ own health as classified according to the EQ-5D. Furthermore, we observe a discrepancy between relative health vis-à-vis age peers as measured by an ordinal comparison and relative health as measured by a VAS. Finally, respondents, especially women, tended to overestimate the health of other people of their age.

Conclusions

We provide evidence that people’s own health rating is related to the perception of health of contemporaries. Our results indicate that knowledge about a respondent’s perception of others’ health is useful in explaining health state valuations.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Multidimensional Intergenerational Instrumental Support and Self-Rated Health Among Older Adults in Rural China: Trajectories and Correlated Change Over 11 Years

OBJECTIVES

This study investigated the dynamic relationship between multidimensional intergenerational instrumental support and health over time. This approach is of theoretical, methodological, and practical significance in gerontological research.

METHOD

Data came from The Well-Being of Older People in Anhui Province in 2001, 2003, 2006, 2009, and 2012. Of the 1,636 participants at baseline, a working sample of 1,557 older adults was used. Trajectories and correlated change were estimated using parallel latent growth curve modeling with maximum likelihood estimation.

RESULTS

"Received household-chore help" decreased over time, whereas "received personal-care help" increased over time. "Provided household-chore help" and "provided personal-care help" increased and then decreased over time. Increasing receipt of "household-chore help" and "personal-care help" were associated with faster decline in health over time.

DISCUSSION

Findings suggest distinctive patterns of changes for different dimensions of intergenerational instrumental support and their relationship with changes in perception of health over time in later life.

Is self-rated health in adolescence a predictor of prescribed medication in adulthood? Findings from the Nord Trøndelag Health Study and the Norwegian Prescription Database

Self-rated health (SRH) is a commonly used health indicator predicting morbidity and mortality in a range of populations. However, the relationship between SRH and medication is not well established. The aim of this study was to examine adolescent SRH as a predictor for prescribed medication later in young adulthood. Eighteen years' prospective data from the Nord-Trøndelag Health Study (HUNT) and the Norwegian Prescription Database (NorPD) were analyzed. Baseline data, gathered from 8982 adolescents (mean age 16.0 years) in the Young-HUNT I survey (1995-1997), were linked to individual data from NorPD, including information on all medications prescribed in 2013-2014. Gender-stratified negative binomial regression models were used to investigate the association between SRH and medication, also adjusted for age, baseline self-reported medicine use, physical and mental disability, smoking, and physical activity. Based on the Anatomical Therapeutic Chemical (ATC) Classification System, total consumption and consumption related to various ATC groups were examined. The adjusted analyses showed a dose-response relationship for females, with poorer SRH predicting higher average medication for both total consumption and for the ATC groups "Musculoskeletal system" (M), "Nervous system" (N; Analgesics (N02), Opioids (N02A)) and "Respiratiory system" (R). The predictive power of SRH, as well as the role of the adjustment factors, varies by gender and drug groups. This knowledge is important in order to identify risks for later disease and to capture pathological changes before and beyond the disease diagnosis, potentially preventing morbidity in the adult population.

Predictors of decline in self-reported health: addressing non-ignorable dropout in longitudinal studies of aging

Predictors of decline in health in older populations have been investigated in multiple studies before. Most longitudinal studies of aging, however, assume that dropout at follow-up is ignorable (missing at random) given a set of observed characteristics at baseline. The objective of this study was to address non-ignorable dropout in investigating predictors of declining self-reported health (SRH) in older populations (50 years or older) in Sweden, the Netherlands, and Italy. We used the SHARE panel survey, and since only 2895 out of the original 5657 participants in the survey 2004 were followed up in 2013, we studied whether the results were sensitive to the expectation that those dropping out have a higher proportion of decliners in SRH. We found that older age and a greater number of chronic diseases were positively associated with a decline in self-reported health in the three countries studies here. Maximum grip strength was associated with decline in self-reported health in Sweden and Italy, and self-reported limitations in normal activities due to health problems were associated with decline in self-reported health in Sweden. These results were not sensitive to non-ignorable dropout. On the other hand, although obesity was associated with decline in a complete case analysis, this result was not confirmed when performing a sensitivity analysis to non-ignorable dropout. The findings, thereby, contribute to the literature in understanding the robustness of longitudinal study results to non-ignorable dropout while considering three different population samples in Europe.

The role of gender in the association between self-rated health and mortality among older adults in Santiago, Chile: A cohort study

Background

Previous studies on the role of gender in the association between self-rated health and mortality have shown contrasting results. This study was aimed to determine the importance of gender in the association between self-rated health and mortality among older people in Santiago, Chile.

Methods

A 10 year follow-up of 1066 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being. Self-rated health was assessed in face to face interviews through a single general question, along with socio-demographic and health status information. Cox proportional hazards and flexible parametric models for survival analyses were employed.

Results

By the end of follow-up, 30.7% of women and 39.4% of men died. Adjusted hazard ratio of poor self-rated health, compared to good self-rated health, was 1.92(95% CI 1.29–2.86). In models stratified by gender, an increased risk of mortality was observed among women who rated their health as poor (HR = 2.21, 95% CI 1.43–3.40), but not among men (HR = 1.04, 95% CI 0.58–1.86). Age was associated with mortality in both groups; for men, functional limitation and underweight were also risk factors and obesity was a protective factor.

Conclusions

Compared to older women who rated their health as good, older women who rated their health as poor had a 2 fold increased risk of mortality over the subsequent 10 years. These findings stress the importance of considering a gender perspective into health programmes, including those focused on older people, in order to address the different elements that increase, on the long run, the risk of dying among older women and men.

Gender and validity of self-rated health in nineteen European countries

AIMS

The aims of this study were to: (1) examine the concurrent validity of self-rated health for mental and physical health in Europe; and (2) evaluate whether self-rated health predicts health problems differentially by gender.

METHODS

Data are from 19 European countries surveyed in the 2014 European Social Survey. We applied ordinary least squares regression to examine the association between self-rated health and summary indicators of physical and mental health problems.

RESULTS

We observed an association between self-rated health and both physical and mental health problems in all countries. Gender differences in the concurrent validity of self-rated health were documented in eleven out of 19 countries.

CONCLUSIONS

Self-rated health is a valid and efficient measure of physical and mental health across the European continent, with significantly greater concurrent validity among women.

Self-rated health and all-cause and cause-specific mortality of older adults: Individual data meta-analysis of prospective cohort studies in the CHANCES Consortium

OBJECTIVES

To evaluate, among the elderly, the association of self-rated health (SRH) with mortality, and to identify determinants of self-rating health as "at-least-good".

STUDY DESIGN

Individual data on SRH and important covariates were obtained for 424,791 European and United States residents, ≥60 years at recruitment (1982-2008), in eight prospective studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios, HRs) in relation to SRH were calculated and subsequently combined with random-effect meta-analyses.

MAIN OUTCOME MEASURES

All-cause, cardiovascular and cancer mortality.

RESULTS

Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH "fair" or "poor" vs. "at-least-good" was associated with increased mortality: HRs 1.46 (95% CI 1·23-1.74) and 2.31 (1.79-2.99), respectively. These associations were evident: for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently, for medical history explained only a modest amount of the unadjusted associations. Factors favourably associated with SRH were: sex (males), age (younger-old), education (high), marital status (married/cohabiting), physical activity (active), body mass index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence).

CONCLUSION

SRH provides a quick and simple tool for assessing health and identifying groups of elders at risk of early mortality that may be useful also in clinical settings. Modifying determinants of favourably rating health, e.g. by increasing physical activity and/or by eliminating obesity, may be important for older adults to "feel healthy" and "be healthy".

Gender and the structure of self-rated health across the adult life span

Despite the widespread use of self-rated health (SRH) in population health studies, the meaning of this holistic health judgment remains an open question. Gender differences in health, an issue of utmost importance in population research and policy, are often measured with SRH; the comparisons could be biased if men and women differ in how they form their health judgment. The aim of this study is to examine whether men and women differ in how health inputs predict their health rating across the adult life span. We use the 2002-2015 National Health Interview Survey data from US-born respondents aged 25-84. Ordered logistic models of SRH as a function of 24 health measures including medical conditions and symptoms, mental health, functioning, health care utilization, and health behaviors, all interacted with gender, test how the measures influence health ratings and the extent to which these influences differ by gender. Using a Bayesian approach, we then compare how closely a select health measure (K6 score) corresponds to SRH levels among men and women. We find little systematic gender difference in the structure of SRH: men and women use wide-ranging health-related frames of reference in a similar way when making health judgments, with some exceptions: mid-life and older men weigh physical functioning deficits and negative health behaviors more heavily than women. Women report worse SRH than men on average but this only holds through mid-adulthood and is reversed at older ages; moreover, the female disadvantage disappears when differences in socio-economic and health covariates are considered. Our findings suggest that the meaning of SRH is similar for women and men. Both groups use a broad range of health-related information in forming their health judgment. This conclusion strengthens the validity of SRH in measuring gender differences in health.

Motor functioning differentially predicts mortality in men and women

INTRODUCTION

Research indicates gender differences in functional performance at advanced ages, but little is known about their impact on longevity for men and women.

OBJECTIVE

To derive a set of motor function factors from a battery of functional performance measures and examine their associations with mortality, incorporating possible gender interactions.

METHOD

Analyses were performed on the longitudinal Swedish Adoption/Twin Study of Aging (SATSA) including twenty-four assessments of motor function up to six times over a 19-year period. Three motor factors were derived from several factor analyses; fine motor, balance/upper strength, and flexibility. A latent growth curve model was used to capture longitudinal age changes in the motor factors and generated estimates of intercept at age 70 (I), rates of change before (S1) and after age 70 (S2) for each factor. Cox regression models were used to determine how gender in interaction with the motor factors was related to mortality.

RESULTS

Females demonstrated lower functional performance in all motor functions relative to men. Cox regression survival analyses demonstrated that both balance/upper strength, and fine motor function were significantly related to mortality. Gender specific analyses revealed that this was true for women only. For men, none of the motor factors were related to mortality.

CONCLUSION

Women demonstrated more difficulties in all functioning facets, and only among women were motor functioning (balance/upper strength and fine motor function) associated with mortality. These results provide evidence for the importance of considering motor functioning, and foremost observed gender differences when planning for individualized treatment and rehabilitation.

Incidence and risk factors of symptomatic dry eye disease in Asian Malays from the Singapore Malay Eye Study

PURPOSE

To evaluate the incidence of symptomatic dry eye disease (SDED) and associated risk factors in a well-characterized cohort of ethnic Malays in Singapore.

METHODS

We included 1682 participants (mean age [SD]: 57 [10]years; 55.4% female) without SDED from the Singapore Malay Eye Study (SiMES), a population-based longitudinal study with baseline examination (SiMES-1) conducted between 2004 and 2006, and follow-up examination (SiMES-2) conducted between 2010 and 2013. SDED was considered to be present if a participant answered "often" or "all the time" to any of the six questions from the Salisbury Eye Evaluation Study dry eye questionnaire. Age-standardized incidence of SDED was calculated as the crude 6-year cumulative incidence standardized to Singapore's population census. Gender-stratified multivariable log-binomial regression models were utilized to determine the independent risk factors of incident SDED.

RESULTS

At the 6-year follow-up, 86 of 1682 participants had developed SDED, which was equivalent to an age-standardized 6-year incidence of 5.1% (95% CI 4.1-6.4%). There were no differences in the incidence of SDED between men and women (P = 0.9). Multivariable models revealed that presence of glaucoma and poorer self-rated health were independently associated with incident SDED in men (P = 0.003 and 0.03, respectively), while contact lens wear (P = 0.002), history of thyroid disease (P = 0.03), and having had cataract surgery (P = 0.02) were predictive of incident SDED in women.

CONCLUSION

One in twenty adult Malays developed SDED over a 6-year period. Risk factors for incident SDED were different between men and women. Future studies and public health interventions should consider this gender-specific difference in risk factors.

Self-rated health, multimorbidity and depression in Mexican older adults: Proposal and evaluation of a simple conceptual model

INTRODUCTION

Self-rated health is an individual and subjective conceptualization involving the intersection of biological, social and psychological factors. It provides an invaluable and unique evaluation of a person's general health status.

OBJECTIVE

To propose and evaluate a simple conceptual model to understand self-rated health and its relationship to multimorbidity, disability and depressive symptoms in Mexican older adults.

MATERIALS AND METHODS

We conducted a cross-sectional study based on a national representative sample of 8,874 adults of 60 years of age and older. Self-perception of a positive health status was determined according to a Likert-type scale based on the question: "What do you think is your current health status?" Intermediate variables included multimorbidity, disability and depressive symptoms, as well as dichotomous exogenous variables (sex, having a partner, participation in decision-making and poverty). The proposed conceptual model was validated using a general structural equation model with a logit link function for positive self-rated health.

RESULTS

A direct association was found between multimorbidity and positive self-rated health (OR=0.48; 95% CI: 0.42-0.55), disability and positive self-rated health (OR=0.35; 95% CI: 0.30-0.40), depressive symptoms and positive self-rated health (OR=0.38; 95% CI: 0.34-0.43). The model also validated indirect associations between disability and depressive symptoms (OR=2.25; 95% CI: 2.01- 2.52), multimorbidity and depressive symptoms (OR=1.79; 95% CI: 1.61-2.00) and multimorbidity and disability (OR=1.98; 95% CI: 1.78-2.20).

CONCLUSIONS

A parsimonious theoretical model was empirically evaluated, which enabled identifying direct and indirect associations with positive self-rated health.

Facets of Subjective Health From Early Adulthood to Old Age

OBJECTIVE

Subjective health is a complex indicator predicting longevity independent of objective health. Few studies examine genetic and environmental mechanisms underlying different facets of subjective health across the life course.

METHOD

Three subjective health measures were examined in 12,900 twins ( M_age = 63.38, range = 25-102) from nine studies in the Interplay of Genes and Environment across Multiple Studies Consortium: self-rated health (SRH), health compared with others (COMP), and health interfering with activities (ACT).

RESULTS

Analyses indicated age and sex differences in mean scores depending on the measure. SRH and ACT showed significant linear and non-linear moderation by age for individual differences in both genetic and environmental variance. Significant sex differences in components of variance were found for SRH and ACT, but not COMP.

DISCUSSION

Subjective health appears to be dependent on frame of reference and reflect different aspects of health. Results suggest different genetic and environmental mechanisms underlie each facet.

Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation

Background

A strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.

Objectives

To generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.

Design

Cross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).

Results

The utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.

Conclusions

We found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Influence of volunteer-led net step exercise class on older people's self-rated health in a depopulated town: A longitudinal study

In a depopulated region where population aging is advancing, it is necessary to establish a method so local residents themselves can be actively involved in older people’s health promotion. Net Step Exercise, a novel dual-task walking program, introduced residents to opportunities for physical activities and social participation without any health specialist support. In one depopulated town (Ikeda, Nakagawa-gun, Hokkaido, Japan), volunteer residents have held Net Step Exercise classes throughout the town since 2007. We longitudinally examined the influence of volunteer-led Net Step Exercise class participation on subsequent self-rated health in all individuals aged 70–79 years living in Ikeda. A total of 662 people who completed a baseline mail-in questionnaire survey in 2012 were followed until 2014. Logistic regression analysis was performed to examine the association with self-rated health after two years of class participation once a month or more at baseline, after controlling for confounds such as age, sex, years of education, living alone, baseline self-rated health, regular exercise, and other physical activities. The odds ratio of poor self-rated health in older people who participated in classes was 0.53 (95% confidence interval [CI]: 0.34–0.85) compared to older people not participating in classes. Even after confounding factors were adjusted, the odds ratio of class participation was 0.50 (95% CI: 0.29–0.85). This study showed that participation in volunteer-led Net Step Exercise might prevent poor self-rated health. Such Net Step Exercise classes are a feasible method for older people’s health promotion in depopulated municipalities.

•

Local residents’ active involvement in older people’s health promotion is vital.

•

NSE provides physical exercise, cognitive activity, and social participation.

•

Older people in NSE class had significantly lower risk of poor self-rated health.

•

The association held despite covariates for monthly class attendance or more.

•

Local residents’ volunteer leading of NSE classes promotes health in older people.

Associations Between Fetal Growth and Self-Perceived Health Throughout Adulthood: A Co-twin Control Study

The literature shows evidence for long-lasting effects of low birth weight (LBW) on many health outcomes, but little is known about effects on self-perceived health. Findings are mixed and studies are small, mostly focusing on LBW effects on health outcomes before adulthood. Further, as LBW and most health conditions including self-perceived health are partly heritable, associations between birth weight (BW) and adverse health outcomes may also be due to shared genetic as well as other (pre- and postnatal) unmeasured environmental influences. We explored LBW effects on self-perceived health in early and later adulthood using a very large and genetically informative sample of more than 50,000 Swedish twins. In addition, analyses within twin pairs (the co-twin control design) were used to examine potential associations between BW and the offspring's risk for poor self-perceived health independent of shared environmental or genetic factors, evidence which is critical for the understanding of underlying mechanisms. Results showed that lower BW was significantly associated with poorer self-perceived health during adulthood, although the effect size was small. Co-twin control analyses suggested that this increased risk may be due to shared underlying liability (environmental or genetic) rather than a direct effect of BW, but findings were not conclusive.

Gender Differences in Marital Status Moderation of Genetic and Environmental Influences on Subjective Health

From the IGEMS Consortium, data were available from 26,579 individuals aged 23 to 102 years on 3 subjective health items: self-rated health (SRH), health compared to others (COMP), and impact of health on activities (ACT). Marital status was a marker of environmental resources that may moderate genetic and environmental influences on subjective health. Results differed for the 3 subjective health items, indicating that they do not tap the same construct. Although there was little impact of marital status on variance components for women, marital status was a significant modifier of variance in all 3 subjective health measures for men. For both SRH and ACT, single men demonstrated greater shared and nonshared environmental variance than married men. For the COMP variable, genetic variance was greater for single men vs. married men. Results suggest gender differences in the role of marriage as a source of resources that are associated with subjective health.

The Health of India's Elderly Population: A Comparative Assessment Using Subjective and Objective Health Outcomes

This study examined relationships between and predictors of objective and subjective health measures among 766 individuals aged ≥ 45 years in India using the 2010 pilot wave of the Longitudinal Aging Study in India (LASI). Correlations between and gender differences in objective [grip strength, lung function] and subjective [self-rated health (SRH), dependence in activities of daily living (dADL)] health measures were examined. Multivariate logistic regression analyses, accounting for sample design, were conducted to identify predictors of poor health. Fewer individuals were classified as at risk according to subjective (SRH, 9 %; dADL, 12 %) than objective (lung function, 57 %; grip strength, 77 % women, 87 % men) indicators. Poor SRH was only weakly correlated with dADL (r = 0.103, p ≤ 0.05) and grip strength (r = −0.138, p ≤ 0.001). From this study we conclude that older Indians tend to report more positive perception of health than the objective measures of health indicates, and that subjective and objective health indicators capture different aspects of health and only weakly correlated.

Self-rated health and mortality in a prospective Chinese elderly cohort study in Hong Kong

OBJECTIVES

In the West, self-rated health reliably predicts death, but conceptualizations of health and cause-composition of mortality may be contextually specific. Little is known as to how self-rated health predicts death in non-Western settings.

METHODS

Multivariable Cox regression analysis was used to assess the adjusted associations of age-comparative and self-comparative self-rated health with death from all- and specific-causes using a population-based cohort of 66,820 Chinese (65+years) enrolled from 1998 to 2001 at 18 Elderly Health Centers in Hong Kong, and followed until May 31, 2012.

RESULTS

During an average of 10.9 years follow-up, 19,845 deaths occurred with 6336 from cancer. Worse age-comparative self-rated health, compared with better, was positively associated with death from all-causes (hazard ratio 1.68, 95% confidence interval 1.59, 1.77), cardiovascular disease (hazard ratio 1.83, 95% confidence interval 1.66, 2.02), stroke (hazard ratio 1.93, 95% confidence interval 1.63, 2.29), ischemic heart disease (hazard ratio 1.77, 95% confidence interval 1.51, 2.08), cancer (hazard ratio 1.17, 95% confidence interval 1.06, 1.30) and respiratory disease (hazard ratio 2.25, 95% confidence interval 2.01, 2.52), adjusted for age and sex. Self-comparative self-rated health was not associated with higher mortality.

CONCLUSION

Age-comparative self-rated health predicted death in older people from a non-Western setting although the association was less marked than in Western settings.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Classification models for identification of at-risk groups for incident memory complaints

BACKGROUND

Memory complaints in older adults may be a precursor of measurable cognitive decline. Causes for these complaints may vary across age groups. The goal of this study was to develop classification models for the early identification of persons at risk for memory complaints using a broad range of characteristics.

METHODS

Two age groups were studied, 55-65 years old (N = 1,416.8) and 65-75 years old (N = 471) using data from the Longitudinal Aging Study Amsterdam. Participants reporting memory complaints at baseline were excluded. Data on predictors of memory complaints were collected at baseline and analyzed using logistic regression analyses. Multiple imputation was applied to handle the missing data; missing data due to mortality were not imputed.

RESULTS

In persons aged 55-65 years, 14.4% reported memory complaints after three years of follow-up. Persons using medication, who were former smokers and had insufficient/poor hearing, were at the highest risk of developing memory complaints, i.e., a predictive value of 33.3%. In persons 65-75 years old, the incidence of memory complaints was 22.5%. Persons with a low sense of mastery, who reported having pain, were at the highest risk of memory complaints resulting in a final predictive value of 56.9%. In the subsample of persons without a low sense of mastery who (almost) never visited organizations and had a low level of memory performance, 46.8% reported memory complaints at follow-up.

CONCLUSIONS

The classification models led to the identification of specific target groups at risk for memory complaints. Suggestions for person-tailored interventions may be based on these risk profiles.

The Impact of the REACH II Intervention on Caregivers’ Perceived Health

The primary goal of the current study was to examine the impact of a caregiving support program on caregivers’ perceived health at 6 months following baseline assessment in the Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II) intervention. A composite measure of perceived health was established and incorporated self-rated health, change in self-rated health, and improvement in physical health. A total of 494 participants receiving the REACH II intervention or an education-only intervention were included in this study. Mixed effect linear regression analysis was performed to examine the effect of the intervention and the factors that mediate this relationship. Findings suggest that the enhanced supportive intervention led to significant improvement in caregivers’ overall perceived health at 6 months. This effect remains significant after controlling for positive satisfaction with caregiving. Improving caregivers’ stress and burden while fostering positive rewards and appraisals may provide indirect health benefits and maintain overall health in dementia caregivers.

Gender and regional differentials in health expectancy in Greece

Background

Differentials and inequalities in heath status are closely related to the implementation and the sustainability of public health policies. The paper investigates differences in health expectancy as an indicator of population health among regions and between genders.

Design and Methods

Based on activity limitation, we compute Healthy Life Years indicator by applying the prevalence-based Sullivan method. The analysis is based on data from the National Health Survey conducted in Greece in 2009 by the Hellenic Statistical Authority, carried out on a multistage probability sample of 6172 individuals.

Results

The results show that men are more likely than women to live a greater part of their life in good health. When regions are considered (NUTS_1 and NUTS_2 levels), the resulting diversities in healthy life years are more pronounced than those in life expectancy.

Conclusions

The paper provides additional insights about health status discrepancies among Greek geographic regions and between genders. The results indicate that men are more likely to report to be in good health than women, and the differences by gender are more pronounced at regional than at national level. This empirical evidence can be used for monitoring both, the population health status and the undesired differentials in health expectancy, and may therefore be a useful tool for health policies aiming at reducing heath inequalities among individuals.

Alternative Measures of Self-Rated Health for Predicting Mortality Among Older People: Is Past or Future Orientation More Important?

PURPOSE

The purpose of this study was to compare the prognostic validity of alternative measures of health ratings, including those that tap temporal reflections, on adult mortality.

DESIGN AND METHODS

The study uses a national sample of 1,266 Americans 50-74 years old in 1995, with vital status tracked through 2005, to compare the effect of 3 types of health ratings on mortality: conventional indicator of self-rated health (SRH), age comparison form of SRH, and health ratings that incorporate temporal dimensions. Logistic regression was used to estimate the odds of mortality associated with alternative health ratings while adjusting for health conditions, lifestyle factors, and status characteristics and resources.

RESULTS

Self-rated health was a consistent predictor of mortality, but the respondent's expected health rating-10 years in the future-was an independent predictor. Future health expectations were more important than past (recalled change) in predicting mortality risk: People with more negative expectations of future health were less likely to survive.

IMPLICATIONS

The findings reveal the importance of future time perspective for older people and suggest that it is more useful to query older people about their future health expectations than about how their health has changed.

Attention-deficit/hyperactivity disorder, physical health, and lifestyle in older adults

OBJECTIVES

To increase insight into the effect of attention-deficit/hyperactivity disorder (ADHD) on health in general in older adults.

DESIGN

Two-phase sampling side-study.

SETTING

Longitudinal Aging Study Amsterdam (LASA).

PARTICIPANTS

Two hundred twenty-three randomly selected LASA respondents.

MEASUREMENTS

Information was collected during home visits on physical health, medication use, and lifestyle characteristics in Phase 1 and on ADHD diagnosis in Phase 2. The associations between independent variables and ADHD were examined with linear and logistic regression analyses.

RESULTS

The adjusted regression estimates of the linear regression analysis showed that the number of ADHD symptoms was positively associated with the presence of chronic nonspecific lung diseases (CNSLD) (B = 2.58, P = .02), cardiovascular diseases (B = 2.18, P = .02), and number of chronic diseases (B = 0.69, P = .04) and negatively associated with self-perceived health (B = -2.83, P = .002). Lifestyle is not a mediator of the association between ADHD and physical health.

CONCLUSION

Attention-deficit/hyperactivity disorder in older adults was associated with chronic physical illness and poorer self-perceived health. Contrary to expectations, there were no associations between symptoms of ADHD and lifestyle variables.

Marital status, self-rated health, and mortality: overestimation of health or diminishing protection of marriage?

This study challenges two well-established associations in medical sociology: the beneficial effect of marriage on health and the predictive power of self-rated health on mortality. Using The National Health Interview Survey 1986-2004 with 1986-2006 mortality follow-up (789,096 respondents with 24,095 deaths) and Cox Proportional Hazards Models, we find the protective effect of marriage against mortality decreases with deteriorating health so that the married and unmarried in poor health are at similar risk for death. We also find the power of self-rated health to predict mortality is higher for the married than for any unmarried group. By using ordered logistic regression models, we find thresholds shift such that, compared to the unmarried, the married may not report poorer health until developing more severe health problems. These findings suggest the married tend to overestimate their health status. These two phenomena (diminishing protection and overestimation) contribute to but do not completely explain each other.

Caregiving and elderly health in Mexico

Using the National Mexican Health and Aging Study panel dataset, the authors estimate the effect of having informal care on the probability of dying and on the change in elderly health over a two-year period. Three measures of functional health were used: self-reported health, activities of daily living, and instrumental activities of daily living. We develop an empirical strategy that relies on the panel structure of the dataset to sort out the possible correlation between unobservable characteristics that affect both elderly health and an individual's decision to provide informal care. Our findings suggest that informal care provided by daughters reduces the probability of dying. In addition, informal care provided by daughters reduces the probability of having a decline in activities of daily living and instrumental activities of daily living, while it has no effect on the observed changes in self-reported health status. The protective effect of informal care provided by sons is not statistically significant for any health outcomes. A discussion of the policy options to increase elderly health and to improve the role of caregivers is included.

The role of different predictors in 20-year mortality among Krakow older citizens

BACKGROUND

The aim of this study was to assess the change in the predictive ability of gender-related 20-year all-cause mortality in community-dwelling older people.

METHODS

The baseline investigation was conducted in 1986-1987 and survival of 2472 subjects aged 65 years and older was followed up for 20 years. The associations of socioeconomic conditions and health measures with mortality were assessed using Cox hazard model with time-dependent covariates.

RESULTS

Our study confirmed that higher education and being employed during the baseline were protective factors in males, but not among females. Healthy lifestyle was a predictive factor for all-cause mortality for both men and women and its predictive value was strong over the whole observation period. The study showed that poor self-rated health (SRH) was a valid predictor of mortality in elderly women, but not in men, and the effect of the length of follow-up on mortality was not observed. Overall, different sets of all-cause mortality predictors were found for men and women. For men the role of socioeconomic status factors was confirmed as well as healthy lifestyle and presence of chronic conditions, especially coronary heart disease (CHD) and asthma. For women the most important predictors were lifestyle factors and the feeling of life-weariness as well as SRH and diabetes mellitus present during the baseline study.

CONCLUSIONS

The impact of most of the examined factors on mortality was found to be stable over the twenty years of observation with the exception of the self-reported CHD, whose predictive value decreased over time.

The relationships between self-rated health and serum lipids across time

BACKGROUND AND PURPOSE

We studied the hypothesized effects of changes in self-rated health (SRH) on subsequently assessed changes in the levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and triglycerides (TRI), separately for men and women. We also investigated the reverse causation hypothesis, expecting the initial changes in the levels of serum lipids to predict subsequently assessed changes in SRH levels.

METHODS

We used a longitudinal design and controlled for possible confounders known to be precursors of both SRH and the above three serum lipids. Participants were apparently healthy men (N = 846) and women (N = 378) who underwent a routine health check at three points of time (T1, T2, and T3); T1 and T3 were on the average 40 and 44 months apart for the men and women, respectively.

RESULTS AND CONCLUSIONS

For the men, relative to T1 SRH, an increase in T2 SRH was associated with an increase in the T3 HDL-C levels relative to T2 HDL-C and with a decrease in the T3 TRI levels relative to T2 TRI. For the women, initial changes in the SRH levels did not predict follow-up changes in either of the lipids. For both genders, the reverse causation hypothesis, expecting the T1-T2 change in each of the serum lipids to predict T2-T3 change in SRH, was not supported. For the men, there is support for the hypothesis that the effects of SRH on morbidity and mortality, found by past meta-analytic studies, could be mediated by serum lipids.

Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders

AIMS

We aimed to examine whether pain-inducing musculoskeletal disorders might explain the gender difference in the strength of the self-rated health (SRH)-mortality association.

METHODS

We pooled data from two National Health and Nutrition Examination Surveys (conducted in 1998 and 2001), which were linked to national mortality data of Korea using 13-digit unique personal identification numbers. There were 9,912 study participants, and 456 deaths were recorded (average length of follow-up = 5.7 years). Using a checklist of chronic conditions, the prevalences of major pain-causing musculoskeletal disorders (arthritis, sciatica, and herniated intervertebral disc) were obtained.

RESULTS

The relative risk (RR) of mortality for the poor and very poor categories of SRH tended to be greater in men than in women. Compared with those without musculoskeletal disorders, the RR for those with musculoskeletal disorders was similar in men but lower in women. Women had a greater prevalence of musculoskeletal disorders than men, and women with musculoskeletal disorders reported poorer health than did men with these disorders. In individuals without major musculoskeletal disorders, the strength of the SRH-mortality association was reduced in men but increased in women. Similar patterns in RRs for SRH by gender were observed when sociodemographic characteristics (education and marital status), number of severe chronic illnesses, and health behaviors (cigarette smoking, alcohol consumption, and regular physical exercise) were additionally adjusted for.

CONCLUSIONS

Nonfatal musculoskeletal disorders may explain gender differences in the SRH-mortality association. Larger prospective studies in different cultural settings may help advance our understanding of the role of pain and pain-inducing musculoskeletal disorders in explaining gender differences in the SRH-mortality association.