What does self rated health measure? Results from the British Whitehall II and French Gazel cohort studies

Social environment, health cognition, and health behavior: how individuals with non-fixed employment end up with adverse health outcomes in China under the era of VUCA?-findings from PLS-SEM and fsQCA

Objectives

This article studied the single-factor causal relationships between the social environment, health cognition, and health behavior of the individuals with non-fixed employment and their adverse health outcomes, as well as the complex causal relationships of multiple factors on these outcomes.

Methods

Partial Least Squares Structural Equation Modeling (PLS-SEM) and Fuzzy-Set Qualitative Comparative Analysis (fsQCA) are employed. Data is collected from the results of an open questionnaire Psychology and Behavior Investigation of Chinese Residents 2021.

Results

PLS-SEM analysis reveals that health risk behaviors and cognition play a mediating role in impact of the social environment on adverse health outcomes, indicating that individuals with non-fixed employment susceptible to adverse health outcomes. fsQCA analysis identifies that weak social support is a core condition leading to outcomes of depression and anxiety. There are shared configurations and causal pathways between the outcomes of physical health and depression.

Conclusion

The study supports the social determinants theory of health and suggests that the fundamental reason for people being trapped in adverse health outcomes is the health inequality caused by social stratification, and the external shock of uncertainty in the era of VUCA (Volatility, Uncertainty, Complexity, and Ambiguity).

Exploring factors associated with self-rated health in individuals with diabetes and its impact on quality of life: Evidence from the Survey of Health, Ageing, and Retirement in Europe

BACKGROUND

Self-rated health (SRH), a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including people with diabetes. Diabetes is negatively associated with SRH and quality of life (QoL). Little is known about how people with diabetes rate their health and which aspects influence the rating. Also, the predictive value of SRH on future QoL has not yet been evaluated.

METHODS

We analyzed data from 46 592 participants of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using linear regression, we aimed to determine which sociodemographic, socioeconomic, medical, social, mental, and health behavior factors determine SRH in people with diabetes. In addition, we analyzed the predictive value of SRH on future QoL using the generalized estimating equations procedure.

RESULTS

We determined that country, current job situation, hospitalization, pain, polypharmacy, memory, eyesight, activities of daily living, number of chronic diseases, and depression are all linked to SRH. Together these variables explained 38% of the SRH's variance, whereas depression, pain, and memory had the greatest influence on SRH of people with diabetes. We also found that SRH independently predicted future QoL, supported by a regression coefficient of β = -1.261 (Wald chi-square test, χ2 = 22.097, df = 1, p < .05).

CONCLUSIONS

As SRH is linked to future QoL, we conclude that incorporating SRH assessment into medical evaluations can help health care professionals gaining a more comprehensive understanding of an individual's health trajectory and supporting patients to enhance their QoL.

Association between self-reported and objectively assessed physical functioning in the general population

Knowledge about a patient's physical fitness can aid in medical decision-making, but objective assessment can be challenging and time-consuming. We aimed to investigate the concordance of self-reported health status and physical functioning with the 6 minute walking distance (6MWD) as objective measure of physical performance. The prospective characteristics and course of heart failure stages A/B and determinants of progression (STAAB) cohort study iteratively follows a representative sample of residents of the city of Würzburg, Germany, aged 30-79 years, without a history of heart failure (HF). The 6MWD was measured in 2752 individuals (aged 58 ± 11 years, 51% women) from a population-based cohort under strictly standardized conditions. Self-reported health status and physical functioning were assessed from items of the short form 36 (SF-36). After the respective classification of self-reported health status and physical functioning into 'good', 'moderate', and 'poor', we determined the association of these categories with 6MWD by applying a generalized linear model adjusted for age and sex. Prevalence of self-reported good/moderate/poor general health and physical functioning was 41/52/7% and 45/48/7%, respectively. Mean 6MWD in the respective categories was 574 ± 70/534 ± 76/510 ± 87 m, and 574 ± 72/534 ± 73/490 ± 82 m, with significant sex-specific differences between all categories (all p < 0.001) as well as significant differences between the respective groups except for the categories 'moderate' and 'poor' health status in men. This cross-sectional analysis revealed a strong association between self-reported health status and physical functioning with the objective assessment of 6MWD, suggesting that physicians can rely on their patients' respective answers. Nevertheless, sex-specific perception and attribution of general health and physical functioning deserve further in-depth investigation. Decision-making based on self-reported health requires prospective evaluation in population-based cohorts as well as adult inpatients.

Beyond objective metrics: A comparative analysis of health care systems incorporating subjective dimensions to improve comparability of access and equity in healthcare assessments

Comparing health care systems is important for several reasons. E.g. lower-resource health care systems can learn from higher-resource ones, and country-specific progress can be made. Previous rankings of health care systems have been based on objective factors such as the number of available hospital beds or health care spending. An index is considered here that includes a subjective level that is intended to represent access to the health care system. Therefore, this study investigates the divergence between subjective and objective indices related to health care expenditure, with a focus on the influence of involuntary and voluntary payments. Utilizing the Rational Choice Theory as a framework, it explores how individual preferences and perceived benefits affect these indices. The analysis reveals that social insurance contributions, which are mandatory and beyond individual control, are evaluated differently in subjective indices compared to objective indices. This discrepancy is less pronounced for voluntary expenditures, where individuals have decision-making power. The findings highlight significant variations in the correlations between macroeconomic health care indicators and the indices, emphasizing the critical role of autonomy in financial decisions related to health care.

How do labour market conditions explain the development of mental health over the life-course? a conceptual integration of the ecological model with life-course epidemiology in an integrative review of results from the Northern Swedish Cohort

BACKGROUND

The aim of this study was to contribute to the theoretical development within the field of labour market effects on mental health during life by integrating Bronfenbrenner's ecological model with mainly earlier theoretical work on life-course theory.

METHODS

An integrative review was performed of all 52 publications about labour market conditions in relation to mental health from the longitudinal Northern Swedish Cohort study. Inductive and deductive qualitative content analysis were performed in relation to Bronfenbrenner's ecological framework combined with life-course theories.

RESULTS

The following nine themes were identified: 1. Macroeconomic recession impairs mental health among young people. 2. The mental health effects on individuals of youth unemployment seem rather insensitive to recession. 3. Small but consistent negative effect of neighbourhood unemployment and other work-related disadvantaged on individuals' mental health over life. 4. Youth unemployment becomes embodied as scars of mental ill-health over life. 5. Weak labour market attachment impairs mental health over life. 6. Bidirectional relations between health and weak labour market attachment over life. 7. Macrolevel structures are of importance for how labour market position cause poor health. 8. Unequal gender relations at work impacts negatively on mental health. 9. The agency to improve health over life in dyadic relations. Unemployment in society permeates from the macrolevel into the exolevel, defined by Bronfenbrenner as for example the labour market of parents or partners or the neighbourhood into the settings closest to the individual (the micro- and mesolevel) and affects the relations between the work, family, and leisure spheres of the individual. Neighbourhood unemployment leads to poor health among those who live there, independent of their employment status. Individuals' exposure to unemployment and temporary employment leads to poorer mental health over the life-course. Temporal dimensions were identified and combined with Bronfenbrenner levels into a contextual life-course model CONCLUSION: Combining the ecosocial theory with life-course theories provides a framework for understanding the embodiment of work-related mental health over life. The labour market conditions surrounding the individual are of crucial importance for the embodiment of mental health over life, at the same time as individual agency can be health promoting. Mental health can be improved by societal efforts in regulations of the labour market.

A longitudinal study on self-rated health changes in disabled older people

There is a growing demand for quality healthcare for senior citizens among the disabled older population, considering their rising numbers. This study examines the longitudinal change in the health status of disabled older people and determines its effects on social exclusion and differences based on age at disability onset. The analysis was performed using a multilevel growth model on the health data for disabled older people (≥60 years) derived from the Korea Welfare Panel Study (KWePS). The following findings were observed based on the stated model: (1) The Self-Rated Health (SRH) of disabled older people increased over time, with significant individual differences in the initial status and growth rate; (2) The domains of economic and social network exclusion were associated with changes in the health status of disabled older people; and (3) The longitudinal effects of social exclusion on SRH changes in disabled older people varied according to the age at disability onset. Based on these results, strategies and implications for the development of health-promoting interventions for disabled older people were presented.

To what extent does income explain the effect of unemployment on mental health? Mediation analysis in the UK Household Longitudinal Study

BACKGROUND

Employment and income are important determinants of mental health (MH), but the extent that unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income.

METHODS

We included adults 25-64 years from nine waves of the UK Household Longitudinal Study (n = 45 497/obs = 202 297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as General Health Questionnaire-12 score ≥4. We conducted causal mediation analysis using double-robust marginal structural modelling, estimating odds ratios (OR) and absolute differences for effects of unemployment on CMD in the same year, before (TE) and after (CDE) blocking the income pathway. We calculated percentage mediation by income, with bootstrapped standard errors.

RESULTS

The TE of unemployment on CMD risk was OR 1.66 (95% CI 1.57-1.76), with 7.09% (6.21-7.97) absolute difference in prevalence; equivalent CDEs were OR 1.55 (1.46-1.66) and 6.08% (5.13-7.03). Income mediated 14.22% (8.04-20.40) of the TE. Percentage mediation was higher for job losses [15.10% (6.81-23.39)] than gains [8.77% (0.36-17.19)]; it was lowest for those 25-40 years [7.99% (-2.57 to 18.51)] and in poverty [2.63% (-2.22 to 7.49)].

CONCLUSIONS

A high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for younger people and those in poverty. Population attributable fractions suggested 16.49% of CMD burden was due to unemployment, with 13.90% directly attributable to job loss rather than resultant income changes. Similar analytical approaches could explore how this differs across contexts, by other factors, and consider longer-term effects.

Validation of a Brief Form of the Self-Administered Multidimensional Prognostic Index: The SELFY-BRIEF-MPI Project

In clinical practice, self-administered and brief tools to promptly identify older people at risk of frailty are required. The Multidimensional Prognostic Index (MPI), derived from the Comprehensive Geriatric Assessment (CGA) seems reliable enough to serve this purpose, but despite the several versions developed over the past 15 years, it lacks a self-administered and brief version. In this study, we aimed to evaluate the agreement between an abbreviated form of the SELFY-MPI (i.e., SELFY-BRIEF-MPI) and the standard version of the MPI. Four Italian hospitals consecutively enrolled outpatients and inpatients >65 years. The sample included 105 participants (mean age = 78.8 years, 53.3% females). Overall, the two versions showed non-statistically significant differences (Standard-MPI 0.42 ± 0.19 vs.. SELFY-BRIEF-MPI 0.41 ± 0.18; p = 0.104) and a very strong correlation (R = 0.86, p < 0.001). The Bland-Altman Plot revealed that only 5/105 measurements (4.76%) were outside the limits of agreement. The accuracy of the SELFY-BRIEF-MPI in identifying frail people (defined as a Standard-MPI > 0.66) was optimal (area under the curve, AUC = 0.90, p < 0.001). To predict multidimensional frailty, a SELFY-BRIEF-MPI score of 0.60 exhibited the greatest sensitivity/specificity ratio. In conclusion, the SELFY-BRIEF-MPI reported a good agreement with the standard version of the MPI, indicating its application in the screening of multidimensional frailty among older people.

A Data-Driven Approach to Identify the Predictors of Perceived Health Status Among Chinese and Korean Americans

Asian Americans are the country's fastest-growing racial group, and several studies have focused on the health outcomes of Asian Americans, including perceived health status. Perceived health status provides a summarized view of the health of populations for diverse domains, such as the psychological, social, and behavioral aspects. Given its multifaceted nature, perceived health status should be carefully approached when examining any variables' influence because it results from interactions among many variables. A data-driven approach using machine learning provides an effective way to discover new insights when there are complex interactions among multiple variables. To date, there are not many studies available that use machine learning to examine the effects of diverse variables on the perceived health status of Chinese and Korean Americans. This study aims to develop and evaluate three prediction models using logistic regression, random forest, and support vector machines to find the predictors of perceived health status among Chinese and Korean Americans from survey data. The prediction models identified specific predictors of perceived health status. These predictors can be utilized when planning for effective interventions for the better health outcomes of Chinese and Korean Americans.

The contribution of work and health-related lifestyle to educational inequalities in physical health among older workers in Germany. A causal mediation analysis with data from the lidA cohort study

OBJECTIVES

The objective of the study was to investigate the contribution of work factors and health-related lifestyle to educational inequalities in physical health among older workers in Germany by applying causal mediation analysis with longitudinal data.

METHODS

Data from the German lidA study was used. 2653 persons (53% female, 47% male) aged 46 (born 1965) and 52 (born 1959) at baseline were followed up for seven years with exposure and outcome assessments in 2011 (t0), 2014 (t1) and 2018 (t2). The total effect of education on physical health was decomposed into a natural direct effect (NDE) and a natural indirect effect (NIE) by using a sex-stratified causal mediation analysis with an inverse odds weighting approach. Baseline health, partner status and working hours were entered as a first set of mediators preceding the putative mediators of interest. All analyses were adjusted for age and migrant status.

RESULTS

Independent of the first set of mediators, work factors explained 21% of educational inequalities in physical health between low and high educated women and 0% comparing moderate versus high educated women. The addition of health behaviors explained further 26% (low vs. high education) and 20% (moderate vs. high education), respectively. Among men, net of the first set of mediators, work factors explained 5% of educational inequalities in physical health between low and high educated and 6% comparing moderate versus high educated persons. Additional 24% (low vs. high education) and 27% (moderate vs. high education) were explained by adding health behaviors to the models.

CONCLUSIONS

To reduce educational inequalities in physical health among older workers in Germany, interventions to promote healthy behaviors are promising. Improving working conditions is likely an important prerequisite.

A natural experiment to assess how urban interventions in lower socioeconomic areas influence health behaviors: the UrbASanté study

BACKGROUND

Mechanisms underlying the associations between changes in the urban environment and changes in health-related outcomes are complex and their study requires specific approaches. We describe the protocol of the interdisciplinary UrbASanté study, which aims to explore how urban interventions can modify environmental exposures (built, social, and food environments; air quality; noise), health-related behaviors, and self-reported health using a natural experiment approach.

METHODS

The study is based on a natural experiment design using a before/after protocol with a control group to assess changes in environmental exposures, health-risk behaviors, and self-reported health outcomes of a resident adult population before and after the implementation of a time series of urban interventions in four contiguous neighborhoods in Paris (France). The changes in environmental exposures, health-related behaviors, and self-reported health outcomes of a resident adult population will be concurrently monitored in both intervention and control areas. We will develop a mixed-method framework combining substantial fieldwork with quantitative and qualitative analytical approaches. This study will make use of (i) data relating to exposures and health-related outcomes among all participants and in subsamples and (ii) interviews with residents regarding their perceptions of their neighborhoods and with key stakeholders regarding the urban change processing, and (iii) existing geodatabases and field observations to characterize the built, social, and food environments. The data collected will be analyzed with a focus on interrelationships between environmental exposures and health-related outcomes using appropriate approaches (e.g., interrupted time series, difference-in-differences method).

DISCUSSION

Relying on a natural experiment approach, the research will provide new insights regarding issues such as close collaboration with urban/local stakeholders, recruitment and follow-up of participants, identification of control and intervention areas, timing of the planned urban interventions, and comparison of subjective and objective measurements. Through the collaborative work of a consortium ensuring complementarity between researchers from different disciplines and stakeholders, the UrbASanté study will provide evidence-based guidance for designing future urban planning and public health policies.

TRIAL REGISTRATION

This research was registered at the ClinicalTrial.gov (NCT05743257).

Should I Stay or Should I Go (to the Office)?-Effects of Working from Home, Autonomy, and Core Self-Evaluations on Leader Health and Work-Life Balance

Leaders represent a high-demand group in organizations. The effects of leaders' personal and workplace resources on their health and work-life balance have often slipped under the radar, as most studies are directed outwardly and focus on follower outcomes. With this study, we closed a gap in the research and investigated the positive effects of remote work, autonomy, and leaders' core-self evaluations (CSE) on two important leader outcomes: health and work-life balance. We hypothesized that the relationship between remote work and the outcomes would be moderated by leaders' CSE and their autonomy-in such a way that leaders with lower resources benefit more from remote work and achieve better health and work-life balance the more days they spend working from home. A sample of 367 leaders reported their frequency of working from home, their autonomy, and CSE. Their health and work-life balance were assessed five months later. Results showed a moderating effect of CSE on both outcomes, indicating that leaders with low CSE benefit more in terms of health and work-life balance. There was no moderating effect of autonomy. Leaders with high resources (autonomy and CSE) had overall higher levels of health and work-life balance regardless of work location. Practitioners in organizations should consider working from home as a resource for leaders, particularly if personal resources are lower.

A Meta-Analysis on the Influence of Age-Friendly Environments on Older Adults' Physical and Mental Well-Being

The importance of age-friendly environments (AFEs) for older adults has been empirically and theoretically highlighted by the extant literature. However, the strength of the association between environments and older adults’ well-being has not been comprehensively quantified. Given the different attributes of the physical and mental dimensions, this meta-analysis aims to synthesise and quantify the association between AFEs and the physical and mental well-being of older adults. Fourteen eligible studies were included in this analysis: among which eight explored the link between AFEs and physical well-being, and eleven investigated AFEs in association with mental well-being. A random-effects model showed a small but significant correlation between AFEs and the mental well-being of older adults (r = 0.160, 95% CI [0.084, 0.224], p < 0.001), and the correlation between AFEs and physical well-being was also significant (r = 0.072, 95% CI [0.026, 0.118], p < 0.01). The number of environmental factors involved in AFEs moderated the association with physical well-being, from which the association was only significant among studies focusing on fewer environmental factors (n < 6). Results of this meta-analysis indicated that AFEs may be more effective in promoting the emotions of older adults, compared to ameliorating their physical functioning. The limitations of current empirical studies and directions for future research in the field of environmental gerontology were also discussed.

The Impact of Income and Social Capital on the Health of People with Developmental Disabilities

This study examines the impact of income and social capital on the health of people with developmental disabilities, focusing on the moderating effects of income and social capital on health. Hierarchical regression analysis was conducted using data from 235 people with developmental disabilities who participated in the second wave of the Disability and Life Dynamics Panel. The findings show that people with developmental disabilities who were female, employed, and did not have multiple disabilities and chronic diseases were more likely to display higher levels of self-rated health. Furthermore, self-rated health was higher in those earning a higher income. The social network had a significantly positive effect on health, but its moderating effect on the impact of income did not carry statistical significance. Trust was found to have a moderating effect on the impact of income on health, where the group with greater trust and lower income was healthier than the group with lower trust. The findings suggest the need to provide income support and establish social capital for people with developmental disabilities to improve their health, and this study offers related policy implications.

Trajectories of alcohol consumption in relation to all-cause mortality in patients with cardiovascular disease: a 35-year prospective cohort study

BACKGROUND AND AIMS

Research into alcohol consumption and cardiovascular disease (CVD) patients' prognosis has largely ignored the longitudinal dynamics in drinking behaviour. This study measured the association between alcohol consumption trajectories and mortality risk in CVD patients.

DESIGN

Prospective cohort study.

SETTING

UK-based Whitehall II Study.

PARTICIPANTS

A total of 1306 participants with incident non-fatal CVD (coronary heart disease/stroke) events.

MEASUREMENTS

Up to eight repeated measures of alcohol intake were available for each patient from the most recent assessment phase pre-incident CVD and all subsequent phases post-incident CVD, spanning up to three decades. Six trajectory groups of alcohol consumption were identified using group-based trajectory modelling and related to the risk of all-cause mortality, adjusting for demographics and changes in life-style and health status.

FINDINGS

Three hundred and eighty deaths were recorded during a median follow-up of 5 years after patients' last alcohol assessment. Compared with patients who consistently drank moderately (≤ 14 units/week), former drinkers had a greater risk of mortality (hazard ratio = 1.74, 95% confidence interval = 1.19-2.54) after adjustment for covariates. There was no significantly increased risk of mortality in long-term abstainers, reduced moderate drinkers, stable or unstable heavy drinkers. Cross-sectional analyses based only on drinking information at patients' last assessment found no significant differences in mortality risk for abstainers, former or heavy drinkers versus moderate drinkers.

CONCLUSIONS

Cardiovascular disease patients who consistently drink ≤ 14 units/week appear to have a similar risk of mortality to those who are long-term abstainers, which does not support a protective effect of moderate drinking on total mortality. Cardiovascular disease patients who stop drinking appear to have increased mortality risk compared with continuous moderate drinkers, but this may be linked to poor self-rated health before cardiovascular disease onset.

Genome-wide association studies in non-anxiety individuals identified novel risk loci for depression

BACKGROUND

Depression is a debilitating mental disorder that often coexists with anxiety. The genetic mechanisms of depression and anxiety have considerable overlap, and studying depression in non-anxiety samples could help to discover novel gene. We assess the genetic variation of depression in non-anxiety samples, using genome-wide association studies (GWAS) and linkage disequilibrium score regression (LDSC).

METHODS

The GWAS of depression score and self-reported depression were conducted using the UK Biobank samples, comprising 99,178 non-anxiety participants with anxiety score <5 and 86,503 non-anxiety participants without self-reported anxiety, respectively. Replication analysis was then performed using two large-scale GWAS summary data of depression from Psychiatric Genomics Consortium (PGC). LDSC was finally used to evaluate genetic correlations with 855 health-related traits based on the primary GWAS.

RESULTS

Two genome-wide significant loci for non-anxiety depression were identified: rs139702470 (p = 1.54 × 10^-8, OR = 0.29) locate in PIEZO2, and rs6046722 (p = 2.52 × 10^-8, OR = 1.09) locate in CFAP61. These associated genes were replicated in two GWAS of depression from PGC, such as rs1040582 (p_{replication GWAS1} = 0.02, p_{replication GWAS2} = 2.71 × 10^-3) in CFAP61, and rs11661122 (p_{replication GWAS1} = 8.16 × 10^-3, p_{replication GWAS2} = 8.08 × 10^-3) in PIEZO2. LDSC identified 19 traits genetically associated with non-anxiety depression (p < 0.001), such as marital separation/divorce (rg = 0.45, SE = 0.15).

CONCLUSIONS

Our findings provide novel clues for understanding of the complex genetic architecture of depression.

Personality and fatigue: meta-analysis of seven prospective studies

The present study examined the cross-sectional and longitudinal associations between the five major personality traits and fatigue. Participants were adults aged 16-104 years old (N > 40,000 at baseline) from the Health and Retirement Study, the National Social Life, Health, and Aging Project, the Wisconsin Longitudinal Study graduate and sibling samples, the National Health and Aging Trends Survey, the Longitudinal Internet Studies for the Social Sciences and the English Longitudinal Study of Ageing. Personality traits, fatigue, demographic factors, and other covariates were assessed at baseline, and fatigue was assessed again 5-20 years later. Across all samples, higher neuroticism was related to a higher risk of concurrent (meta-analytic OR = 1.73, 95% CI 1.62-1.86) and incident (OR = 1.38, 95% CI 1.29-1.48) fatigue. Higher extraversion, openness, agreeableness, and conscientiousness were associated with a lower likelihood of concurrent (meta-analytic OR range 0.67-0.86) and incident (meta-analytic OR range 0.80-0.92) fatigue. Self-rated health and physical inactivity partially accounted for these associations. There was little evidence that age or gender moderated these associations. This study provides consistent evidence that personality is related to fatigue. Higher neuroticism and lower extraversion, openness, agreeableness, and conscientiousness are risk factors for fatigue.

Factors related to self-rated health: a survey among patients and their general practitioners

OBJECTIVE

To explore associations between general practice patients' SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors.

DESIGN

A cross-sectional study. Data were collected from GP and patient questionnaires.

SETTING

General practices in Southeast Norway.

SUBJECTS

47 general practitioners (GPs) who included 866 consecutive patients.

MAIN OUTCOME MEASURES

SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses.

RESULTS

Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH.

CONCLUSION

The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.KEY POINTSThere is a high prevalence of poor SRH in general practice patients.The likelihood of reporting poor SRH is partly independent of the diagnosis given.The number of symptoms was the factor strongest associated with poor SRH.

Does Self-Care Make You a Better Leader? A Multisource Study Linking Leader Self-Care to Health-Oriented Leadership, Employee Self-Care, and Health

Leadership plays an important role in employee well-being. In light of a growing research interest in leaders’ resources as determinants of healthy leadership, it is not yet clear how leaders’ behavior regarding their own health (self-care) may trickle down to employees. Drawing on Conservation of Resources Theory and the model of Health-Oriented Leadership, this study tests two mechanisms through which employees may benefit from self-caring leaders: (a) through staff care, that is, concern for their employees’ health (improved leadership hypothesis); and (b) through a direct relationship between leaders’ and employees’ self-care (role-modeling hypothesis). In turn, both staff care and employee self-care would relate positively to employee health. Multilevel path models based on a sample of N = 46 supervisors and 437 employees revealed that leader self-care was positively related to leader-rated staff care at Level 2, which was positively related to employee-rated staff care at Level 1. In turn, employee-rated staff care was positively related to employee health. The findings support the improved leadership hypothesis and underline the importance of leader self-care as a determinant of healthy leadership.

Age differences in trajectories of self-rated health of young people with Multiple Sclerosis

BACKGROUND

Recent evidence has suggested an existence of a multiple sclerosis (MS) prodrome. Hence, some young adults with MS are very likely to have had symptoms in childhood or adolescence. It is, therefore, reasonable to assume that people aged under 25 years with MS might have had pediatric-onset. In contrast, young people aged between 26 and 35 are less likely to have had pediatric-onset. Contrasting these two groups of people could lead to valuable information about the impact of MS over time. The purpose of this study is to characterize how self-rated health (SRH) in young people with MS changed over time and to estimate the extent to which SRH differs between age groups (18 to 25 years and 26 to 35 years) and sex.

METHODS

This study utilized placebo arm data from the Multiple Sclerosis Outcome Assessment Consortium database. Responses to the RAND-36 SRH item of 393 participants were included. Group-based trajectory models (GBTM) were used to identify patterns of change over two years. Ordinal regression was performed to estimate whether these trajectory groups differed by age group, sex, and relapse event.

RESULTS

Results of GBTM showed that all groups were stable over time except one progressing from a rating of "very good" to "excellent". Posterior probabilities showed that 35% of people consistently rated their health "very good or excellent" and 2% consistently rated their health as "poor". Health perceptions differed across age groups (β = 0.5, OR: 1.7 CI: 1.1, 2.6) but not sex (β = -0.1, OR: 0.9 CI: 0.6 1.3). Compared to the younger group, people aged 26 to 35 years are 1.7 times more likely to rate their health poorer. People with relapses are also 2.2 times more likely to rate their health poorer (β = 0.8, OR: 2.2 CI: 1.5, 3.2).

CONCLUSION

Trajectories of SRH of young people with MS were relatively stable. In the absence of drug treatment, people in the younger group (<25 years) rated their health better than those in a slightly older group which is consistent with lower disability.

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

Aim

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

Methods

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

Results

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

Conclusion

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

Racismo e iniquidade racial na autoavaliação de saúde ruim: o papel da mobilidade social intergeracional no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

Resumo: Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.

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

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

Health Patterns among Migrant and Non-Migrant Middle- and Older-Aged Individuals in Europe-Analyses Based on Share 2004-2017

INTRODUCTION

European populations are becoming older and more diverse. Little is known about the health differences between the migrant and non-migrant elderly in Europe. The aim of this paper was to analyse changes in the health patterns of middle- and older-aged migrant and non-migrant populations in Europe from 2004 to 2017, with a specific focus on differences in age and gender. We analysed changes in the health patterns of older migrants and non-migrants in European countries from 2004 to 2017.

METHOD

Based on data from the Survey of Health, Ageing and Retirement in Europe (6 waves; 2004-2017; n = 233,117) we analysed three health indicators (physical functioning, depressive symptoms, and self-rated health). Logistic regression models for complex samples were calculated. Interaction terms (wave * migrant * gender * age) were used to analyse gender and age differences and the change over time.

RESULTS

Middle- and older-aged migrants in Europe showed significantly higher rates of depressive symptoms, lower self-rated health, and a higher proportion of limitations on general activities compared to non-migrants. However, different time trends were observed. An increasing health gap was identified in the physical functioning of older males. Narrowing health gaps over time were observed in women.

DISCUSSION

An increasing health gap in physical functioning in men is evidence of cumulative disadvantage. In women, evidence points towards the hypothesis of aging-as-leveler. These different results highlight the need for specific interventions focused on healthy ageing in elderly migrant men.

Cohort profile: the Ontario Life After Workplace Injury Study (OLAWIS)

PURPOSE

The substantial economic burden of work-related injury and illness, borne by workers, employers and social security programmes, is primarily attributed to the durations of work disability among workers whose recovery requires a period of absence from work, with the majority of costs arising from the minority of workers with the longest duration absences. The objective of the Ontario Life After Workplace Injury Study is to describe the long-term health and labour market outcomes of workers disabled by work injury or illness after they are no longer receiving benefits or services from the work disability insurance authority.

PARTICIPANTS

Workers disabled by a work-related injury or illness were recruited from a sample frame of disability benefit claimants with oversampling of claimants with longer benefit durations. Characteristics of workers, their employers and claimant benefits were obtained from baseline administrative data. Interviews completed at 18 months post injury (T1) and to be completed at 36 months (T2) measure return-to-work and work status; income; physical and mental health; case manager and healthcare provider interactions and employer accommodations supporting return-to-work and sociodemographic characteristics. Of eligible claimants, 40% (1132) participated in the T1 interview, with 96% consenting to participate in the T2 interview.

FINDINGS TO DATE

Preliminary descriptive analyses of T1 data have been completed. The median age was 50 years and 56% were male. At 18 months following injury, 61% were employed by their at-injury employer, 16% had changed employment and 23% were not working. Past-year prescription opioid use was prevalent (34%), as was past-year cannabis use (31%). Longer duration claimants had poorer function, recovery and health and more adverse labour market outcomes.

FUTURE PLANS

Multivariate analyses to identify modifiable predictors of adverse health and labour market outcomes and a follow-up survey of 96% of participants consenting to follow-up at 36 months are planned.

The association between mental health and shift work: Findings from the Atlantic PATH study

We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. Shift workers reported higher levels of each of the mental health-related domains compared to non-shift workers. There was a significant increased risk of depression (OR = 1.13, 95% CI, 1.00-1.27) and poor self-rated health (OR = 1.13, 95% CI, 1.14-1.55) among shift workers compared to non-shift workers. Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.

Helpfulness of Workplace Accommodations in Maintaining Health and Work Ability in Older Employees with Poor Health in Germany

OBJECTIVE

Supporting employees with health impairments to stay at work through workplace accommodation is a well-researched topic. However, research on workplace accommodations for older employees is lacking.

METHODS

Cross-sectional data from the German lidA cohort study in 2018 focusing on older employees who reported poor health (n = 421) was analyzed. A multiple logistic regression analysis was conducted to asses a potential association between the accommodation type and perceived helpfulness of workplace accommodations in older employees with poor health.

RESULTS

Changes in working times (OR 6.59), in work tasks (OR 3.50) and in the workplace (OR 2.57) were perceived as most helpful.

CONCLUSION

The results indicate that workplace accommodations can be helpful in older employees with health impairments and that this is not by chance, but that the perceived effectiveness has determinants and can be influenced.

Hierarchical Regression of Wellbeing and Self-Rated Health among Older Adults in Abu Dhabi

This study investigates the wellbeing factors related to self-rated health for older adults in Abu Dhabi (≥55 years). The purpose is to provide a comprehensive analysis of the determinants of self-rated health, considering various wellbeing factors, controlling for factors such as gender, nationality and long-standing illness if present. This research drew from a sample of 2375 older adults who participated in the Abu Dhabi Quality-of-Life Survey (QoL) conducted in 2018. Hierarchical multiple regression analysis was employed where the first two models corresponded to gender, nationality and having a long-standing illness or not. The third model focused on the wellbeing factors of Abu Dhabi citizens (i.e., social networks and connection, income and housing, sports and activities, mental feelings). The analysis revealed the insignificance of gender and nationality as controlled variables while having a long-standing illness showed significant adverse effects. The most significant variables were social support networks, family and social arrangements and connections. Other variables of significance included housing satisfaction, household income satisfaction, frequency of practicing sports, current mental status and life satisfaction. Policymakers could use the outcomes as insider intelligence for policymakers and social work professionals to create policies, programs and services to enhance the lives of older people in Abu Dhabi.

The Great Recession, behavioral health, and self-rated health: An examination of racial/ethnic differences in the US

The Great Recession has been associated with racial/ethnic disparities in economic loss, alcohol-related problems and mental health in the US. In this study, we examine its effect on overall health, the role of heavy drinking and mental health, and whether these relationships vary by race/ethnicity. Using US National Alcohol Survey data collected from White, African American and Latino individuals between June 2009 and March 2010 (N = 4656), we conducted gender-stratified simultaneous path modeling to test racial/ethnic differences in hypothesized paths from recession-related hardships to overall self-rated health through current depressive symptoms and heavy drinking. Recession impacts were measured using an index of job-related, financial and housing hardships. Models accounted for demographic characteristics and heavy drinking, health conditions and alcohol-related health harms occurring prior to the Great Recession. We found that in men and women of each racial/ethnic group, more accumulated recession hardships were associated with greater depressive symptoms and more frequent heavy drinking, and depressive symptoms were associated with poorer self-rated health. Further, heavy drinking was related to poorer self-rated health in Black men and depressive symptoms in Latino men, and for Black and Latina women, prior heavy drinking was associated with current depressive symptoms. Findings highlight adverse, behavioral and overall health consequences of a severe recession for men and women of diverse racial/ethnic groups, as well as unique risks for Black and Latino men and women. Findings suggest the need for behavioral health interventions alongside multisector strategies to bolster the labor market and social safety net during severe economic downturns.

Distinguishing independent and shared effects of material/structural conditions and psychosocial resources on educational inequalities in self-rated health: results from structural equation modelling

OBJECTIVES

The aim of this study was to distinguish independent and shared effects of material/structural factors and psychosocial resources in explaining educational inequalities in self-rated health (SRH) by using structural equation modelling.

STUDY DESIGN

Cross-sectional survey.

METHODS

Data were derived from a questionnaire sent to a random sample of the population in five counties in Sweden in 2008. The study population (aged 25-75 years) included 15,099 men and 17,883 women. Exploratory structural equation modelling was used to analyse the pathways from educational level to SRH.

RESULTS

The pathway including both material/structural factors (e.g. financial buffer and unemployment) and psychosocial resources (e.g. sense of coherence and social participation) explained about 40% of educational differences in SRH for both men and women. The pathways including only the independent effects of psychosocial resources (14% in men and 20% in women) or material/structural factors (9% and 18%, respectively) explained substantial but smaller proportions of the differences.

CONCLUSIONS

The major pathway explaining educational inequalities in SRH included both material/structural factors and psychosocial resources. Therefore, to reduce educational inequalities in SRH, interventions need to address both material/structural conditions and psychosocial resources across educational groups.

Self-reported mental health status of donor sperm-conceived adults

While donor-conceived children have similar mental health outcomes compared to spontaneously conceived children, there is an inconsistency between studies investigating mental health outcomes of donor-conceived people in adulthood. This study is an online health survey that was completed by 272 donor sperm-conceived adults and 877 spontaneously conceived adults from around the world. Donor sperm-conceived adults had increased diagnoses of attention deficit disorder (P = 0.004), and autism (P = 0.044) in comparison to those conceived spontaneously. Donor sperm-conceived adults self-reported increased incidences of seeing a mental health professional (P < 0.001), identity formation problems (P < 0.001), learning difficulties (P < 0.001), panic attacks (P = 0.038), recurrent nightmares (sperm P = 0.038), and alcohol/drug dependency (P = 0.037). DASS-21 analysis revealed that donor sperm-conceived adults were also more stressed than those conceived spontaneously (P = 0.013). Both donor sperm and spontaneously conceived cohorts were matched for sex, age, height, alcohol consumption, smoking, exercise, own fertility, and maternal smoking. The increase in adverse mental health outcomes is consistent with some studies of donor-conceived adult mental health outcomes. These results are also consistent with the Developmental Origins of Health and Disease (DOHaD) phenomenon that has linked adverse perinatal outcomes, which have been observed in donor-conceived neonates, to increased risk of chronic disease, including mental health. Further work is required to reconcile our observations in adults to contrary observations reported in donor-conceived children.

Correlates of self-rated health in people with diabetic peripheral neuropathy: a longitudinal study

AIM

Self-rated health, a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including persons with diabetes. This study examines correlates of self-rated health in adults with diabetic peripheral neuropathy (DPN).

METHODS

Participants recruited from the UK and USA (n = 295; mean (± sd) age: 61.5 ± 10.7 years; 69% male; 71% type 2 diabetes) rated their health at baseline and 18 months. DPN severity was assessed using the neuropathy disability score and the vibration perception threshold. Validated self-report measures assessed neuroticism, DPN-symptoms of pain, unsteadiness and reduced sensation in feet, DPN-related limitations in daily activities, DPN-specific emotional distress and symptoms of depression.

RESULTS

In the fully adjusted baseline model, younger age, presence of cardiovascular disease and higher depression symptom scores showed likely clinically meaningful independent associations with worse health ratings. Being at the UK study site and presence of nephropathy indicated potentially meaningful independent associations with lower baseline health ratings. These predictors were largely consistent in their association with health ratings at 18 months.

CONCLUSION

Results identify independent correlates of health ratings among adults with DPN. Future research should investigate the clinical implications of associations and examine changes in these variables over time and potential effects on changes in health perceptions. If these associations reflect causal pathways, our results may guide interventions to target issues that are likely to have an impact on subjectively experienced health as an important patient-reported outcome in DPN care.

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

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

It's Sunny, Be Healthy? An International Comparison of the Influence of Sun Exposure and Latitude Lines on Self-Rated Health

The positive impact of sunshine on self-rated health is well known. For the first time, the relationship between sunshine and self-rated health is examined in the context of latitude lines in international comparison. The further people live from the equator, the lower sun exposure (UVB exposure) and the more often they experience a vitamin D deficiency. UVB exposure decreases with degrees of latitudinal lines, and in addition to that, sunshine duration is shorter in northern countries. In order to consider the connection, sunshine duration and degree of latitude lines were manually enriched from the German Meteorological Service (Deutscher Wetterdienst) to the International Social Survey Programs (2011): Health and Health Care and analyzed with a logistic multilevel model, as well as the inclusion of sunshine duration as a mediator. If sunshine hours, as well as latitude lines, are considered separately in models, both show a statistically significant effect. Together in one model, the sunshine hours lose their relationship and additionally there is no mediation. This suggests that the location of the region is the decisive component when considering self-rated health. Furthermore, an interaction between age and sunshine hours as well as latitude lines is also shown.

Self-rated health as a predictor of mortality according to cognitive impairment: findings from the Korean Longitudinal Study of Aging (2006-2016)

OBJECTIVES

Self-rated health is an instrumental variable to assess the overall health status of a population. However, it remains questionable whether it is still useful for cognitively impaired individuals. Therefore, this study aims to analyze whether self-rated health by the cognitively impaired predicts mortality reliably.

METHODS

This study used 7,881 community-dwelling individuals, aged 45 and above, from the Korean Longitudinal Study of Aging (2006-2016). It used the Cox proportional hazard models for analysis. Cognitive status was classified based on the Korean Mini Mental State Examination score and a stratified analysis was used to determine whether the predictability of self-rated health varies according to cognitive status.

RESULTS

For cognitively intact individuals, the adjusted hazard ratios (aHR) of mortality were 2.00 (95% confidence interval [CI], 1.18 to 3.41, model 4) for those with ‘bad’ self-rated health and 2.40 (95% CI, 1.35 to 4.25, model 4) for those with ‘very bad’ self-rated heath, respectively, compared with those with ‘very good’ health. The results remain statistically significant even after adjusting for socio-demographic factors, health status, and health-related behaviors. For cognitively impaired individuals, the aHR of mortality was statistically significant for those with ‘very bad’ self-rated health, compared with those with ‘very good’ health, when socio-demographic factors were accounted for (aHR, 3.03; 95% CI, 1.11 to 8.28, model 2).

CONCLUSIONS

Self-rated health by cognitively impaired individuals remains useful in predicting mortality. It appears to be a valid and reliable health indicator for the rising population with cognitive impairment, especially caused by aging population.

Investigating the Relationship between Stress and Self-Rated Health during the Financial Crisis and Recession in 2008: The Mediating Role of Job Satisfaction and Social Support in Spain

Background: the 2008 financial crisis and subsequent recession had a strong impact on employment and certain health indicators, such as mental health. Many studies carried out with diverse samples attest to the negative influence of stress on health. However, few studies focus on stress and self-rated health among the Spanish workforce, or analyse which variables can act as a buffer against the negative effects of stress on self-perceived health. Aim: to analyse the mediator role of social support and job satisfaction in the relationship between work-related stress and self-rated health among the Spanish working population between 2006 and 2017. Method: repeated cross-sectional study using Spanish Surveys from 2006 to 2017, a total of 32.105 participants (47.4% women) aged 16 years and over (M = 42.3, SD = 10.7) answered a series of questions about work-related stress (PV), self-rated health (CV), job satisfaction, and social support (mediator variables) through the National Health Survey (NHS) prevalences of work-related stress, self-rated health, job satisfaction, and social support were calculated (standardised by age). We performed mediation/moderation analysis with Macro Process for SPSS to analyse the role of social support and job satisfaction in the relationship between self-rated health and work-related stress among the Spanish working population. Results: three mediation analyses were conducted, one for each time point in the study period. The results revealed a significant direct association between stress and job satisfaction. In the 2006 model, both job satisfaction and social support acted as mediators between stress and self-rated health, while in the 2011 and 2017 models, only job satisfaction acted as a mediator. The data reveal that the working population in Spain has a good capacity for resilience, since no drop in health indicators was observed. Conclusion: following the economic recession, employment has partially recovered. However, social and employment policies are required to help the population face the recent situation triggered by the Coronavirus crisis.

Associations between indoor temperature, self-rated health and socioeconomic position in a cross-sectional study of adults in England

OBJECTIVE

Excess winter deaths are a major public health concern in England and Wales, with an average of 20 000 deaths per year since 2010. Feeling cold at home during winter is associated with reporting poor general health; cold and damp homes have greater prevalence in lower socioeconomic groups. Overheating in the summer also has adverse health consequences. This study evaluates the association between indoor temperature and general health and the extent to which this is affected by socioeconomic and household factors.

DESIGN

Cross-sectional study.

SETTING

England.

PARTICIPANTS

Secondary data of 74 736 individuals living in England that took part in the Health Survey for England (HSE) between 2003 and 2014. The HSE is an annual household survey which uses multilevel stratification to select a new, nationally representative sample each year. The study sample comprised adults who had a nurse visit; the analytical sample was adults who had observations for indoor temperature and self-rated health.

RESULTS

Using both logistic and linear regression models to examine indoor temperature and health status, adjusting for socioeconomic and housing factors, the study found an association between poor health and higher indoor temperatures. Each one degree increase in indoor temperature was associated with a 1.4% (95% CI 0.5% to 2.3%) increase in the odds of poor health. After adjusting for income, education, employment type, household size and home ownership, the OR of poor health for each degree temperature rise increased by 19%, to a 1.7% (95% CI 0.7% to 2.6%) increase in odds of poor health with each degree temperature rise.

CONCLUSION

People with worse self-reported health had higher indoor temperatures after adjusting for household factors. People with worse health may have chosen to maintain warmer environments or been advised to. However, other latent factors, such as housing type and energy performance could have an effect.

Accumulation of economic hardship and health during the COVID-19 pandemic: Social causation or selection?

This study examines whether economic hardship during the COVID-19 pandemic is deleteriously associated with psychological distress and self-rated health. A social causation perspective suggests that exposure to economic hardship will harm well-being, but a social selection perspective suggests that the appearance of health effects of hardship during the pandemic are attributable to the increased risk of exposure to hardship associated with poor well-being at the start of the pandemic. We also propose a third perspective, economic selection, which suggests that economic hardship prior to the pandemic negatively affects health and increases risk of exposure to hardship during the pandemic; consequently, an association between health and economic hardship during the pandemic may be spurious, and entirely due to pre-existing levels of hardship. To test these competing perspectives, we use a longitudinal study based in Canada that began in late March of 2020 and followed respondents monthly in April, May, and June. Baseline psychological distress and self-rated health, as well as economic hardship prior to the pandemic, independently predict the accumulation of monthly periods of hardship from April to June. The accumulation of periods of hardship from April to June is deleteriously associated with psychological distress and self-rated health in June. Controls for prior economic hardship and baseline health weaken the association between accumulation of periods of hardship and psychological distress, while also eliminating the association between accumulation of hardship and self-rated health. These findings favor a social causation perspective for psychological distress and a social selection perspective for self-rated health, with less evidence found in support of economic selection. This study took place during the first months of the COVID-19 pandemic, though, and associations with self-rated health may have become more evident as hardship further wore on individual well-being over a longer period of time.

Transpersonal Genetic Effects Among Older U.S. Couples: A Longitudinal Study

BACKGROUND

Emerging social genetics research suggests one's genes may influence not just one's own outcomes but also those of close social alters. Health implications, particularly in late life, remain underexplored. Using combined genetic and survey data, this study examined such transpersonal genetic associations among older U.S. couples.

METHOD

Data were from married or cohabiting couples in the 2006-2016 waves of the Health and Retirement Study, nationally representative of U.S. adults over 50. Measures included a polygenic score for educational attainment, and self-rated health. Analysis was through parallel process latent growth models.

RESULTS

Women's and men's genetic scores for education had transpersonal linkages with their partner's health. Such associations were solely with life-course variations and not late-life change in outcomes. Moreover, they were indirect, mediated by educational attainment itself. Evidence also emerged for individual-level genetic effects mediated by the partner's education.

DISCUSSION

In addition to the subject-specific linkages emphasized in extant genetics literature, relational contexts involve multiple transpersonal genetic associations. These appear to have consequences for a partner's and one's own health. Life-course theory indicates that a person is never not embedded in such contexts, suggesting that these patterns may be widespread. Research is needed on their implications for the life-course and gene-environment correlation literature.

Associations of adverse and positive childhood experiences with adult physical and mental health and risk behaviours in Slovenia

Background: Many studies demonstrated the relationship between adverse childhood experiences (ACEs) and diminished health functioning in adulthood. A growing literature has shown that positive childhood experiences (PCEs) co-occurring with ACEs reduce the risks for negative outcomes. Objective: The aim was to investigate how ACEs and PCEs are simultaneously associated with health outcomes in adulthood, including self-rated health, physical and mental health outcomes, and health-risk behaviours. Methods: A panel sample of 4,847 Slovenian adults was used and the data were weighted to closely resemble the Slovenian population. A series of logistic regression analyses were performed to examine how ACEs and PCEs predict the risk of various health outcomes. Results: Significant associations, as measured by adjusted odds ratios, were found between higher ACEs exposure and each of the 16 health outcomes evaluated. Adjusting for above median PCEs attenuated the association between ACEs and 6 health outcomes (poor self-rated physical and mental health, depression, anxiety, suicide attempt, physical inactivity; OR for ≥ 4 vs. 0 ACEs, 1.48-9.34). Mirroring these findings, above median PCEs were associated with lowered odds of these 6 health outcomes after adjusting for ACEs (OR for above vs. below median PCEs, 0.46-0.67), but not with odds of physical health outcomes and most of the health-risk behaviours. Stratified analyses by ACEs exposure level showed that the association between PCEs and self-rated health remained stable across ACEs exposure levels, while the association between PCEs and mental health outcomes and physical inactivity varied across ACEs exposure levels. Conclusions: Our results suggest that above median PCEs attenuate the association between ACEs and poor self-rated health, mental health problems, and physical inactivity in later life, and are negatively associated with these health problems even in the concurrent presence of ACEs. Interventions to promote PCEs can help to reduce unfavourable long-term health outcomes following childhood adversity.

Change in Mobility: Consistency of Estimates and Predictors Across Studies of Older Adults

OBJECTIVES

This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.

METHODS

Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.

RESULTS

Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.

DISCUSSION

To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.

Non-parental care in childhood and health up to 30 years later: ONS Longitudinal Study 1971-2011

BACKGROUND

Children who spend time in non-parental care report worse health later in life on average, but less is known about differences by type of care. We examined whether self-rated health of adults who had been in non-parental care up to 30 years later varied by type of care.

METHODS

We used longitudinal data from the office for National Statistics Longitudinal Study. Participants were aged <18 and never-married at baseline of each census year from 1971 to 2001. Separately for each follow-up period (10, 20 and 30 years later), multi-level logistic regression was used to compare self-rated health outcomes by different care types.

RESULTS

For combined census years, sample sizes were 157 896 dependent children with 10 years of follow-up, 166 844 with 20 years of follow-up and 173 801 with 30 years of follow-up. For all follow-up cohorts, longitudinal study members who had been in care in childhood, had higher odds of rating their health as 'not good' vs. 'good'; with highest odds for residential care. For example, 10-year follow-up odds ratios were 3.5 (95% confidence interval: 2.2-5.6) for residential care, 2.1 (1.7-2.5) for relative households and 2.6 (2.1-3.3) for non-relative households, compared with parental households after adjustment for childhood demographics. Associations were weakest for 10-year, and strongest for 20-year, follow-up. Additional adjustment for childhood social circumstances reduced, but did not eliminate, associations.

CONCLUSION

Decades after children and young people are placed in care, they are still more likely to report worse health than children who grew up in a parental household.

Education and health: The joint role of gender and sexual identity

BACKGROUND

Prior research has found that education's association with health can differ by social positions such as gender. Yet, none of the existing work has tested whether the relationship between education and self-rated health is equivalent across sexual orientation groups, and additionally, if these associations differ for men and women. Deploying the intersectionality perspective, we expand current debates of education as a resource substitution or multiplication to include sexual orientation.

METHODS

We answer these questions using data from the Behavioral Risk Factor Surveillance System (BRFSS), a probability-based sample of adults living in 44 US states and territories for selected years between 2011 and 2017 (n = 1,219,382).

RESULTS

Supporting resource multiplication, we find that compared to their same-gender heterosexual counterparts, education is less health-protective for bisexual adults, especially bisexual women. Gay men and lesbian women, on the other hand, seem to have similar associations of education with health as their same-gender heterosexual counterparts. Turning to gender comparisons across sexual identity groups, we find that resource substitution may operate only among heterosexual women when compared with heterosexual men.

CONCLUSIONS

In sum, this study suggests that the relationship between education and health may depend on the intersection of gender and sexual orientation among U.S. adults.

Diverging ideas of health? Comparing the basis of health ratings across gender, age, and country

BACKGROUND

Self-rated health (SRH) is arguably the most widely used generic health measurement in survey research. However, SRH remains a black box for researchers. In our paper, we want to gain a better understanding of SRH by identifying its determinants, quantifying the contribution of different health domains to explain SRH, and by exploring the moderating role of gender, age groups, and the country of residence.

METHOD

Using data from 61,365 participants of the fifth wave (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE) living in fifteen European countries, we explain SRH via linear regression models. The independent variables are grouped into five health domains: functioning, diseases, pain, mental health, and behavior. Via dominance analysis, we focus on their individual contribution to explaining SRH and compare these contributions across gender, three age groups, and fifteen European countries.

RESULTS

Our model explains SRH rather well (R² = .51 for females/.48 for males) with functioning contributing most to the appraisal (.20/.18). Diseases were the second most relevant health dimension (.14/.16) followed by pain (.08/.07) and mental health (.07/.06). Health behavior (.02/.01) was less relevant for health ratings. This ranking held true for almost all countries with only little variance overall. A comparison of age groups indicated that the contribution of diseases and behavior to SRH decreased over the life-course while the contribution of functioning to R² increased.

CONCLUSION

Our paper demonstrates that SRH is largely based on diverse health information with functioning and diseases being most important. However, there is still room for idiosyncrasies or even bias.

To what extent do socioeconomic inequalities in SRH reflect inequalities in burden of disease? The HELIUS study

BACKGROUND

Self-rated health (SRH), an attractive measure for health monitoring, shows persistent inequalities with regard to socioeconomic status (SES). However, knowledge on the extent to which inequalities in SRH reflect inequalities in disease burden is lacking.

METHODS

Data come from the multi-ethnic HEalthy LIfe in an Urban Setting study (Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish or Moroccan origin, N = 19 379, aged 18-70). SES was defined by educational and occupational level. Disease burden was operationalized as chronic diseases, physical and mental functioning (measured with SF-12) and depressive symptoms (measured with PHQ-9). We applied logistic regression analyses and reported average marginal effects (AME).

RESULTS

Dutch origin participants with low educational or low occupational level had higher probabilities of reporting fair/poor SRH, compared to the highest levels (AME = 0.20 95% CI: 0.13;0.27; and 0.12 (0.09;0.15), respectively). Associations were attenuated after adjusting for all disease burden indicators, to AME = 0.03 (0.01;0.04) and AME = 0.02 (-0.00;0.04). In all the non-Dutch origin groups, a larger part of the inequalities remained after adjustment.

CONCLUSION

Socioeconomic inequalities in SRH are for a large part explained by higher disease burden in lower socioeconomic groups, but less so in those with non-Dutch origin. Future research should examine if our conclusions also hold for trend data on inequalities in SRH.

The association between depressive symptoms and self-rated health among university students: a cross-sectional study in France and Japan

BACKGROUND

Depressive disorders in University students have risen dramatically in the past few decades to the extent that students' mental health has become a current global public health priority. Obtaining information from University students about their mental health is challenging because of potential embarrassment of disclosing one's concerns and fear of stigmatization. Self-rated health might be a good solution to evaluate mental health state by a simple and neutral indicator. The aim of the study is to investigate the association between depressive symptoms and self-rated health by sex among University students in France and Japan.

METHODS

A cross-sectional study was conducted by using two large cohorts of students aged ≥18 years (n = 5655 in Bordeaux, France and n = 17,148 in Kyoto, Japan). Depressive symptoms (PHQ-2 scale), Likert scale of self-rated health, socio-demographic characteristics and health habits were collected through self-administered questionnaires. Multivariate logistic regression models were performed to describe the association between depressive symptoms and other variables including self-rated health, stratified by sex.

RESULTS

A high score of PHQ-2 (high depressive symptoms) was associated with poor self-rated health in both cohorts independently of all other variables (OR 2.82, 95%CI 1.99-4.01 in France, OR 7.10, 95%CI 5.76-8.74 in Japan). Although the prevalence of depressive symptoms between sexes was different in French students (males 15.4%, females 25.0%, p < 0.001), it was similar in Japanese students (males 3.5%, females 3.3%, p = 0.466), who reported less depressive symptoms than French students. The association between depressive symptoms and poor self-rated health was greater in Japanese females (OR 12.40, 95%CI 7.74-20.00) than in males (OR 6.30, 95%CI 4.99-7.95), whereas the strength of the association was almost similar in French students (OR 2.17, 95%CI 0.86-5.47 in males, OR 2.98, 95%CI 2.03-4.38 in females).

CONCLUSIONS

Depressive symptoms were associated with self-rated health among University students in both countries with slightly differences in sex. Self-rated health would be a simple, reliable and universal indicator for healthcare professionals and University staff to identify students at risk of depression.