The self-rated health status and key influencing factors in middle-aged and elderly: Evidence from the CHARLS

Self-rated health is an independent predictor of subsequent late mortality after blood or marrow transplantation: A Blood or Marrow Transplant Survivor Study report

BACKGROUND

The prevalence of suboptimal self-rated health (SRH) and its association with subsequent all-cause and cause-specific mortality after blood or marrow transplantation (BMT) were examined.

METHODS

Study participants were drawn from the multicenter Blood or Marrow Transplant Survivor Study, and included patients who were transplanted between 1974 and 2014 and had survived ≥2 years after BMT. Participants (aged ≥18 years) completed a survey at a median of 9 years from BMT, and were followed for a median of 5.6 years after survey completion. Survivors provided information on sociodemographic factors, chronic health conditions, health behaviors, and SRH (a single-item measure rated as excellent, very good, good, fair, or poor; excellent, very good, and good SRH were classified as good SRH, and fair and poor were classified as suboptimal SRH). The National Death Index Plus and Accurint databases and medical records provided vital status through December 2021.

RESULTS

Of 3739 participants, 784 died after survey completion (21%). Overall, 879 BMT survivors (23.5%) reported suboptimal SRH. Pain, low socioeconomic status, psychological distress, lack of exercise, severe/life-threatening chronic health conditions, post-BMT relapse, obesity, smoking, and male sex were associated with suboptimal SRH. BMT survivors who reported suboptimal SRH had a 1.9-fold increased risk of all-cause mortality (95% confidence interval [CI], 1.6-2.3), 1.8-fold increased risk of recurrence-related mortality (95% CI, 1.4-2.5), and 1.9-fold increased risk of non-recurrence-related mortality (95% CI, 1.4-2.4) compared to those who reported good SRH.

CONCLUSIONS

This single-item measure could help identify vulnerable subpopulations who could benefit from interventions to mitigate the risk for subsequent mortality.

Analysis of the health status and its influencing factors of the low-income populations in Wuxi, China

Objective

To understand the physical health condition and its influencing factors among the low-income population.

Method

Low-income residents who visited or consulted at our Hospital during 2022 were selected for this study. Through telephone or face-to-face interviews, a self-made basic information questionnaire was used for data collection. The physical health level of the low-income population was analyzed, and a logistic regression model was applied to study its influencing factors.

Results

A total of 2,307 people were included in this study, of which 2,069 had various types of diseases, indicating a disease rate of 89.68%. Multivariate logistic regression analysis showed that age ≥ 60 years old (OR = 1.567, 95%CI: 1.122-2.188), poor mental health status (OR = 2.450, 95%CI: 1.203-3.678), smoking (OR = 1.752, 95%CI: 1.269-2.206), pulse pressure difference ≥ 60 (OR = 1.485, 95%CI: 1.164-1.787), and poor hearing (OR = 1.268, 95%CI: 1.026-1.324) were risk factors for disease, whereas being female (OR = 0.729, 95%CI: 0.540-0.984) was a protective factor for physical health.

Conclusion

As a developing country with a large population, we should particularly focus on the physical health issues of the low-income population, take targeted measures for disease situations, and improve the quality of life of the low-income population.

Joint Association of Physical Frailty and Self-Rated Health With Mortality Among Community-Dwelling Older Adults

BACKGROUND

The relationship between subjective and objective health is complex and not always matched. Although frailty and self-rated health (SRH) have been separately associated with adverse outcomes, their joint effects remained unclear.

METHODS

Participants were 5 300 adults ≥60 years from the China Health and Retirement Longitudinal Study in 2011. Frailty, measured by the validated physical frailty phenotype approach, was classified as nonfrail, prefrail, and frail. SRH was categorized into 3 groups: excellent/very good/good, fair, and poor/very poor. We used the Cox models to examine the independent and joint association of frailty and SRH with mortality. We used the interaction approach to determine whether the association of SRH with mortality differed by frailty. Subgroup analyses were conducted by depression and cognitive impairment.

RESULTS

About 8.1% of frail participants reported excellent/very good/good health; 21.2% of the nonfrail reported poor/very poor health. Prefrailty and frailty were associated with a 1.63- and 2.38-fold increase in the hazard of mortality than the nonfrail, respectively, after adjusting for SRH. Reporting fair and poor/very poor health was associated with a 29% and 100% increase in the hazard of mortality, respectively, after adjusting for frailty. No significant interaction was found. Prefrail and frail older adults with excellent/very good/good health had a similar mortality as the nonfrail with poor/very poor SRH. The association of SRH with mortality was less pronounced among individuals with depression or cognitive impairment.

CONCLUSIONS

SRH is a potential marker of resilience among people living with frailty that may be a target for ameliorating health risks induced by frailty.

Chronic diseases and determinants of community health services utilization among adult residents in southern China: a community-based cross-sectional study

BACKGROUND

The burden of chronic diseases has become a major public health concern, and high-efficiency use of community health services is essential in combating chronic diseases. This study described the status of chronic diseases in southern China and explored the determinants of health service utilization among adult residents.

METHODS

Data were obtained from one part of community survey data from four counties in Ganzhou City, southern China. A multistage, stratified random sampling method was used to conduct a cross-sectional survey between 2018 and 2020. Overall, 7430 valid questionnaires were collected. A lasso-linear regression analysis was performed to explore the determinants of community health service utilization.

RESULTS

According to the study, most participants (44.6%) reported having relatively good health, while 42.1% reported having moderate health. Chronic diseases were reported by 66.9% of the respondents. The three most prevalent self-reported chronic diseases were hypertension (22.6%), hyperlipidemia (5.9%), and diabetes (5.9%). Among residents with chronic diseases, 72.1% had one chronic disease, while the rest had multiple. Only 13.9% of residents frequently utilized community health services, while 18.9% never used them. Additionally, among residents who reported having chronic diseases, 14.1% had never attended community health services. Four categories of factors were the key determinants of community health service utilization: (1) personal characteristics, age, and sex; (2) health-related factors, such as family history, self-reported health conditions, and the number of chronic diseases; (3) community health service characteristics, such as satisfaction with and accessibility to community health services; and (4) knowledge of chronic diseases. Specifically, women tend to utilize healthcare services more frequently than men. Additionally, residents who are advanced in age, have a family history of chronic diseases, suffer from multiple chronic conditions, rate their self-reported health condition as poor, have a better knowledge about chronic diseases, have better accessibility to community health services, and have higher the satisfaction with community health services, tend to utilize them more frequently.

CONCLUSIONS

Given the limited healthcare resources, the government should promote the effective utilization of community health facilities as a critical community-based strategy to combat the growing threat of chronic diseases in southern China. The priority measures involve enhancing residents' access to and satisfaction with community health services and raising awareness of chronic illnesses among older individuals with poor health status.

The health status, social support, and subjective well-being of older individuals: evidence from the Chinese General Social Survey

Objectives

This study aims to investigate the impact of health status and social support on the subjective well-being of older individuals.

Methods

Using data from the China General Social Survey 2017, this research analyzed 5,187 Chinese citizens aged 60 years and older. The predicted effect of each variable on subjective well-being was evaluated through hierarchical regression analysis. The direct and indirect effects of social support and health status on subjective well-being are examined based on a structural equation model.

Results

The mental health and social support positively impact subjective well-being. Mental health mediates the effect of physical health on subjective well-being, and social support mediates the relationship between physical and mental health and subjective well-being.

Conclusion

The findings provide strong evidence for the interrelationship mechanisms among the factors influencing subjective well-being. Consequently, improving mental health services and social support systems is advantageous for enhancing the well-being of Chinese seniors.

Factors affecting the medication literacy of older adults and targeted initiatives for improvement: a cross-sectional study in central China

Introduction

This study explored the state of rational drug use among older adults in central China, aiming to unveil factors influencing their medication literacy and proposing targeted improvement measures.

Methods

A cross-sectional study involving 454 participants aged 60 and above was conducted in Hubei province between February 1 and May 30, 2023, with data collected through face-to-face interviews by pharmacists. Multiple logistic regression analysis was conducted to determine factors that affected medication literacy.

Results

Of the 412 valid questionnaires, findings revealed inadequate knowledge of rational drug use among older adults in central China. Those who fully understood (105, 25.49%, OR = 9.349, p < 0.001, 95%CI = 3.884-22.502) or partially understood (228, 55.34%, OR = 3.295, p = 0.002, 95%CI = 1.548-7.013) drug instructions exhibited significantly higher medication literacy than those who did not understand (79, 19.17%). Subsequent research revealed a lack of awareness in reading drug instructions or difficulty in understanding them. Most older adults seldom heard of but exhibited high acceptance of medication guidance services.

Discussion

In conclusion, the ability to comprehend drug instructions significantly influenced the medication literacy of older adults. Initiatives such as revising age-appropriate drug instructions could effectively enhance rational drug use among this demographic.

Decomposition and comparative analysis of health inequities between the male and female older adults in China: a national cross-sectional study

BACKGROUND

This study aimed to examine the factors influencing self-rated health (SRH) among Chinese older adults by gender differences and provide suggestions and theoretical references to help make policies for older adults' health concerns by government agencies.

METHODS

Chinese Longitudinal Health Longevity Survey (CLHLS) in 2018 was adopted, the chi-squared test and the logistic regression analysis were performed to analyse self-rated health reported by Chinese female and male older adults and its influencing factors. In addition, Fairlie decomposition analysis was performed to quantify the contribution level of different influencing factors.

RESULTS

Among older adults, males (48.0%) reported a significantly higher level of good self-rated health than females (42.3%). Residence, body mass index (BMI), self-reported income, smoking, drinking, exercise, and social activity were the factors that influenced SRH reported by male and female respondents, with age, marital status and education reaching the significance level only in women. The Fairlie decomposition model can explain the underlying reasons for 86.7% of the gender differences in SRH, with self-reported income (15.3%), smoking (32.7%), drinking (42.5%), exercise (17.4%), social activity (15.1%) and education (-14.6%) being the major factors affecting gender differences in SRH.

CONCLUSIONS

The study results can help promote the implementation of the Healthy China Initiative, inform intervention measures, and offer new proposals on creating policies for older adults' health issues by the Chinese government to improve health equity.

Healthy immigration effect among internal migrants in megacities: a cross-sectional study in Shanghai, China

Objectives

To verify the healthy immigration effect on self-rated health (SRH) among Chinese internal migrants, identify the determinants of SRH, and provide recommendations for the Chinese government to formulate effective intervention strategies to improve population governance and health management in megacities.

Methods

A sample comprising 1,147 white-and blue-collar migrant workers was randomly selected through an online survey conducted in Shanghai from August to December 2021. Multivariate logistic regression models were used to verify the healthy immigration effect as well as determinants of the effect among internal migrants in Shanghai.

Results

Among 1,024 eligible internal migrants, 864 (84.4%) were aged between 18 and 59 years, 545 (53.2%) were men, and 818 (79.9%) were married. When confounders in the logistic regression models were adjusted, the odds ratio of SRH for internal migrants who had lived in Shanghai for 5-10 years was 2.418 (p < 0.001), whereas the odds ratio for those who had lived there for ≥10 years was not statistically significant. Additionally, marital status, a postgraduate or higher degree, income level, number of physical examinations in the past 12 months, and the number of critical diseases they were suffering from, were significant contributing factors for favorable SRH among the internal migrants. Furthermore, a cross-sectional analysis revealed that SRH demonstrated a healthy immigration effect among blue-collar internal migrants from the manufacturing industry but not among white-collar internal migrants.

Conclusion

A healthy immigration effect was observed among internal migrants in Shanghai. The migrant population that had lived in Shanghai for 5-10 years had more health advantages than the locals, whereas those who had lived there for ≥10 years did not. The Chinese government should understand this effect and enact measures accordingly, such as implementing physical examinations, improving acculturation, addressing individual characteristics, and improving socioeconomic conditions to improve the physical and mental health of internal migrants. Enacting such changes could facilitate the integration of migrants into the local culture of megacities.

Association between specific social activities and depressive symptoms among older adults: A study of urban-rural differences in China

Background

Engaging in social activities can help older persons with their depressed symptoms. Few studies, however, have looked into the connection between social interactions and depressed symptoms in Chinese older persons. The aim of this study was to investigate differences in older Chinese individuals' social activity involvement and depressive symptoms across urban and rural settings.

Methods

A cross-sectional investigation using information from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which was limited to older individuals aged 60 and over. Generalized linear models were constructed to assess the effects of participants' characteristics and specific social activities on CES-D scores. The association between specific social activities and depressed symptoms was investigated using multivariate logistic regression analysis.

Results

In this study, it was discovered that older individuals had a prevalence of depressed symptoms of 36.2%, with rural older adults having a greater prevalence of depressive symptoms (39.7%) than urban older adults (30.9%). Our results showed that for urban respondents, providing help to others (not regularly. OR = 0.753, 95% CI: 0.579–0.980, P = 0.035), going to a sport (not regularly. OR = 0.685, 95% CI: 0.508–0.924, P = 0.013), and using the Internet (not regular. OR = 0.613, 95% CI: 0.477–0.789, P &lt; 0.001; almost weekly. OR = 0.196, 95% CI: 0.060–0.645, P = 0.007) were all significantly and negatively associated with depressive symptoms, while for rural respondents, interacting with friends (not regularly. OR = 1.205, 95% CI: 1.028–01.412, P = 0.021) and using the Internet (not regularly. OR = 0.441, 95% CI: 0.278–0.698, P &lt; 0.001) were significantly and negatively associated with depressive symptoms.

Conclusions

According to our research, there is a cross-sectional relationship between participating in a specific social activity and depressed symptoms in Chinese older adults, and this relationship varies across urban and rural older adults. This suggests that taking part in specific social activities may be crucial for reducing depression symptoms in older persons, developing more focused interventions that might support healthy aging, and offering a guide for policymakers and activists working to improve the mental health of seniors.

Sensory impairments and subjective well-being status in middle-aged and older Chinese population: Cross-sectional and longitudinal analyses of a nationally representative survey

Purpose

To investigate the impacts of sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI) and dual sensory impairment (DSI) on subjective wellbeing measurements including life expectancy (LE), life satisfaction (LS) and self-rated health (SRH) in middle-aged and older Chinese population.

Methods

We obtained data from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 9,293 Chinese middle-aged and older adults aging over 45 were included at baseline 2011 in this study, and 3,932 participants who accomplished all 4 interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and subjective wellbeing measurements were collected. Other covariates included socio-demographic characteristics, medical condition and lifestyle-related factors. The impacts of baseline sensory status on LE, LS and SRH were assessed using univariate and multivariate logistic regression analyses. A linear regression analysis with generalized estimating equations (GEE) was used to assess the association between time-varying sensory statuses with LE, LS and SRH over 8 years after being adjusted with multi-confounding factors.

Results

Participants with SIs had significantly lower level of LE, LS, and SRH, compared to those who were free of SI. All kinds of SIs were significantly associated with LE, LS, and SRH according to cross-sectional data. The correlations between SIs and LE or SRH over 8 years were also noticed. However, only SHI and DSI were found to be significantly associated with LS according to longitudinal data (all p values &lt; 0.05).

Conclusion

Sensory impairments had explicitly detrimental effects on subjective wellbeing status over time among middle-aged and older Chinese population.

Association between Psychological Resilience and Self-Rated Health in Patients with Knee Osteoarthritis

This study aimed to evaluate whether psychological resilience is an independent factor of self-rated health (SRH) among patients with knee osteoarthritis (KOA). A cross-sectional study with convenience sampling was designed. Patients with doctor-diagnosed KOA were recruited from the orthopedic outpatient departments of a hospital in southern Taiwan. Psychological resilience was measured by the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and SRH was measured by three items, including the current SRH, the preceding year-related SRH, and age-related SRH. The three-item SRH scale was categorized as "high" and "low-moderate" groups by terciles. Covariates included KOA history, site of knee pain, joint-specific symptoms measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), comorbidity measured by Charlson Comorbidity Index, and demographic variables (i.e., age, sex, education attainment, and living arrangements). A multiple logistic regression was used to detect the independent variables with significant odds ratios that can predict "high" SRH among participants. Results: In total, 98 patients with KOA (66 women and 32 men) with a mean age (±SD) of 68.3 ± 8.5 years were enrolled and were analyzed. A total of 38.8% (n = 38) of participants were categorized as "high SRH", while 61.2% (n = 60) were categorized as "low-moderate SRH". Multiple logistic regression showed that CD-RISC-10 had an increased odds ratio (OR) for high SRH (OR [95% CI] = 1.061 [1.003-1.122]; p = 0.038), whereas bilateral pain (vs. unilateral pain), WOMAC stiffness, and WOMAC physical limitation showed a decreased OR for high SRH (0.268 [0.098-0.732], 0.670 [0.450-0.998], and 0.943 [0.891-0.997], respectively). Our findings provide evidence indicating that psychological resilience plays a significant positive role in the SRH in our study sample. Further research is required to extend the growing knowledge regarding the application of psychological resilience on KOA.

Self-rated health among older adults in India: Gender specific findings from National Sample Survey

INTRODUCTION

The self-rated health (SRH) is a widely adopted indicator of overall health. The sponge hypothesis suggests that predictive power of SRH is stronger among women compared to men. To gain a better understanding of how gender influences SRH, this study examined whether and what determinants of gender disparity exist current self-rated health (SRHcurrent) and change in SRH (SRHchange) among older adults in Indian setting.

MATERIALS AND METHODS

We used cross-sectional data from the 75th National Sample Survey Organizations (NSSO), collected from July 2017 to June 2018. The analytical sample constitutes 42,759 older individuals aged 60 years or older with 21,902 older men and 20,857 older women (eliminating two non-binary individuals). Outcome measures include two variables of poor/worse SRH status (SRHcurrent and SRHchange). We have calculated absolute gaps in the prevalence of poor SRHcurrent and worse SRHchange by background characteristics. We carried out binary logistic regression models to examine the predictors of poor SRHcurrent and worse SRHchange among older adults.

RESULTS

The overall absolute gender gap in poor SRHcurrent was 3.27% and it was 0.58% in worse SRHchange. Older women had significantly higher odds of poor SRHcurrent [AOR = 1.09; CI = 0.99, 1.19] and worse SRHchange [AOR = 1.09; CI = 1.02, 1.16] compared to older men. Older adults belonging to middle-aged, oldest-old, economically dependent, not working, physically immobile, suffering from chronic diseases, belonging to Muslim religion, and Eastern region have found to have higher odds of poor SRHcurrent and worse SRHchange. Educational attainments showed lower odds of have poor SRHcurrent and worse SRHchange compared to those with no education. Respondents belonging to richest income quintile and those who were not covered by any health insurance, belonging to Schedule caste, OBC, Western and Southern regions are found to have lower odds of poor SRHcurrent and worse SRHchange. Compared to those in the urban residence, respondents from rural residence [AOR = 1.09; CI = 1.02, 1.16] had higher odds of worse SRHchange.

CONCLUSIONS

Supporting the sponge hypothesis, a clear gender gap was observed in poor current SRH and worse change in SRH among older adults in India with a female disadvantage. We further found lower socioeconomic and health conditions and lack of resources as determinants of poor current SRH and its worse change, which is crucial to address the challenge of the older people's health and their perception of well-being.

Health status and public health education for internal older migrants in China: Evidence from a nationally representative survey

Background

Self-rated health has been widely used as a useful screening tool to subjectively evaluate individuals' health status. Under the context of the rapid growth of aging, there was a dramatic rapid expansion in internal older migrants in China. Serious concerns on the issues of health status continue to attract quite a lot of attention over the past decades. Public health education is one of the most important health care services and methods to improve individuals' health status. However, most previous studies focus on the utilization of public health services such as visiting to doctors, physical examination, and hospitalization. There was limited evidence on the self-rated health and public health education of older migrants.

Objectives

The study aimed to evaluate self-rated health and the associated determinants in older migrants, as well as to gain a deeper insight into the current status of public health education received by older migrants.

Methods

We derived the data from the National Migrants Population Health and Family Planning Dynamic Monitor Survey 2018, a cross-sectional study, for secondary analysis. Internal migrants aged 60 years old or over were included in the study. Self-rated health was the dependent variable, while sociodemographic characteristics were the independent variable. The univariate and multivariate analyses were performed by Stata 15.1.

Results

A total of 5,589 older migrants were included in the study. Eighty-two percentage of older migrants reported healthy self-rated health. There was a significant association between age, gender, minzu, education level, monthly income, public health education, and self-rated health (P < 0.5). However, the proportion of older migrants that received specific public health education was <50%. The most common approach to receiving public health education was through the leaflet, while <20% of older migrants received public health education through public consultation and one-to-one education.

Conclusions

It was necessary to promote the publicity of public health education in older migrants through easy access and diverse approaches in order to effectively spread health-related knowledge to older migrants to satisfy their health needs and maintain their health.

The Health-Seeking Behavior among Malaysian Adults in Urban and Rural Areas Who Reported Sickness: Findings from the National Health and Morbidity Survey (NHMS) 2019

Understanding care-seeking behavior among urban and rural populations can help to support the planning and implementation of appropriate measures to improve health in the community. This study aims to determine the factors associated with the health-seeking behavior among Malaysian adults in urban and rural areas who reported sickness. This study used data of Malaysian adults aged 18 years and over from the National Health and Morbidity Survey 2019; a cross-sectional, national household survey that targeted all non-institutionalized residents in Malaysia. Respondent’s characteristics and health-seeking behavior were described using complex sample descriptive statistics. Multivariable logistic regression analysis was conducted to examine the association between potential factors (sociodemographic characteristics, enabling, and health need) and health-seeking behaviors (seeking treatment from healthcare practitioners and self-medication). A total of 10,484 respondents, estimated to represent 18.9 million Malaysian adults aged 18 years and over, were included in the analysis. Prevalence of seeking treatment from healthcare practitioners and self-medication among Malaysian adults with self-reported sickness were 57.3% and 23.3%, respectively. Self-reported sickness among both the urban and rural populations who rated their health as poor to very poor was more likely to seek treatment than those who rated good to excellent. However, among the urban population, those who rated their health as poor to very poor were less likely to self-medicate. Among the urban population, government employees were more likely to seek treatment, and being without formal education significantly increased the likelihood to self-medicate. Among the rural population, those with at least one long-term condition were more likely to seek treatment than those with none. Understanding the factors which influence health-seeking behavior among the urban and rural population could close the gaps in healthcare utilization among the population in Malaysia.