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Martins CA, do Prado CB, Ferreira JRS, Zandonade E, de Paula Alves Bezerra OM, Salaroli LB. Self-rated health status and associated factors in rural workers. BMC Public Health 2023; 23:680. [PMID: 37046261 PMCID: PMC10091575 DOI: 10.1186/s12889-023-15548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Self-rated health status can be considered a good predictor of morbidity and mortality and has been used due to its easy assessment and applicability. The instrument is efficient for understanding sociodemographic, environmental and clinical conditions that may be related to the self-rated health status. Thus, this study aims to analyze the self-assessment of health status in rural workers and its association with socioeconomic characteristics, lifestyle, clinical condition and work characteristics. METHODS This is a cross-sectional study carried out with 787 male and female rural reporting agriculture as their main source of income in the municipality of Santa Maria de Jetibá. A simple and direct question was used "In general, compared to people your age, how do you rate your own state of health?" to see how rural workers rate their current health status. The independent variables analyzed were socioeconomic, clinical, health and work conditions. The magnitude of the associations was evaluated by means of hierarchical logistic regression. RESULTS It was found that 42.1% of rural workers self-rated their health status as regular or poor. Belonging to socioeconomic classes C (OR = 1.937; 95% CI = 1.009-3.720) or D/E (OR = 2.280; 95% CI = 1.178-4.415), being overweight (or having excess weight) (OR = 1.477; 95% CI = 1.086-2.008), multimorbidity (OR = 1.715; 95% CI = 1.201-2.447) and complex multimorbidity (OR = 1.738; 95% CI = 1.097-2.751) were risk factors for worse self-rated health. CONCLUSION It was concluded that chronic diseases, socioeconomic status and overweight are risk factors for negative self-rated health. The identification of these determinants through self-rated status can support the planning of actions aimed at improving the health of the rural population. TRIAL REGISTRATION This study was approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Espírito Santo (Protocol No. 2091172; CAAE No. 52839116.3.0000.5060). All research participants gave their informed consent.
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Affiliation(s)
- Cleodice Alves Martins
- Graduate Program Nutrition and Health, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29040-090, Brazil
| | - Camila Bruneli do Prado
- Graduate Program Collective Health, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29040-090, Brazil
| | - Júlia Rabelo Santos Ferreira
- Graduate Program Collective Health, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29040-090, Brazil
| | - Eliana Zandonade
- Graduate Program Collective Health, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29040-090, Brazil
| | - Olívia Maria de Paula Alves Bezerra
- Department of Family Medicine, Mental and Collective Health, Medical School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Luciane Bresciani Salaroli
- Graduate Program Nutrition and Health, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29040-090, Brazil.
- Graduate Program Collective Health, Health Sciences Center, Federal University of Espírito Santo, Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29040-090, Brazil.
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Phillips SP, O’Connor M, Vafaei A. Women suffer but men die: survey data exploring whether this self-reported health paradox is real or an artefact of gender stereotypes. BMC Public Health 2023; 23:94. [PMID: 36635656 PMCID: PMC9837889 DOI: 10.1186/s12889-023-15011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Susan P. Phillips
- grid.410356.50000 0004 1936 8331Dept. of Family Medicine, Queen’s University, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Dept. of Public Health Sciences, Queen’s University, Kingston, ON Canada
| | - Madlen O’Connor
- grid.410356.50000 0004 1936 8331Dept. of Family Medicine, Queen’s University, Kingston, ON Canada
| | - Afshin Vafaei
- grid.410356.50000 0004 1936 8331Dept. of Family Medicine, Queen’s University, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Dept. of Public Health Sciences, Queen’s University, Kingston, ON Canada
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Suso-Palau D, López-Cuadrado T, Duque-León D, Ortiz C, Galán I. Predictive capacity of self-rated health on all-cause mortality in Spain: differences across sex, age and educational level. J Epidemiol Community Health 2022; 76:jech-2021-217965. [PMID: 35764387 DOI: 10.1136/jech-2021-217965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Daniel Suso-Palau
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain
- Imbanaco Clinic - QuirónSalud Group, Cali, Colombia
| | - Teresa López-Cuadrado
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain
- Department of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cristina Ortiz
- Department of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Iñaki Galán
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain
- Department of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
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Alaba OA, Hongoro C, Thulare A, Lukwa AT. Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7114. [PMID: 34281051 PMCID: PMC8296912 DOI: 10.3390/ijerph18137114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/01/2021] [Accepted: 06/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The United Nations' 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for "leaving no one behind". However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa's and India's Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children's health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. METHODS Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. RESULTS The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (-0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother's education, and mother's age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. CONCLUSIONS The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother's education, and mother's age. In conclusion, if socioeconomic inequalities in children's health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely "some under-five children will be left behind".
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Affiliation(s)
- Olufunke A. Alaba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
| | - Charles Hongoro
- Developmental, Capable and Ethical State, Human Sciences Research Council, Pretoria 0001, South Africa;
- School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Aquina Thulare
- National Department of Health, Pretoria 0001, South Africa;
| | - Akim Tafadzwa Lukwa
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa;
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Wang L, Tang Y, Roshanmehr F, Bai X, Taghizadeh-Hesary F, Taghizadeh-Hesary F. The Health Status Transition and Medical Expenditure Evaluation of Elderly Population in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136907. [PMID: 34199100 PMCID: PMC8296990 DOI: 10.3390/ijerph18136907] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Because of the rapid expansion of the aging population in China, their health status transition and future medical expenditure have received increasing attention. This paper analyzes the health transition of the elderly and how their health transition impacts medical expenditures. At the same time, feasible policy suggestions are provided to respond to the rising medical expenditure and the demand for social care. (2) Methods: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 and analyzed using the Markov model and the Two-Part model (TPM) to forecast the size of the elderly population and their medical expenditures for the period 2020-2060. (3) Results: The study indicates that: (1) for the elderly with a mild disability, the probability of their health improvement is high; in contrast, for the elderly with a moderate or severe disability, their health deterioration is almost certain; (2) the frequency of the diagnosis and treatments of the elderly is closely related to their health status and medical expenditure; alternatively, as the health status deteriorates, the intensity of the elderly individuals' acceptance of their diagnosis and treatment increases, and so does the medical expense; (3) the population of the elderly with mild and moderate disability demonstrates an inverted "U"-shape, which reaches a peak around 2048, whereas the elderly with severe disability show linear growth, being the target group for health care; (4) with the population increase of the elderly who have severe disability, the medical expenditure increases significantly and poses a huge threat to medical service supply. Conclusions: It is necessary to provide classified and targeted health care according to the health status of the elderly. In addition, improving the level of medical insurance, establishing a mechanism for sharing medical expenditure, and adjusting the basic demographic structure are all important policy choices.
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Affiliation(s)
- Lianjie Wang
- School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou 310018, China;
| | - Yao Tang
- School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou 310018, China;
- Correspondence: (Y.T.); (F.T.-H.)
| | - Farnaz Roshanmehr
- Shibata Laboratory, School of Advanced Science and Engineering, Waseda University, Tokyo 162-8480, Japan;
- Kagawa Nutrition University, Saitama 350-0288, Japan
| | - Xiao Bai
- School of Finance, Zhejiang University of Finance and Economics, Hangzhou 310018, China;
| | - Farzad Taghizadeh-Hesary
- Clinical Oncology Department, Shahid Beheshti University of Medical Sciences, Tehran 19857-17443, Iran;
| | - Farhad Taghizadeh-Hesary
- Social Science Research Institute, Tokai University, Tokyo 259-1292, Japan
- Correspondence: (Y.T.); (F.T.-H.)
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Shu Z, Xiao J, Dai X, Han Y, Liu Y. Effect of family "upward" intergenerational support on the health of rural elderly in China: Evidence from Chinese Longitudinal Healthy Longevity Survey. PLoS One 2021; 16:e0253131. [PMID: 34143838 PMCID: PMC8213075 DOI: 10.1371/journal.pone.0253131] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/01/2021] [Indexed: 11/21/2022] Open
Abstract
As health challenging rural elderly in an aging population, more attention is being paid on impact of family intergenerational support on the health of the elderly. This paper investigates the effects of children's intergenerational economic support and non-economic support on physical, mental, and functional health of rural elderly in China in the mean while. This paper applies the 2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS), in particular, applying exploratory factor analysis to ascertain latent variables and Structural Equation Model (SEM), and analyzes the impacts of "Upward" intergenerational support on health of rural elderly. As resulted, after controlling the socioeconomic status of the rural elderly, the family "upward" intergenerational support influences the elderly's physical health at a percentage of 11.7%, mental health 29.8%, and physiological function 12.6%. Moreover, "Upward" economic support has a positive effect on physiological function (P<0.05). "Upward" non-economic support has negative effects on physiological function and mental health (P<0.05), while it has a positive effect on physical health. In addition, economically independent rural elderly are more likely to benefit from the health of "upward" intergenerational support, especially mental health. In particular, those results are robust. "Upward" intergenerational support plays an important role for the health of rural elderly. For the rural elderly of economic independence, to improve the quality of care and spiritual support, it is important to solve the health problems. In addition, it is necessary to build a comprehensive old-age security and support system for family, community, and society jointly to improve the health of the rural elderly.
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Affiliation(s)
- Zhan Shu
- School of Public Administration, Central China Normal University, Wuhan, Hubei Province, P.R.China
- Center for Labor and Social Security, Central China Normal University, Wuhan, Hubei Province, P.R.China
| | - Jinguang Xiao
- School of Public Administration, Central China Normal University, Wuhan, Hubei Province, P.R.China
| | - Xianhua Dai
- School of Public Administration, Central China Normal University, Wuhan, Hubei Province, P.R.China
- Center for Labor and Social Security, Central China Normal University, Wuhan, Hubei Province, P.R.China
| | - Yu Han
- School of Public Administration, Central China Normal University, Wuhan, Hubei Province, P.R.China
| | - Yingli Liu
- School of Public Administration, Central China Normal University, Wuhan, Hubei Province, P.R.China
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Healthy aging predicts mortality risks: Results from the Korean longitudinal study of aging (2006-2014). Arch Gerontol Geriatr 2021; 94:104333. [PMID: 33516975 DOI: 10.1016/j.archger.2020.104333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION While there has been some gerontological research on healthy aging, few studies have identified a reasonable health status for the older adults. Guided by the four healthy aging concepts in studies from the US and Spain, this study sought to determine a useful definition for Korean older adults by examining the associations between each of the four healthy aging definitions and mortality. METHODS A longitudinal analysis was conducted based on the 2,960 older people (65 years or older) who participated in the Korean Longitudinal Study of Aging (2006-2014). Four healthy aging gradient definitions (Rowe and Kahn, Group Ⅰ, Group II, and Group III) were determined: absence of disease, free of disability, physical and cognitive function, and engagement with life. RESULTS The young old who failed to achieve healthy aging were found to have a higher risk of mortality in all four healthy aging gradient definitions in both males (HR range from 4.15 to 5.39) and females (HR range from 4.07 to 9.55). In old old, however, the unhealthy aging mortality risk in Rowe and Kahn's definition was disappeared, but predominant mortality risks were found in Group III for both male (HR = 3.16, 95% CI 1.67 - 5.98) and female (HR = 3.65, 95% CI 1.36 - 9.81) CONCLUSION: To promote healthy aging, we suggest that the definition for the young old includes rigid disease criteria, and old old emphasize functional ability. Age-specific aims for healthy aging may be useful for defining healthy aging.
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Di Lego V, Di Giulio P, Luy M. Gender Differences in Healthy and Unhealthy Life Expectancy. INTERNATIONAL HANDBOOK OF HEALTH EXPECTANCIES 2020. [DOI: 10.1007/978-3-030-37668-0_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gender differences in the effect of self-rated health (SRH) on all-cause mortality and specific causes of mortality among individuals aged 50 years and older. PLoS One 2019; 14:e0225732. [PMID: 31800615 PMCID: PMC6892490 DOI: 10.1371/journal.pone.0225732] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/11/2019] [Indexed: 11/19/2022] Open
Abstract
Although different gender associations between self-rated health (SRH) and mortality have been reported, the results of the respective studies have been inconsistent and little is known about the cause-specific relation of mortality with SRH by gender. Therefore, to evaluate the gender differences in all-cause or specific causes of mortality by SRH, this retrospective cohort study was conducted using the data of 19,770 Korean adults aged 50 years and over who underwent health screening at Seoul National University Hospital between March 1995 and December 2008. SRH was surveyed using a simple questionnaire, and the all-cause mortality and cause-specific mortality were followed up from baseline screening until December 31, 2016. Results showed that the relationship between SRH and all-cause mortality differed by gender, and the differences also varied depending on the cause of death. In men, the adjusted hazard ratio (aHR) of all-cause mortality was higher in the poor SRH group than the very good SRH groups even after adjustment for socio-demographic, clinical, and behavioral risk factors (aHR:1.97, 95% CI 1.51-2.56), and these results were similar to those for cancer, cardiovascular, and respiratory disease mortalities (aHR:1.52, 95% CI 0.93-2.50; aHR: 2.11, 95% CI 1.19-3.74; aHR:10.30, 95% CI 2.39-44.44, respectively). However, in women, the association between SRH and all-cause mortality was insignificant, and inverse relationships were found for cardiovascular and respiratory disease mortalities in the poor and very good SRH groups. Cancer mortality had a positive relation with SRH (aHR: 1.14, 95% CI 0.75-1.72; aHR: 2.58, 95% CI 1.03-6.48; aHR: 0.49, 95% CI 0.24-0.98; aHR: 0.15, 95% CI 0.04-0.57: all-cause, cancer, cardiovascular, and respiratory disease mortalities, respectively). Clinicians need to take these gender differences by SRH into account when evaluating the health status of over-middle aged adults.
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Baker TA, Vásquez E, Minahan JA. Variability of Pain Outcomes and Physical Activity Among a Diverse Sample of Older Men: Is It More Than Just Race? Gerontol Geriatr Med 2019; 5:2333721419878587. [PMID: 31633001 PMCID: PMC6767716 DOI: 10.1177/2333721419878587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/24/2022] Open
Abstract
There is a compendium of data documenting the increasing number of older adults.
This suggests the continued need to understand identified health outcomes across
domains of pain and physical activity, particularly among older men. Therefore,
the aim of this study was to evaluate race similarities and/or differences in
pain and rates of physical activity among White, Black, and Hispanic men 60+
years of age. Data were taken from the Health and Retirement Study, a
longitudinal panel study surveying a representative sample of people in the
United States. Logistic regression analysis was used to examine associations
between race and pain and the odds of regular physical activity. Results showed
that Black men were less likely to participate in light or moderate/vigorous
physical activity. Similarly, pain increased the odds of physical activity among
Hispanics, but decreased the odds of physical activity among White men. Findings
may reflect a number of factors that impact the well-being of what it means to
experience pain and physical functioning, while also assuming a masculine
identity. This perspective may allow for a better understanding of short- and
long-term implications of the pain experience and the pain and physical
functioning dyad among this group of men.
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Evans MC, Cobb S, Smith J, Bazargan M, Assari S. Depressive Symptoms among Economically Disadvantaged African American Older Adults in South Los Angeles. Brain Sci 2019; 9:E246. [PMID: 31546718 PMCID: PMC6826709 DOI: 10.3390/brainsci9100246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although social, behavioral, and health factors correlate with depressive symptoms, less is known about these links among economically disadvantaged African American (AA) older adults. OBJECTIVE To study social, behavioral, and health correlates of depressive symptoms among economically disadvantaged AA older adults. METHODS This survey was conducted in South Los Angeles between 2015 and 2018. A total number of 740 AA older adults (age ≥55 years) were entered to this study. Independent variables were gender, age, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, chronic medical conditions (CMCs), and pain intensity. The dependent variable was depressive symptoms. Linear regression model was used to analyze the data. RESULTS Age, financial difficulties, smoking, CMCs, and pain intensity were associated with depressive symptoms. Gender, educational attainment, living arrangement, marital status, and drinking were not associated with depressive symptoms. CONCLUSION Factors such as age, financial difficulties, smoking, CMCs, and pain may inform programs that wish to screen high risk economically disadvantaged AA older adults for depressive symptoms.
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Affiliation(s)
- Meghan C Evans
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - James Smith
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
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Older women are frailer, but less often die then men: a prospective study of older hospitalized people. Maturitas 2019; 128:81-86. [PMID: 31561828 DOI: 10.1016/j.maturitas.2019.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/17/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital. STUDY DESIGN We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up. MAIN OUTCOME MEASURES People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year. RESULTS Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27-4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50-2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34-0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06-1.91) during the year after hospital discharge. CONCLUSION Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the 'male-female health-survival paradox' to acutely ill patient groups.
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Assari S, Smith J, Bazargan M. Depression Fully Mediates the Effect of Multimorbidity on Self-Rated Health for Economically Disadvantaged African American Men but Not Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1670. [PMID: 31091652 PMCID: PMC6572520 DOI: 10.3390/ijerph16101670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/17/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
Background. Although chronic medical conditions (CMCs), depression, and self-rated health (SRH) are associated, their associations may depend on race, ethnicity, gender, and their intersections. In predominantly White samples, SRH is shown to better reflect the risk of mortality and multimorbidity for men than it is for women, which suggests that poor SRH among women may be caused not only by CMCs, but also by conditions like depression and social relations-a phenomenon known as "the sponge hypothesis." However, little is known about gender differences in the links between multimorbidity, depression, and SRH among African Americans (AAs). Objective. To study whether depression differently mediates the association between multimorbidity and SRH for economically disadvantaged AA men and women. Methods. This survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 AA older adults (age ≥ 55 years) were enrolled in this study, of which 266 were AA men and 474 were AA women. The independent variable was the number of CMCs. The dependent variable was SRH. Age and socioeconomic status (educational attainment and marital status) were covariates. Depression was the mediator. Gender was the moderator. Structural Equation Modeling (SEM) was used to analyze the data. Results. In the pooled sample that included both genders, depression partially mediated the effect of multimorbidity on SRH. In gender specific models, depression fully mediated the effects of multimorbidity on SRH for AA men but not AA women. For AA women but not AA men, social isolation was associated with depression. Conclusion. Gender differences exist in the role of depression as an underlying mechanism behind the effect of multimorbidity on the SRH of economically disadvantaged AA older adults. For AA men, depression may be the reason people with multimorbidity report worse SRH. For AA women, depression is only one of the many reasons individuals with multiple CMCs report poor SRH. Prevention of depression may differently influence the SRH of low-income AA men and women with multimorbidity.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - James Smith
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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Jung MS, Lee KS, Kim M, Yun H. Gender-Specific Relationship Between Executive Function and Self-Rated Health. Osong Public Health Res Perspect 2019; 10:93-101. [PMID: 31065536 PMCID: PMC6481577 DOI: 10.24171/j.phrp.2019.10.2.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Mi Sook Jung
- Chungnam National University, College of Nursing, Daejeon, Korea
| | - Kyoung Suk Lee
- Seoul National University, College of Nursing, the Research Institute of Nursing Science, Seoul, Korea
| | - Mijung Kim
- Chungnam National University, College of Nursing, Daejeon, Korea
| | - Hyeri Yun
- Chungnam National University, College of Nursing, Daejeon, Korea
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Assari S, Smith J, Bazargan M. Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091522. [PMID: 31036795 PMCID: PMC6538989 DOI: 10.3390/ijerph16091522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/08/2023]
Abstract
Background: The association between age and health-related quality of life (HRQoL) is still under debate. While some research shows older age is associated with better HRQoL, other studies show no or negative association between age and HRQoL. In addition, while the association between age and HRQoL may depend on race, ethnicity, gender, and their intersections, most previous research on this link has been performed in predominantly White Middle Class. Objective: To explore gender differences in the association between age and mental and physical HRQoL in a sample of economically disadvantaged African American (AA) older adults. Methods: This cross-sectional survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 economically disadvantaged AA older adults (age ≥ 55 years) were enrolled in this study, using non-random sampling. This includes 266 AA men and 474 AA women. The independent variable of interest was age. Dependent variables of interest were physical component scores (PCS) and mental component scores (MCS), two main summary scores of the HRQoL, measured using Short Form-12 (SF-12). Gender was the moderator. Socioeconomic status (educational attainment and financial difficulty) were covariates. Linear regression models were used to analyze the data. Results: AA women reported worse PCS; however, gender did not impact MCS. In the pooled sample, high age was associated with better PCS and MCS. In the pooled sample, a significant interaction was found between gender and age on PCS, suggesting a stronger effect of age on PCS for AA men than AA women. In gender-stratified models, older age was associated with better PCS for AA men but not AA women. Older age was similarly and positively associated with better MCS for AA men and women. Conclusions: There may be some gender differences in the implications of ageing for the physical HRQoL of AA older adults. It is unclear how old age may have a boosting effect on physical HRQoL for AA men but not AA women. Future research should test gender differences in the effect of age on physical health indicators such as chronic disease as well as cognitive processes involved in the evaluation of own's health in AA men and women.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - James Smith
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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Gu H, Kou Y, You H, Xu X, Yang N, Liu J, Liu X, Gu J, Li X. Measurement and decomposition of income-related inequality in self-rated health among the elderly in China. Int J Equity Health 2019; 18:4. [PMID: 30621687 PMCID: PMC6325844 DOI: 10.1186/s12939-019-0909-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population ageing in China has brought increasing attention to the health inequalities of the elderly. The purpose of this paper is to measure income-related health inequality among the elderly in China and decompose its causes. METHODS The data are from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2013, which contains 6176 individuals aged 60 years and above. A multiple linear regression model was used to analyze the influencing factors of self-rated health (SRH) among the elder people. Furthermore, the corrected concentration index were used to measure income-related health inequality. Wagstaff-type decomposition analysis was employed to explore the cause of inequality. The measurement and decomposition of health inequality was also performed separately in the male and female subgroups. RESULTS Most elderly declared their health status as "fair" (51.33%) or "poor" (21.88%). Income, gender, residence, region, health insurance and other factors had significant association with SRH (P < 0.05). The corrected concentration index (CCI) was 0.06, indicating pro-rich inequality in health among the elderly. Decomposition analyses revealed that the main contributors to health inequality included income, residence, region, health insurance, and employment. For female elderly, most of the inequality was due to residence (50.78%) and income (49.51%); for male elderly, most of the inequality was due to insurance (38.65%) and income (22.26%); for the total sample, employment had a negative contribution to health inequality (- 25.83%). CONCLUSION The findings confirm a high proportion of elderly with poor SRH, and health inequality in the Chinese. Some socioeconomic strategies should be conducted to reduce this health inequality among the elderly, such as reducing income disparities, consolidating health insurance schemes, and narrowing urban-rural and regional gaps. Older females with low incomes in rural areas are a vulnerable subgroup and warrant targeted policy attention.
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Affiliation(s)
- Hai Gu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Yun Kou
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Hua You
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Xinpeng Xu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Nichao Yang
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Jing Liu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Xiyan Liu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Jinghong Gu
- Nanjing Foreign Language School, Nanjing, China
| | - Xiaolu Li
- Department of Otolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Assari S, Lankarani MM, Piette JD, Aikens JE. Self-Rated Health and Glycemic Control in Type 2 Diabetes: Race by Gender Differences. J Racial Ethn Health Disparities 2018; 5:721-727. [PMID: 28779480 PMCID: PMC6378221 DOI: 10.1007/s40615-017-0416-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although some studies have shown a link between self-rated health (SRH) and glycemic control in type 2 diabetes (DM), other studies have failed to support this association. The purpose of this study was to determine whether these equivocal findings can be explained by specific interactions between gender, race, and SRH, as suggested by the intersectionality literature. METHODS This cross-sectional study included 287 patients with DM (85 Black men, 78 Black women, 64 White men, and 60 White women). After adjusting for demographic and medical factors, we regressed HbA1c on SRH with and without interactions between gender, race, and SRH. We conducted additional subgroup analyses to further characterize gender by race group differences. RESULTS Although there was no main effect of SRH upon HbA1c (b = .16, 95% CI: .08-.39), we found a significant interaction between gender and SRH on HbA1c (b = -.50, 95% CI: -.97 to -.03). In race by gender-stratified models, SRH (b = .53, 95% CI: .00-1.07) was associated with HbA1c in Black men. SRH was not associated with HbA1c in White men, White women, or Black women. CONCLUSION Combined race and gender differences may exist in the link between SRH and glycemic control in DM. Specifically, Black men with DM may be more attuned to the relationship between their overall health and their glycemic control.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Maryam Moghani Lankarani
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA
| | - John D Piette
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - James E Aikens
- Department of Family Medicine, Michigan Medicine, Ann Arbor, MI, USA
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Self-rated health and its association with all-cause mortality of older adults in Poland: The PolSenior project. Arch Gerontol Geriatr 2018; 79:13-20. [PMID: 30075413 DOI: 10.1016/j.archger.2018.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/29/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022]
Abstract
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.
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Yoshimitsu K, Tabira T, Kubota M, Ikeda Y, Inoue K, Akasaki Y. Factors affecting the self-rated health of elderly individuals living alone: a cross-sectional study. BMC Res Notes 2017; 10:512. [PMID: 29073932 PMCID: PMC5658978 DOI: 10.1186/s13104-017-2836-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/19/2017] [Indexed: 11/22/2022] Open
Abstract
Objective In Japan, the number of elderly individuals living alone is continuing to increase as society ages. Although studies have considered quality of life, life expectancy, and gender differences in elderly individuals living alone, only a few have considered the health and lifestyle of these individuals. Therefore, we aimed to investigate the factors that affect the self-rated health of elderly individuals living alone to understand this group and how best to offer them support. Results We include 113 individuals. There was a significant difference (P < 0.05) in some characteristics (e.g., age, chronic illness, frequency of hospital visits in 1 month, and caregivers), activities of daily living (e.g., motor tasks), and instrumental activities of daily living (e.g., household affairs, heavy housework, outdoor household, and outdoor activities).
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Affiliation(s)
- Koji Yoshimitsu
- Department of Basic Occupational Therapy, Faculty of Medicine, School of Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Takayuki Tabira
- Department of Basic Occupational Therapy, Faculty of Medicine, School of Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masatomo Kubota
- Department of Basic Occupational Therapy, Faculty of Medicine, School of Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yuriko Ikeda
- Department of Basic Occupational Therapy, Faculty of Medicine, School of Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Kazuhiro Inoue
- Department of Basic Occupational Therapy, Faculty of Medicine, School of Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yasuaki Akasaki
- Department of Basic Occupational Therapy, Faculty of Medicine, School of Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
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Duboz P, Boëtsch G, Gueye L, Macia E. Self-rated health in Senegal: A comparison between urban and rural areas. PLoS One 2017; 12:e0184416. [PMID: 28886107 PMCID: PMC5590920 DOI: 10.1371/journal.pone.0184416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Although the relationship between mortality and self-rated health has been demonstrated in sub-Saharan Africa, information in this area is rudimentary. In Senegal, no study has been undertaken comparing self-rated health between urban and rural areas. The objective of this study is therefore to compare self-rated health and its main predictors in Dakar and in a rural isolated area, Tessekere municipality, taking into account socio-demographic and economic factors, social relations, as well as measures of physical and mental health. Material and methods This study was carried out in 2015 on a population sample of 1000 individuals living in Dakar and 500 individuals living in the municipality of Tessekere, constructed using the quota method. Self-rated health, health variables, psychosocial, sociodemographic and economic characteristics were collected during face-to-face interviews. Statistical analyses used were Chi-square tests and binary logistic regressions. Results Results show that self-rated health in Senegalese urban area (Dakar) is better than in rural area (Tessekere), but the determinants of self-rated health partly differ between these two environments. Age and gender play a fundamental role in self-rated health as much in Dakar as in Tessekere but diabetes and social support play a role in self-rated health only in urban environment, whereas economic well-being is associated to self-rated health only in rural area. Conclusion The analyses carried out in these two environments show that despite the existence of common determinants (age, gender, stress), the determinants for formulating an answer to the question of self-rated health differ. People’s social and cultural environments thus play a fundamental role in the process of rating one’s health and, in the short and long term, in the mortality rate.
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Affiliation(s)
- Priscilla Duboz
- UMI 3189 ESS (CNRS/UCAD/UGB/USTTB/CNRST), Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop de Dakar (UCAD), Dakar-Fann, Senegal
- Tessekere International Human-Environment Observatory (Labex DRIIHM, INEE, CNRS), Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop de Dakar (UCAD), Dakar-Fann, Senegal
- * E-mail:
| | - Gilles Boëtsch
- UMI 3189 ESS (CNRS/UCAD/UGB/USTTB/CNRST), Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop de Dakar (UCAD), Dakar-Fann, Senegal
- Tessekere International Human-Environment Observatory (Labex DRIIHM, INEE, CNRS), Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop de Dakar (UCAD), Dakar-Fann, Senegal
| | - Lamine Gueye
- UMI 3189 ESS (CNRS/UCAD/UGB/USTTB/CNRST), Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop de Dakar (UCAD), Dakar-Fann, Senegal
| | - Enguerran Macia
- UMI 3189 ESS (CNRS/UCAD/UGB/USTTB/CNRST), Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Université Cheikh Anta Diop de Dakar (UCAD), Dakar-Fann, Senegal
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Abstract
BACKGROUND Previous studies have reported that self-rated health (SRH) predicts subsequent mortality. However, less is known about the association between SRH and functional ability. The aim of this study was to examine whether SRH predicts decline in basic activities of daily living (ADL), even after adjustment for depression, among community-dwelling older adults in Japan. METHODS A three-year prospective cohort study was conducted among 654 residents aged 65 years and older without disability in performing basic ADL at baseline. SRH was assessed using a visual analogue scale (range; 0-100), and dichotomized into low and high groups. Information on functional ability, sociodemographic factors, depressive symptoms, and medical conditions were obtained using a self-administered questionnaire. Logistic regression analysis was used to examine the association between baseline SRH and functional decline three years later. RESULTS One hundred and eight (16.5%) participants reported a decline in basic ADL at the three-year follow-up. Multiple logistic regression analysis showed that the low SRH group had a higher risk for functional decline compared to the high SRH group, even after controlling for potential confounding factors (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.3-4.4). Furthermore, a 10-point difference in SRH score was associated with subsequent functional decline (OR = 1.37; 95% CI = 1.16-1.61). CONCLUSIONS SRH was an independent predictor of functional decline. SRH could be a simple assessment tool for predicting the loss or maintenance of functional ability in community-dwelling older adults. Positive self-evaluation might be useful to maintain an active lifestyle and stay healthy.
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The role of gender in the association between self-rated health and mortality among older adults in Santiago, Chile: A cohort study. PLoS One 2017; 12:e0181317. [PMID: 28719627 PMCID: PMC5515418 DOI: 10.1371/journal.pone.0181317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/29/2017] [Indexed: 11/25/2022] Open
Abstract
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.
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Bamia C, Orfanos P, Juerges H, Schöttker B, Brenner H, Lorbeer R, Aadahl M, Matthews CE, Klinaki E, Katsoulis M, Lagiou P, Bueno-de-Mesquita HBA, Eriksson S, Mons U, Saum KU, Kubinova R, Pajak A, Tamosiunas A, Malyutina S, Gardiner J, Peasey A, de Groot LC, Wilsgaard T, Boffetta P, Trichopoulou A, Trichopoulos D. 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. Maturitas 2017; 103:37-44. [PMID: 28778331 DOI: 10.1016/j.maturitas.2017.06.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/27/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
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".
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Affiliation(s)
- Christina Bamia
- National and Kapodistrian University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, 115 27 Athens, Greece; Hellenic Health Foundation, 115 27, Athens, Greece.
| | - Philippos Orfanos
- National and Kapodistrian University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, 115 27 Athens, Greece; Hellenic Health Foundation, 115 27, Athens, Greece
| | | | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany; Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
| | - Roberto Lorbeer
- Institute for Community Medicine, University Medicine, Ernst Moritz Arndt University Greifswald, 17475 Greifswald, Germany; Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, 80336 Munich, Germany
| | - Mette Aadahl
- Research Centre for Prevention and Health, Center for Health, The Capital Region of Denmark, 2600 Glostrup, Denmark
| | - Charles E Matthews
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Nutritional Epidemiology Branch, Bethesda, MD, 20892-9704, USA
| | | | | | - Pagona Lagiou
- National and Kapodistrian University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, 115 27 Athens, Greece; Hellenic Health Foundation, 115 27, Athens, Greece; Department of Epidmiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - H B As Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, 3508 GA Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, W2 1 PG London, United Kingdom; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Sture Eriksson
- Umeå University, Department of Geriatrics, SE 90185 Umeå, Sweden
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Ruzena Kubinova
- National Institute of Public Health, Šrobarova 48, 10042 Prague 10, Czech Republic
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Faculty of Health Sciences, 31-137 Krakow, Poland
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukilėlių av. 17, Kaunas LT-50161, Lithuania
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, 630089, Novosibirsk, Russia; Novosibirsk State Medical University, 630091, Novosibirsk, Russia
| | - Julian Gardiner
- Department of Epidemiology and Public Health, University College London, WC1E 6BT, UK
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, WC1E 6BT, UK
| | - Lisette Cpgm de Groot
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, NL-6700 EV Wageningen, The Netherlands
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - Paolo Boffetta
- Hellenic Health Foundation, 115 27, Athens, Greece; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Antonia Trichopoulou
- National and Kapodistrian University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, 115 27 Athens, Greece; Hellenic Health Foundation, 115 27, Athens, Greece
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, 115 27, Athens, Greece; Department of Epidmiology, Harvard School of Public Health, Boston, MA 02115, USA; Bureau of Epidemiologic Research, Academy of Athens, 115 27Athens, Greece
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Zajacova A, Huzurbazar S, Todd M. Gender and the structure of self-rated health across the adult life span. Soc Sci Med 2017; 187:58-66. [PMID: 28654822 DOI: 10.1016/j.socscimed.2017.06.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/21/2017] [Accepted: 06/15/2017] [Indexed: 11/24/2022]
Abstract
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.
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Martinson ML, Teitler JO, Plaza R, Reichman NE. Income disparities in cardiovascular health across the lifespan. SSM Popul Health 2016; 2:904-913. [PMID: 29349197 PMCID: PMC5757909 DOI: 10.1016/j.ssmph.2016.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/13/2016] [Accepted: 10/21/2016] [Indexed: 01/04/2023] Open
Abstract
Using data from the 1999-2014 National Health and Nutrition Examination Survey (n ~ 46,000), this study documents income disparities in the age patterning of cardiovascular conditions across the lifespan in the U.S. The conditions were assessed from laboratory test results, self-reports of medications used to treat specific conditions, and anthropometric measurements, allowing us to capture whether individuals at given ages had developed the various conditions, regardless of previous diagnosis and treatment. We found evidence of large income disparities in the presence of cardiovascular conditions and risk factors for females, smaller disparities in the same conditions for males, and few disparities that increased with age for either gender. Results were very similar when considering disparities by education instead of income. The findings suggest that the widening socioeconomic gradients in health over the lifespan found in many previous studies-which have generally focused on self-rated health, activity limitations, or diagnosed conditions-reflect, at least to some extent, differences in diagnosis, treatment, and management of health conditions rather than age-related differences in developing them. The findings also suggest that preventive healthcare is not an important source of socioeconomic disparities in cardiovascular health in the U.S., at least for men. The observed patterns of income disparities in cardiovascular conditions over the lifespan are more consistent with theories of early life conditions and the imprinting of health endowments and susceptibilities early in life than with cumulative life exposure or stress hypotheses.
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Affiliation(s)
- Melissa L. Martinson
- University of Washington, School of Social Work, 4101 15th Avenue NE, Seattle, WA 98105, United States
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Assari S. Gender differences in the predictive role of self-rated health on short-term risk of mortality among older adults. SAGE Open Med 2016; 4:2050312116666975. [PMID: 27651902 PMCID: PMC5019363 DOI: 10.1177/2050312116666975] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/03/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Despite the well-established association between self-rated health and mortality, research findings have been inconsistent regarding how men and women differ on this link. Using a national sample in the United States, this study compared American male and female older adults for the predictive role of baseline self-rated health on the short-term risk of mortality. METHODS This longitudinal study followed 1500 older adults (573 men (38.2%) and 927 women (61.8%)) aged 66 years or older for 3 years from 2001 to 2004. The main predictor of interest was self-rated health, which was measured using a single item in 2001. The outcome was the risk of all-cause mortality during the 3-year follow-up period. Demographic factors (race and age), socio-economic factors (education and marital status), and health behaviors (smoking and drinking) were covariates. Gender was the focal moderator. We ran logistic regression models in the pooled sample and also stratified by gender, with self-rated health treated as either nominal variables, poor compared to other levels (i.e. fair, good, or excellent) or excellent compared to other levels (i.e. good, fair, or poor), or an ordinal variable. RESULTS In the pooled sample, baseline self-rated health predicted mortality risk, regardless of how the variable was treated. We found a significant interaction between gender and poor self-rated health, indicating a stronger effect of poor self-rated health on mortality risk for men compared to women. Gender did not interact with excellent self-rated health on mortality. CONCLUSION Perceived poor self-rated health better reflects risk of mortality over a short period of time for older men compared to older women. Clinicians may need to take poor self-rated health of older men very seriously. Future research should test whether the differential predictive validity of self-rated health based on gender is due to a different meaning of poor self-rated health for older men and women and whether poor self-rated health reflects different health statuses based on gender.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Gender differentials and old age survival in the Nairobi slums, Kenya. Soc Sci Med 2016; 163:107-16. [DOI: 10.1016/j.socscimed.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 06/01/2016] [Accepted: 07/02/2016] [Indexed: 11/21/2022]
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Caroli E, Weber-Baghdiguian L. Self-reported health and gender: The role of social norms. Soc Sci Med 2016; 153:220-9. [PMID: 26921837 DOI: 10.1016/j.socscimed.2016.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/04/2016] [Accepted: 02/14/2016] [Indexed: 11/20/2022]
Abstract
The role of social norms in accounting for the different attitudes of men and women with respect to health is still an open issue. In this research, we investigate the role of social norms associated with specific gender environments in the workplace in accounting for differences in health-reporting behaviours across men and women. Using the 2010 European Working Conditions Survey, we build a database containing 30,124 observations. We first replicate the standard result that women report worse health than men, whatever the health outcome we consider. We then proxy social norms by the gender structure of the workplace environment and study how the latter affects self-reported health for men and women separately. Our findings indicate that individuals in workplaces where women are a majority tend to report worse health than individuals employed in male-dominated work environments, be they men or women. These results are robust to controlling for a large array of working condition indicators, which allows us to rule out that the poorer health status reported by individuals working in female-dominated environments could be due to worse job quality. This evidence suggests that social norms associated with specific gender environments play an important role in explaining differences in health-reporting behaviours across gender, at least in the workplace.
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Affiliation(s)
- Eve Caroli
- PSL, University Paris Dauphine, LEDa-LEGOS, Paris School of Economics and IZA, France.
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Assari S, Lankarani MM, Burgard S. Black-white difference in long-term predictive power of self-rated health on all-cause mortality in United States. Ann Epidemiol 2015; 26:106-114. [PMID: 26803458 DOI: 10.1016/j.annepidem.2015.11.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/23/2015] [Accepted: 11/28/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite the well-established association between self-rated health (SRH) and mortality, limited information exists on Black-White differences in this link. Using a nationally representative sample of adults in the United States, the present study had four aims: (1) to assess whether the association between baseline SRH and all-cause mortality over a long follow-up differs for blacks and whites, (2) to test whether any race difference in the SRH-mortality link depends on how the SRH variable is treated (e.g., nominal, dichotomous, continuous), (3) to test if the SRH-mortality link or any differences in the association by race are explained by differences in objective health measures (chronic medical conditions [CMC]), and (4) to assess whether these associations vary by gender. METHODS Data came from the Americans' Changing Lives Study, a nationally representative longitudinal cohort of U.S. adults 25 years and older with up to 25 years of follow-up. The study followed 3361 blacks or whites for all-cause mortality between 1986 and 2011. The predictor of interest was a single-item measure of SRH in 1986, treated as a nominal, dichotomous (fair/poor vs. excellent/very good/good), and continuous variable. Confounders included baseline age, education, income, depressive symptoms, and CMC. Race (black vs. white) was the focal effect modifier. We ran Cox proportional hazard models for the pooled sample and also stratified by race and gender, before and after adjusting for CMC. RESULTS Regardless of how SRH was treated and for both men and women, we found significant interactions between race and SRH, indicating a stronger predictive role of SRH for all-cause mortality among whites compared to blacks. Before adjustment for chronic medical conditions, lower SRH was associated with higher risk of mortality among blacks and whites, but after adjustment, the SRH-mortality association was no longer significant among blacks. CONCLUSIONS Baseline SRH continues to predict long-term mortality among white but not black Americans after adjustment for chronic medical conditions at baseline, and these patterns are similar for men and women. Future research should test whether the differential predictive validity of SRH across race groups arises because SRH reflects different aspects of health of black and white Americans.
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Affiliation(s)
- Shervin Assari
- Department of Psychiatry, University of Michigan, Ann Arbor; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor.
| | | | - Sarah Burgard
- Department of Sociology, University of Michigan, Ann Arbor; Department of Epidemiology, University of Michigan, Ann Arbor; Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor
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Chen LK. Rethinking successful aging: Older female volunteers’ perspectives in Taiwan. ASIAN JOURNAL OF WOMENS STUDIES 2015. [DOI: 10.1080/12259276.2015.1072939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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The Health of India's Elderly Population: A Comparative Assessment Using Subjective and Objective Health Outcomes. JOURNAL OF POPULATION AGEING 2015; 8:245-259. [PMID: 26594258 PMCID: PMC4644192 DOI: 10.1007/s12062-015-9122-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 06/15/2015] [Indexed: 01/08/2023]
Abstract
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.
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Kodama S, Fujii N, Furuhata T, Sakurai N, Fujiwara Y, Hoshi T. Dietary quality and its structural relationships among equivalent income, emotional well-being, and a five-year subjective health in Japanese middle-aged urban dwellers. ACTA ACUST UNITED AC 2015; 73:30. [PMID: 26185622 PMCID: PMC4504118 DOI: 10.1186/s13690-015-0081-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/10/2015] [Indexed: 11/26/2022]
Abstract
Background Although dietary quality in middle-age and the prime age of a person’s work career might be determined by positive emotional well-being based on socioeconomic status (SES), causation among determinants of dietary quality still remains unclear. Our purpose was to elucidate the structural relationships among five-year prior dietary quality, equivalent income, emotional well-being, and a five-year subjective health by sex and age group separately. Methods In 2003, 10,000 middle-aged urban dwellers aged 40-64 years, who lived in ward A in the Tokyo metropolitan area, were randomly selected and a questionnaire survey was conducted by mail. In 2008, we made a follow-up survey for dwellers, and were able to gather their survival status. A total of 2507, middle-aged men (n = 1112) and women (n = 1395), were examined at baseline. We created three latent variables for a structural equation modeling (SEM), five-year subjective health reported in 2003 and in 2008, dietary quality of principle food groups diversity and eating behavior in 2003, and emotional well-being constructed by enjoyment & ikigai (meaning of life) and by close people in 2003. Equivalent income in 2003 was calculated as SES indicator. Results In the SEM analysis of both men and women, there was an indirect effect of the equivalent income on dietary quality and on five-year subjective health, via emotional well-being explained by ikigai and having comforting people close to the individuals, significantly. There tended to be a larger direct effect of emotional well-being on the dietary quality in men than in women, and also a larger effect accompanying with aging. In women, there was a large direct effect of equivalent income on dietary quality than in men. When examined comprehensively, there appeared to be a larger effect of five-year prior equivalent income on subjective health during five-year in men than in women. Conclusion This study suggests that it is necessary to support the improvement of dietary quality in middle age by considering the characteristics of sex and age group and also by providing supportive environment to enhance emotional well-being based on equivalent income, cooperating different field professionals to provide such as employment or community support program.
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Affiliation(s)
- Sayuri Kodama
- Department of Health and Nutrition, School of Human Ecology, Wayo Women's University, Chiba, Japan
| | - Nobuya Fujii
- Graduate School of Urban System Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Tadashi Furuhata
- Department of Health and Nutrition, School of Human Ecology, Wayo Women's University, Chiba, Japan
| | - Naoko Sakurai
- Graduate School of Medicine, The Jikei University, Tokyo, Japan
| | | | - Tanji Hoshi
- Graduate School of Urban System Science, Tokyo Metropolitan University, Tokyo, Japan
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Zhang H, Bago d'Uva T, van Doorslaer E. The gender health gap in China: A decomposition analysis. ECONOMICS AND HUMAN BIOLOGY 2015; 18:13-26. [PMID: 25867249 DOI: 10.1016/j.ehb.2015.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/09/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
Around the world, and in spite of their higher life expectancy, women tend to report worse health than men until old age. Explanations for this gender gap in self-perceived health may be different in China than in other countries due to the traditional phenomenon of son preference. We examine several possible reasons for the gap using the Chinese SAGE data. We first rule out differential reporting by gender as a possible explanation, exploiting information on anchoring vignettes in eight domains of health functioning. Decomposing the gap in general self-assessed health, we find that about 31% can be explained by socio-demographic factors, most of all by discrimination against women in education in the 20th century. A more complete specification including chronic conditions and health functioning fully explains the remainder of the gap (about 69%). Adding chronic conditions and health functioning also explains at least two thirds of the education contribution, suggesting how education may affect health. In particular, women's higher rates of arthritis, angina and eye diseases make the largest contributions to the gender health gap, by limiting mobility, increasing pain and discomfort, and causing sleep problems and a feeling of low energy.
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Affiliation(s)
- Hao Zhang
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Tinbergen Institute, The Netherlands.
| | - Teresa Bago d'Uva
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Tinbergen Institute, The Netherlands
| | - Eddy van Doorslaer
- Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Tinbergen Institute, The Netherlands
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Saedder EA, Lisby M, Nielsen LP, Bonnerup DK, Brock B. Number of drugs most frequently found to be independent risk factors for serious adverse reactions: a systematic literature review. Br J Clin Pharmacol 2015; 80:808-17. [PMID: 25677107 DOI: 10.1111/bcp.12600] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/23/2015] [Accepted: 01/27/2015] [Indexed: 12/01/2022] Open
Abstract
In order to reduce the numbers of medication errors (MEs) that cause adverse reactions (ARs) many authors have tried to identify patient-related risk factors. However, the evidence remains controversial. The aim was to review systematically the evidence on the relationship between patient-related risk factors and the risk of serious ARs. A systematic search in Pubmed, Embase, Cochrane Systematic Reviews, Psychinfo and SweMed+ was performed. Included full text articles were hand searched for further references. Peer reviewed papers including adults from primary and secondary healthcare were included if they clearly defined seriousness of the ARs and described correlations to risk factors by statistical analysis. A total of 28 studies were identified including 85,212 patients with 3385 serious ARs, resulting in an overall frequency of serious ARs in 4% of patients. Age, gender and number of drugs were by far the most frequently investigated risk factors. The total number of drugs was the most consistent correlated risk factor found in both univariate and multivariate analyses. The number of drugs is the most frequently documented independent patient-related risk factor for serious ARs in both the general adult population as well as in the elderly. The existing evidence is however conflicting due to heterogeneity of populations and study methods. The knowledge of patient-related risk factors for experiencing ARs could be used for electronic risk stratification of patients and thereby allocation of healthcare resources to high risk patients.
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Affiliation(s)
- Eva A Saedder
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Lisby
- Research Centre of Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Peter Nielsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Birgitte Brock
- Department of Biochemistry and Department of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
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Romero-Ortuno R, Fouweather T, Jagger C. Cross-national disparities in sex differences in life expectancy with and without frailty. Age Ageing 2014; 43:222-8. [PMID: 23917483 DOI: 10.1093/ageing/aft115] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND with continued ageing, levels of frailty are an increasing concern. Women live longer than men, but how life expectancies (LE) with frailty differ between men and women and whether sex differences are the same for all European countries is unknown. OBJECTIVE to compare sex differences in LE in phenotypic frailty categories and disability at age ≥50 between European countries. DESIGN the Survey of Health, Ageing and Retirement in Europe (SHARE). SUBJECTS a total of 50,351 people aged ≥50 from SHARE wave 4 (included countries: Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Slovenia, Spain, Sweden). METHODS the SHARE Frailty Instrument for Primary Care and the Global Activity Limitation Indicator were combined to define four phenotypic frailty and disability categories: robust, pre-frail, frail and severely limited. LEs with each state by sex and country were calculated using Sullivan's method. RESULTS at age 70, the LE robust ranged from 4.1 to 10.4 years (men) and 3.0 to 8.9 years (women), LE pre-frail from 0.8-3.1 years (men) and 2.2-5.5 years (women), LE frail from 0.1-1.8 years (men) and 0.4-5.5 years (women) and LE with severe activity limitation from 1.9 to 4.4 years (men) and 2.9 to 7.5 years (women). At all ages and both sexes the fewest years were spent frail. CONCLUSIONS this study is the first to compare differences in LE in frailty categories across European countries. In most European countries, years spent robust (free of frailty or limitation) are significantly less for women than men, perhaps due to socio-economic as well as biological factors.
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Affiliation(s)
- Roman Romero-Ortuno
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Co. Dublin, Ireland
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Moreno X, Huerta M, Albala C. [Global self-rated health and mortality in older people]. GACETA SANITARIA 2013; 28:246-52. [PMID: 24359681 DOI: 10.1016/j.gaceta.2013.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/28/2013] [Accepted: 07/29/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the association between global self-rated health and mortality in older people. METHODS A systematic review was performed. The inclusion criteria were longitudinal studies that assessed self-rated health with a single general question and samples of community-dwelling persons aged 60 years or more. Electronic databases were searched and references were reviewed. RESULTS We selected 18 studies published between 1993 and 2011. Six out of seven studies that analyzed men and women found a higher risk of dying among persons who rated their health as poor; the most frequent covariables were age, gender, chronic diseases, and functional status. Half of the studies that analyzed only men or women found a significant association. The effect of self-reported health on mortality was observed among people younger than 75 years. Results were not dependent on the length of follow-up. CONCLUSIONS The results confirm previous findings suggesting that a negative self-rating of general health predicts mortality. The mechanisms through which this indicator may predict mortality among older people could differ in men and women and need to be elucidated. The role of depression should be investigated, considering that the effect of self-rated health on mortality was not present when depression was included.
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Affiliation(s)
- Ximena Moreno
- Programa de Doctorado en Salud Pública, Escuela de Salud Pública, Universidad de Chile, Santiago, Chile.
| | - Martín Huerta
- Consultorio de Salud Rural Adriana Madrid, Ilustre Municipalidad de María Pinto, Servicio de Salud Metropolitano Occidente, Región Metropolitana, Santiago, Chile
| | - Cecilia Albala
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
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Onadja Y, Bignami S, Rossier C, Zunzunegui MV. The components of self-rated health among adults in Ouagadougou, Burkina Faso. Popul Health Metr 2013; 11:15. [PMID: 23926951 PMCID: PMC3750468 DOI: 10.1186/1478-7954-11-15] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 08/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background Although the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in Africa. In this study, we examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, age, and education level. Methods This study was based on 2195 individuals aged 15 years or older who participated in a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System. Logistic regression models were used to analyze the associations of poor SRH with chronic diseases, functional limitations, and depression, first in the whole sample and then stratified by sex, age, and education level. Results Poor SRH was strongly correlated with chronic diseases and functional limitations, but not with depression, suggesting that in this context, physical health probably makes up most of people’s perceptions of their health status. The effect of functional limitations on poor SRH increased with age, probably because the ability to circumvent or compensate for a disability diminishes with age. The effect of functional limitations was also stronger among the least educated, probably because physical integrity is more important for people who depend on it for their livelihood. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, or depression. Conclusions Our findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou, Burkina Faso. In-depth studies are needed to understand why and how these groups do so.
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Affiliation(s)
- Yentéma Onadja
- Département de démographie, Université de Montréal, 3150 rue Jean-Brillant, local C-5043, H3T 1N8 Montréal (Québec), Canada
| | - Simona Bignami
- Département de démographie, Université de Montréal, 3150 rue Jean-Brillant, local C-5043, H3T 1N8 Montréal (Québec), Canada
| | - Clémentine Rossier
- Institut Supérieur des Sciences de la Population (ISSP), Université de Ouagadougou, 03 BP 7118, Ouagadougou 03, Burkina Faso ; Institut national d'études démographiques (INED), 133 Boulevard Davout, 75980 Paris Cédex 20, France
| | - Maria-Victoria Zunzunegui
- Département de médecine sociale et préventive, Université de Montréal, 1420 Mont-Royal, H2V 4P3 Montréal (Québec), Canada ; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, 3875 rue Saint Urbain, 5e étage, H2W 1V1 Montréal (Québec), Canada
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Tiainen K, Luukkaala T, Hervonen A, Jylhä M. Predictors of mortality in men and women aged 90 and older: a nine-year follow-up study in the Vitality 90+ study. Age Ageing 2013; 42:468-75. [PMID: 23486170 DOI: 10.1093/ageing/aft030] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND information about the predictors of mortality among the oldest-old is limited. Also possible gender differences are poorly known. OBJECTIVE to examine the predictors of mortality among individuals aged 90 and older, focusing on differences between men and women. We also analysed gender differences in survival at different levels of mobility and activities in daily living (ADL). DESIGN this 9-year follow-up study is part of the Vitality 90+ study, a population-based study of people aged 90 and older. SUBJECTS all inhabitants aged 90 and older in the area of Tampere, Finland were contacted, irrespective of health or dwelling place. The study population consisted of 171 men and 717 women. METHODS data were collected with a mailed questionnaire asking questions concerning ADL and mobility, self-rated health, chronic conditions and socio-economic factors. The participation rate was 79%. Cox regression enter models were used for the analysis. RESULTS older age, male gender, disability in ADL and mobility, poor self-rated health and institutionalisation increased the risk of mortality in the total study group. In age-adjusted Cox regression models, ADL and mobility were stronger predictors in men than in women (gender interactions, P < 0.001). Among those who were partly but not totally dependent in ADL or mobility women survived longer than men. CONCLUSION the same health indicators that are important at younger old age also predict mortality in the oldest-old. Disability increases the likelihood of death more in men than women. At a very old age, women survive longer with moderate disability than do men.
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Affiliation(s)
- Kristina Tiainen
- Gerontology Research Center and School of Health Sciences, University of Tampere, Finland.
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Zheng H, Thomas PA. Marital status, self-rated health, and mortality: overestimation of health or diminishing protection of marriage? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2013; 54:128-43. [PMID: 23321283 PMCID: PMC9052865 DOI: 10.1177/0022146512470564] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
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.
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Affiliation(s)
- Hui Zheng
- The Ohio State University, Columbus, OH 43210, USA.
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Kimura M, Moriyasu A, Kumagai S, Furuna T, Akita S, Kimura S, Suzuki T. Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial. BMC Geriatr 2013; 13:8. [PMID: 23343312 PMCID: PMC3560222 DOI: 10.1186/1471-2318-13-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 01/12/2013] [Indexed: 11/10/2022] Open
Abstract
Background The fastest growing age group globally is older adults, and preventing the need for long-term nursing care in this group is important for social and financial reasons. A population approach to diet and physical activity through the use of social services can play an important role in prevention. This study examined the effectiveness of a social health program for community-dwelling older adults aimed at introducing and promoting physical activity in the home at each individual’s pace, helping participants maintain good dietary habits by keeping self-check sheets, and determining whether long-standing unhealthy or less-than-ideal physical and dietary habits can be changed. Method This cluster randomized trial conducted at 6 community centers in an urban community involved 92 community-dwelling older adults aged 65–90 years. The intervention group (3 community centers; n = 57) participated in the social health program “Sumida TAKE10!” which is an educational program incorporating the “TAKE10!® for Older Adults” program, once every 2 weeks for 3 months. The control group (3 community centers; n=35) was subsequently provided with the same program as a crossover intervention group. The main outcome measures were changes in food intake frequency, food frequency score (FFS), dietary variety score (DVS), and frequency of walking and exercise. The secondary outcome measures were changes in self-rated health, appetite, and the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence score. Results Compared to baseline, post-intervention food intake frequency for 6 of 10 food groups (meat, fish/shellfish, eggs, potatoes, fruits, and seaweed), FFS, and DVS were significantly increased in the intervention group, and interaction effects of FFS and DVS were seen between the two groups. No significant differences were observed between baseline and post-intervention in the control group. Frequency of walking and exercise remained unchanged in both groups, and no significant difference in improvement rate was seen between the groups. Self-rated health was significantly increased in the intervention group. Appetite and TMIG Index of Competence score were unchanged in both groups. Conclusions The social health program resulted in improved dietary habits, as measured by food intake frequency, FFS, and DVS, and may improve self-rated health among community-dwelling older adults. Trial registration number UMIN000007357
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Affiliation(s)
- Mika Kimura
- Center for Health Promotion, International Life Sciences Institute Japan, Nishikawa Bldg, 3-5-19 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan.
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Hoshi T, Yuasa M, Yang S, Kurimori S, Sakurai N, Fujiwara Y. Causal relationships between survival rates, dietary and lifestyle habits, socioeconomic status and physical, mental and social health in elderly urban dwellers in Japan: A chronological study. Health (London) 2013. [DOI: 10.4236/health.2013.58177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Khang YH, Kim HR. Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders. J Womens Health (Larchmt) 2012; 19:109-16. [PMID: 20088666 DOI: 10.1089/jwh.2009.1413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Young-Ho Khang
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
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Sex/gender and socioeconomic differences in the predictive ability of self-rated health for mortality. PLoS One 2012; 7:e30179. [PMID: 22276157 PMCID: PMC3261899 DOI: 10.1371/journal.pone.0030179] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 12/14/2011] [Indexed: 11/18/2022] Open
Abstract
Background Studies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups. Methodology/Principal Findings The analyses in the study were based on the Aichi Gerontological Evaluation Study's (AGES) 2003 Cohort Study in Chita Peninsula, Japan, which followed the four-year survival status of 14,668 community-dwelling people who were at least 65 years old at the start of the study. We first examined sex/gender and education-level differences in association with fair/poor SRH. We then estimated the sex/gender- and education-specific hazard ratios (HRs) of mortality associated with lower SRH using Cox models. Control variables, including health behaviors (smoking and drinking), symptoms of depression, and chronic co-morbid conditions, were added to sequential regression models. The results showed men and women reported a similar prevalence of lower SRH. However, lower SRH was a stronger predictor of mortality in men (HR = 2.44 [95% confidence interval (CI): 2.14–2.80]) than in women (HR = 1.88 [95% CI: 1.44–2.47]; p for sex/gender interaction = 0.018). The sex/gender difference in the predictive ability of SRH was progressively attenuated with the additional introduction of other co-morbid conditions. The predictive ability among individuals with high school education (HR = 2.39 [95% CI: 1.74–3.30]) was similar to that among individuals with less than a high school education (HR = 2.14 [95% CI: 1.83–2.50]; p for education interaction = 0.549). Conclusions The sex/gender difference in the predictive ability of SRH for mortality among this elderly Japanese population may be explained by male/female differences in what goes into an individual's assessment of their SRH, with males apparently weighting depressive symptoms more than females.
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Yuasa M, Hoshi T, Hasegawa T, Nakayama N, Takahashi T, Kurimori S, Sakurai N. Causal relationships between physical, mental and social health-related factors among the Japanese elderly: A chronological study. Health (London) 2012. [DOI: 10.4236/health.2012.43021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Halford C, Welin C, Bogefeldt J, Wallman T, Rosengren A, Bardel A, Johansson S, Eriksson H, Svärdsudd K. A population-based study of nearly 15 000 observations among Swedish women and men during 1973-2003. BMJ Open 2012; 2:bmjopen-2012-001353. [PMID: 23117561 PMCID: PMC3547313 DOI: 10.1136/bmjopen-2012-001353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Global self-rated health (SRH) has become extensively used as an outcome measure in population health surveillance. The aim of this study was to analyse the effects of age and secular trend (year of investigation) on SRH. DESIGN Prospective cohort study, using population-based data from eight ongoing cohort studies, with sampling performed between 1973 and 2003. SETTING Sweden. PARTICIPANTS 11 880 women and men, aged 25-99 years, providing 14 470 observations. PRIMARY OUTCOME MEASURE Global SRH. RESULTS In multiple ordinal logistic regression analyses, adjusted for the effects of covariates, there were independent effects of age (p<0.0001) and of year of investigation (p<0.0001) on SRH. In women the association was linear, showing lower levels of SRH with increased age, and more recent year of investigation. In men the association was curvilinear, and thus more complex. The final model explained 76.2% of the SRH variance in women and 74.5% of the variance in men. CONCLUSIONS SRH was strongly and inversely associated with age in both sexes, after adjustment for other outcome-affecting variables. There was a strongly significant effect of year of investigation indicating a change in SRH, in women towards lower levels over calendar time, in men with fluctuations across time.
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Affiliation(s)
- Christina Halford
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Catharina Welin
- Department of Heart and Lung Diseases, Sahlgren Academy, Gothenburg, Sweden
| | - Johan Bogefeldt
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Thorne Wallman
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
- R&D Centre/Centre for Clinical Research, Section of Primary Care, Sörmland County Council, Eskilstuna, Sweden
| | - Annika Rosengren
- Department of Heart and Lung Diseases, Sahlgren Academy, Gothenburg, Sweden
| | - Annika Bardel
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
- R&D Centre/Centre for Clinical Research, Section of Primary Care, Sörmland County Council, Eskilstuna, Sweden
| | - Saga Johansson
- Department of Heart and Lung Diseases, Sahlgren Academy, Gothenburg, Sweden
- Department of Epidemiology, AstraZeneca R&D, Mölndal, Sweden
| | - Henry Eriksson
- Department of Heart and Lung Diseases, Sahlgren Academy, Gothenburg, Sweden
| | - Kurt Svärdsudd
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
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Yoshihama M, Bybee D, Blazevski J. Day-to-day discrimination and health among Asian Indians: A population-based study of Gujarati men and women in Metropolitan Detroit. J Behav Med 2011; 35:471-83. [DOI: 10.1007/s10865-011-9375-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 08/06/2011] [Indexed: 12/22/2022]
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Chepngeno-Langat G, Madise N, Evandrou M, Falkingham J. Gender differentials on the health consequences of care-giving to people with AIDS-related illness among older informal carers in two slums in Nairobi, Kenya. AIDS Care 2011; 23:1586-94. [PMID: 22117125 PMCID: PMC3242068 DOI: 10.1080/09540121.2011.569698] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Informal caregivers, most often older people, provide valuable care and support for people ill due to AIDS, especially in poor-resource settings with inadequate health care systems and limited access to antiretroviral therapy. The negative health consequences associated with care-giving may vary depending on various factors that act to mediate the extent of the effects on the caregiver. This paper investigates the association between care-giving and poor health among older carers to people living with AIDS, and examines potential within-gender differences in reporting poor health. Data from 1429 men and women aged 50 years or older living in two slum areas of Nairobi are used to compare AIDS-caregivers with other caregivers and non-caregivers based on self-reported health using the World Health Organization disability assessment (WHODAS) score and the presence of a severe health problem. Women AIDS-caregivers reported higher disability scores for mobility and the lowest scores in self-care and life activities domains while men AIDS-caregivers reported higher scores in all domains (except interpersonal interaction) compared with other caregivers and non-caregivers. Multiple regression analysis is used to examine the association of providing care with health outcomes while controlling for other confounders. Consistently across all the health measures, no significant differences were observed between female AIDS-caregivers and female non-caregivers. Male AIDS-caregivers were however significantly more likely to report disability and having a severe health problem compared with male non-caregivers. This finding highlights a gendered variation in outcome and is possibly an indication of the differences in care-giving gender-role expectations and coping strategies. This study highlights the relatively neglected role of older men as caregivers and recommends comprehensive interventions to mitigate the impact of HIV and AIDS on caregivers that embrace men as well as women.
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Belachew T, Hadley C, Lindstrom D, Gebremariam A, Michael KW, Getachew Y, Lachat C, Kolsteren P. Gender differences in food insecurity and morbidity among adolescents in southwest Ethiopia. Pediatrics 2011; 127:e398-405. [PMID: 21220395 PMCID: PMC3387862 DOI: 10.1542/peds.2010-0944] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Several studies have shown the adverse health consequences of food insecurity on household members. To what extent this relationship is mediated by gender among adolescents has not been documented. We hypothesized that the health consequences of food insecurity would be more pronounced in girls compared with boys. METHODS We used the first-round data from a 5-year longitudinal family survey of 2084 adolescents aged 13 to 17 years from urban, semiurban, and rural areas of southwest Ethiopia. Stratified random sampling was used to select households and adolescents. Multivariable logistic regression was used to compare self-reported morbidity according to food-security status and gender after adjusting for nutritional and socioeconomic covariates. RESULTS Overall, 29.9% of girls and 19.2% of boys reported illness during the previous 1 month before the survey. Food-insecure girls were twice as likely to report suffering from an illness (P < .01) compared with boys, and the risk of reported illness tripled when girls were food insecure and were part of food-insecure households (P < .01). Girls were 7.4 and 7.0 times more likely to report difficulties with activities because of poor health and having a feeling of tiredness/low energy compared with boys, respectively (P < .001). CONCLUSIONS We report that in a food-insecure situation, gender is an important predictor of an adolescent's self-reported health status. Food-security interventions should consider gender as a key variable to narrow the gap in health between boys and girls.
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Affiliation(s)
- Tefera Belachew
- Nutrition Unit, Population and Family Health Department, Jimma University, Jimma, Ethiopia.
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Jylhä M. Self-Rated Health and Subjective Survival Probabilities as Predictors of Mortality. INTERNATIONAL HANDBOOK OF ADULT MORTALITY 2011. [DOI: 10.1007/978-90-481-9996-9_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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