Gender differences in the predictive role of self-rated health on short-term risk of mortality among older adults

Population frailty trends by education and income levels over a period of 30 years: findings from Swedish registry data

BACKGROUND

Frailty is an age-related health condition affecting an estimated 18% of older adults in Europe and past evidence has shown a relationship between socioeconomic factors and frailty. We examined population frailty trends and the association between frailty and 5-year mortality by education tertiles and income quartiles at ages 75, 85 and 95 in Swedish registry data.

METHODS

All Swedish residents born in 1895-1945 and in the Total Population Register from 1990 to 2020 were included. Frailty was assessed with the Hospital Frailty Risk Score (HFRS), which sums 109 weighted International Classification of Diseases (ICD codes), collected from the National Patient Register.

RESULTS

Regardless of education and income, frailty increased over time, though the association between frailty and 5-year mortality remained stable. Particularly in earlier birth cohorts, although the highest education and income levels had the highest mean HFRS scores, the lowest education and income levels accounted for greater proportions among the frail. These trends varied slightly by sex and age. Men and women had similar levels of frailty, but frailty was more strongly associated with mortality among men.

CONCLUSION

Over time, education and income levels were more equally represented among the frail population in more recent years. More equitable distribution over time may suggest improvement in health disparities, though more work is needed. The overall increase in frailty and unchanged association with mortality indicates that additional research is needed to better understand how to best support the growing ageing population. This would then support the long-term viability of the healthcare system.

COVID-19-Induced Inequalities and Mental Health: Testing the Moderating Roles of Self-rated Health and Race/Ethnicity

This study examines the relationship among COVID-19-induced social, economic, and educational inequalities on mental health (i.e., anxiety and depression). This study also examines if levels of self-rated health (SRH) moderate the relationship (i.e., COVID-induced inequalities [CII] and mental health), as well as examines the racial/ethnic group differences among 567 young adults in the mid-Atlantic region. Using a moderation model, results indicate that CII were significantly related to depression (b = .221, t(554) = 4.59, p = .000) and anxiety (b = .140, t(555) = 3.23, p = .001). SRH and race/ethnicity also moderated both relationships. At above-average SRH (i.e., moderator), higher CII were also significantly related to lower anxiety (Asian young adults only) and lower depression (Asian and White young adults only). Overall, SRH and race/ethnicity are important factors in the mental health impact of COVID-19 on young adults.

Marital status and all-cause mortality rate in older adults: a population-based prospective cohort study

BACKGROUND

Living with a partner and separation is becoming more common among older people. Mortality disparities associated with marital status are significant in increasingly diverse aging populations. The link between marital status and all-cause mortality risk in older adults remains uncertain.

METHODS

This prospective cohort study included data from the US National Health and Nutrition Examination Survey (NHANES). We included NHANES participants ≥ 60 years of age (data from 1999 to 2014). Data for mortality follow-up beginning from the commencement date of survey participation to the last day of December 2015. Univariate- and multivariate-adjusted Cox proportional hazard models for marital status were estimated, and the findings were presented as regression coefficients and 95% confidence intervals (CI). Kaplan-Meier curves were reported.

RESULTS

Compared to never married individuals, the risk of all-cause mortality was 0.77 (0.50-1.18), 0.72 (0.56-0.93), 0.56 (0.36-0.88), and 0.84 (0.67-1.07) in those people living with a partner, married, separated, and divorced, respectively, after adjusting for demographics, socioeconomics, behavior, anthropometric variables, and medical history. The risk of all-cause mortality was 1.24 (0.97-1.59) in widowed participants.

CONCLUSION

This population-based cohort study included a large sample size followed by long-term follow-up. The association between marriage, health, and reduced mortality in older individuals has been illustrated in this study. Being married or separated was associated with a lower risk of mortality.

Multimorbidity patterns and mortality in older adults: Results from the KORA-Age study

The coexistence of several chronic diseases is very common in older adults, making it crucial to understand multimorbidity (MM) patterns and associated mortality. We aimed to determine the prevalence of MM and common chronic disease combinations, as well as their impact on mortality in men and women aged 65 years and older using the population-based KORA-Age study, based in South of Germany. The chronic disease status of the participants was determined in 2008/9, and mortality status was followed up until 2016. MM was defined as having at least two chronic diseases. We used Cox proportional hazard models to calculate the hazard ratios (HRs) and the 95% confidence intervals (CIs) for associations between MM and all-cause mortality. During the study period 495 men (24.6%) and 368 women (17.4%) died. Although the MM prevalence was almost the same in men (57.7%) and women (60.0%), the overall effect of MM on mortality was higher in men (HR: 1.81, 95% CI: 1.47–2.24) than in women (HR: 1.28, 95% CI: 1.01–1.64; p-value for interaction <0.001). The type of disease included in the MM patterns had a significant impact on mortality risk. For example, when both heart disease and diabetes were included in the combinations of two and three diseases, the mortality risk was highest. The risk of premature death does not only depend on the number of diseases but also on the specific disease combinations. In this study, life expectancy depended strongly on a few diseases, such as diabetes, hypertension, and heart disease.

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.

Physical and Mental Health Differences Reported by Three Age Groups of Older Adults With Diabetes

Most studies have classified older adults with diabetes into one group despite substantial variation in health status across different stages of late adulthood. In this study, we examined difference in self-reported physical and mental health among three age groups of older adults with diabetes. Using data from the 2016 National Social Life, Health and Aging Project, Wave 3, we classified 424 individuals diagnosed with diabetes into three age groups, young-old (YO): 50-64 years; middle-old (MO): 65-74; and oldest old (OO): 75+ years. A one-way multivariate analysis of covariance was used to assess group differences, followed by univariate analyses. The results indicate that the YO group reported significantly lower physical health and higher depression than the MO group and higher levels of loneliness than the MO and OO groups. These findings indicate that physical and mental health may differ among different age groups of older adults with diabetes and suggest that the YO might be more vulnerable to diminished physical and mental health than the other age groups.

Age and sex differences in associations between self-reported health, physical function, mental function and mortality

OBJECTIVES

To explore how age and sex affect the impacts of self-rated health, self-reported physical activities, physical function, and depressive symptoms on long-term mortality among community-dwelling middle-aged and older adults using a nationally representative population-based cohort study.

METHODS

Data from 1550 study participants from the Social Environment and Biomarkers of Aging Study (SEBAS) were retrieved for analysis, and all participants were divided into four groups based on their age and gender. Middle aged participants were aged 53 to 64 years, and elderly subjects were ≥ 65 years old. Multivariate logistic regression models were applied to investigate the associations between age, sex, and self-reported disabilities of physical activities, physical function (activities of daily living (ADL) and instrumental activities of daily living (IADL) and depression.

RESULTS

Although the self-reported health status was similar across different age- and sex-stratified subgroups, older women were at the highest risk in self-reported difficulty with physical activities (aOR 2.58 [1.55-4.28]) and difficulty with IADL (aOR 3.32 [2.20-5.03]) compared to men. After adjusting for living arrangement, residence locale, education levels, occupation, socioeconomic status, self-reported health, multimorbidity, impairments in daily activities, and depressive symptoms, older men were found to display the highest risk of mortality (aHR 2.06 [95% CI 1.45-2.93]).

CONCLUSIONS

Although self-reported health was similar across different age and sex stratified subgroups, women (particularly older women) are significantly more likely to have worse physical and functional health than men. After adjusting for all confounding factors, men are at substantially greater risk for mortality despite reporting better health and functional performance.

The Importance of Age in the Prediction of Mortality by a Frailty Index: A Machine Learning Approach in the Irish Longitudinal Study on Ageing

The quantification of biological age in humans is an important scientific endeavor in the face of ageing populations. The frailty index (FI) methodology is based on the accumulation of health deficits and captures variations in health status within individuals of the same age. The aims of this study were to assess whether the addition of age to an FI improves its mortality prediction and whether the associations of the individual FI items differ in strength. We utilized data from The Irish Longitudinal Study on Ageing to conduct, by sex, machine learning analyses of the ability of a 32-item FI to predict 8-year mortality in 8174 wave 1 participants aged 50 or more years. By wave 5, 559 men and 492 women had died. In the absence of age, the FI was an acceptable predictor of mortality with AUCs of 0.7. When age was included, AUCs improved to 0.8 in men and 0.9 in women. After age, deficits related to physical function and self-rated health tended to have higher importance scores. Not all FI variables seemed equally relevant to predict mortality, and age was by far the most relevant feature. Chronological age should remain an important consideration when interpreting the prognostic significance of an FI.

Neighborhood Ethnic Composition and Self-rated Health Among Chinese and Vietnamese American Immigrants

Immigrants tend to live in areas with higher co-ethnic density, and the effect of neighborhood ethnic composition could be particularly salient for health. This study explored associations between neighborhood ethnic composition and self-rated health among Asian immigrants. We analyzed data collected at baseline from 670 Chinese and Vietnamese immigrants enrolled in a lifestyle intervention trial. Residential addresses were geocoded and combined with neighborhood socio-demographic profiles based on census data. We used generalized estimating equations to examine neighborhood ethnic composition and self-rated health. Independent of individual-level factors, living in neighborhoods more densely populated by whites was associated with poor/fair self-rated health. Neighborhood household income and density of participants' own ethnic group were not associated with poor/fair self-rated health. More research is warranted to disentangle reasons why Chinese and Vietnamese immigrants living in white-concentrated neighborhoods reported poorer self-rated health, including investigating effects of discrimination, relative deprivation, and availability of social resources.

A Dream Deferred: African American Women's Diminished Socioeconomic Returns of Postponing Childbearing from Teenage to Adulthood

Background

Brookings Institution has identified postponing childbirth from teenage to adulthood as a major strategy that is needed for upward social mobility of women. However, according to the Minorities' Diminished Returns (MDRs), the associations between aspirations, investments, behaviors, and socioeconomic position (SEP) may be diminished for marginalized groups such as African Americans.

Objective

To extend the existing knowledge on the MDRs, the current study had two aims: First to compare White and African American women for the association between postponing childbearing to adulthood and SEP in a national sample of American women. Second, to test correlates of postponing childbearing to adulthood and SEP at birth with long term outcomes 15 years later when the child was 15 years old.

Methods

For this longitudinal study, data came from the Fragile Families and Child Well-being Study (FFCWS), a national longitudinal prospective study in the United States (US) that followed an ethnically diverse sample of women from childbirth for 15 years from 1998 to 2016. For the first aim, this study included 2679 women composed of 723 Whites and 1956 African Americans. For the second aim, among 1842 individuals who had available data 15 years later, we measured various economic, behavioral, and mental health outcomes when the child was 15 years old. For aim 1 we ran linear regression. Postponing childbearing to adulthood was the independent variable. The dependent variable, SEP (poverty) was treated as a continuous measure with higher score indicating more poverty. Confounders included marital status and delivery characteristics. For the aim 2, we ran Pearson correlation test (exploratory analysis) to test if baseline SEP correlates with future outcomes.

Results

Postponing childbearing from adolescence to adulthood was associated with higher SEP in adulthood, net of all confounders including marital status and education. We found a significant interaction between postponing childbearing from adolescence to adulthood and race on SEP, suggesting that the economic reward of postponing childbearing may be weaker for African American women than for White women.

Conclusions

Although postponing the age at childbirth is a recommended strategy for women who wish to maximize their chance of upward social mobility, this strategy may be associated with smaller economic returns for African American women than White women. The results can also be interpreted as MDRs in investments in terms of a postponing childbearing. In a fair society, the same investment should be similarly rewarded across diverse racial groups. In the reality, however, the US society differently rewards White and African American women who postpone childbearing. Research should explore the roles of social stratification, blocked opportunities, and concentrated poverty in explaining the unequal return of such an investment for African American and White women.

Do response styles affect the predictive validity of self-rated health among Chinese older men and women?

PURPOSE

This study intended to examine whether correcting for response styles of the widely used self-rated health (SRH) question would affect its predictive validity in estimating respondents' mortality risks.

METHODS

We used data on a sample of 3319 men and 3250 women aged 60 and above from a nationally representative survey in China. Response styles were estimated with both ratings on two health anchoring vignettes and self-rated items in domains unrelated to health. Gender-stratified logistic regressions were used to estimate the effects of SRH on 4-year mortality risks. We compared the results before and after adjusting for response styles.

RESULTS

In the unconditional model, the effects of the five-point SRH on 4-year mortality risks were significant in both older women and men, and stronger among Chinese older men based on discrete change in probabilities of mortality at means. Gender difference was observed in response styles. Men assigned lower ratings to the vignettes than women, reflecting their higher standards in defining good health. Women presented higher proportions of extreme responses and lower proportions of midpoint responses. Correcting for response styles had no effect on the predictive validity of SRH for Chinese older men, but had some positive effects for Chinese older women when no other covariates were included.

CONCLUSION

Adjusting for response styles contributed to a small improvement in predicting mortality risks only among Chinese older women under restricted conditions, but not men.

Subjective Health and Happiness in the United States: Gender Differences in the Effects of Socioeconomic Status Indicators

Background

Education, employment, and marital status are among the main socioeconomic status (SES) indicators that are associated with subjective health and happiness. The effects of these SES indicators may, however, be different for various demographic groups.

Aims

To understand if SES indicators differently impact men and women, we tested gender differences in the effects of education, employment, and marital status on the subjective health and happiness of American adults.

Methods

This cross-sectional study used data of the General Social Survey (GSS), a series of nationally representative surveys between 1972 and 2018 in the US. Our analytical sample included 65,814 adults. The main independent variables were education attainment, marital status, and employment. Outcomes were self-rated health (SRH) and happiness measured using single items. Age and year of the study were covariates. Gender was the moderator.

Results

Overall, high education, being employed, and being married were associated with better SRH and happiness. We, however, found significant interactions between gender and educational attainment, marital status, and employment on the outcomes, which suggested that the effect of high education and marital status were stronger for women. In comparison, the effect of employment was stronger for men. Some inconsistencies in the results were observed for SRH compared to happiness.

Conclusions

In the United States, while education, employment, and marital status are critical social determinants of subjective health and happiness, these effects vary between women and men. Men's outcomes seem to be more strongly shaped by employment, while women's outcomes are more strongly shaped by education and marital status.

Association between self-rated health and physical performance in middle-aged and older women from Northeast Brazil

Background

Self-rated Health (SRH) is regarded as a simple and valid measure of a person’s health status, given its association to adverse health outcomes, including low physical performance in older populations. However, studies investigating these associations in low- and middle-income settings are scarce, especially for middle-aged populations. Understanding the validity of SRH in relation to objective health measures in low-income populations could assist in decision making about health policy and strategies, especially in under-resourced settings.

Objective

Assess the relationship between SRH and physical performance measures in middle-aged and older women in a low-income setting of Brazil.

Methods

This is a cross-sectional study of 571 middle-aged (40–59 years old) and older (60–80 years old) women living in Parnamirim and Santa Cruz in the Northeast region of Brazil. Participants reported their health status and were allocated to the “SRH good” or “SRH poor” groups. The physical performance evaluation included: handgrip strength, one-legged balance with eyes open and closed and chair stand test. The relationship between SRH and physical performance for middle-aged and older women was assessed by quantile regression (modeling medians) adjusted for potential confounders (age, socioeconomic variables, body mass index, menopause status, age at first birth, parity, chronic conditions and physical activity).

Results

Middle-aged women from the “SRH good” group presented better physical performance with 1.75 kgf stronger handgrip strength (95% CI [0.47–3.02]; p = 0.004), 1.31 s longer balance with eyes closed ([0.00–2.61]; p = 0.030), and they were 0.56 s faster in the chair stand test ([0.18–0.94]; p = 0.009) than those who reported “SRH poor”. No association was found for balance with eyes open. For older women, there was no evidence of associations between physical performance and SRH.

Conclusion

This study showed that SRH is significantly associated with objective measures of physical performance in a sample of low-income middle-aged women. SRH can be an important tool to indicate the need for further evaluation of physical performance among middle-aged women and can be particularly useful for low-income communities.

Investigation of the Predictors of Self-rated Health of Economically Disadvantaged African American Men and Women: Evidence for Sponge Hypothesis

Background and aims

According to the sponge hypothesis, compared to men's self-rated health (SRH), women's SRH is more likely to reflect conditions other than chronic medical conditions (CMCs) such as psychiatric disorders (PDs). As a result, poor SRH is a weaker predictive factor for mortality risk for women than men. Most of this literature, however, is done in samples that are predominantly middleclass White. To test the sponge hypothesis among economically disadvantaged African Americans (AAs), this study compared low-income AA men and women for the effects of the number of PDs and CMCs on SRH.

Materials and Methods

This cross-sectional study recruited a non-random sample (n = 150) of economically disadvantaged AA adults with PD(s). Structured face-to-face interviews were used to collect data. SRH was measured using a single-item measure. PDs and CMCs were also self-reported. We applied linear regression models to test the interactions between SRH and the number of PDs and CMC as well as gender.

Results

The number of PDs and CMCs were associated with SRH in the pooled sample of low-income AA adults with PD(s). However, we found a significant interaction between the number of PDs and gender. This interaction suggested a stronger association between PDs and SRH for AA women than AA men. Gender did not alter the association between the number of CMCs and SRH.

Conclusion

The number of PDs is a determinant of SRH for low-income AA women but not AA men, supporting the sponge hypothesis.

Autoavaliação negativa da saúde em pessoas idosas associada a condições socioeconômicas e de saúde: inquérito populacional em Rio Branco, Acre

Resumo Objetivo Estimar a prevalência de autoavaliação negativa da saúde e sua associação com condições socioeconômicas, sintomas depressivos, funcionalidade e morbidades autorreferidas em pessoas idosas de Rio Branco, Acre. Método Trata-se de uma pesquisa realizada com dados do Estudo das Doenças Crônicas em Idosos (EDOC-I), um inquérito domiciliar realizado com pessoas a partir de 60 anos residentes em Rio Branco, Acre, Brasil, em 2014 (n=1.016). A autoavaliação negativa da saúde foi definida pelos estratos “ruim” e “muito ruim”. Foram aplicadas as escalas de depressão geriátrica e das atividades da vida diária e instrumentais da vida diária. Como medida de associação da autoavaliação negativa da saúde com variáveis de interesse foi empregada a técnica de regressão logística múltipla. Resultados A prevalência de autoavaliação negativa da saúde foi de 15,4%, apresentando associação estatisticamente significativa com sexo feminino (OR:1,72; IC95%:1,17-2,51), baixa escolaridade (OR:2,33; IC95%:1,37-3,97), sedentarismo (OR:1,84; IC95%: 1,08-3,14) e uso de medicamentos (OR:3,01; IC95%:1,52-5,95). Também se detectou associação com sintomas depressivos (OR:2,55; IC95%:1,74-3,73), presença de multimorbidades (OR:1,73; IC95%:1,15-2,61) e dependência total nas atividades instrumentais da vida diária (OR:2,42; IC95%:1,40-4,17). As morbidades associadas à percepção negativa da saúde foram: asma/bronquite (OR:2,74; IC95%:1,61-4,67), insônia (OR:1,80; IC95%:1,25-2,58) e problemas cardíacos (OR:1,77; IC95%:1,18-2,68). Conclusão Assim, a autoavaliação negativa da saúde das pessoas idosas sofre influência das condições socioeconômicas e de saúde, sendo um indicador útil para o delineamento de estratégias em saúde que favoreçam o envelhecimento com independência e bem-estar físico e emocional.

Dimensional Change Card Sorting of American Children: Marginalization-Related Diminished Returns of Age

BACKGROUND

While age is associated with an increase in cognitive flexibility and executive functioning as a result of normal development during childhood, less is known about the effect of racial variation in children's age-related cognitive development. The Marginalization-related Diminished Returns (MDRs) phenomenon suggests that, under racism, social stratification, segregation, and discrimination, individual-level economic and non-economic resources and assets show weaker effects on children's development for marginalized, racialized, and minoritized families.

AIM

We conducted this study to compare racial groups of children for age-related changes in their card sorting abilities.

METHODS

This cross-sectional study included 10,414 9-10-year-old American children. Data came from the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was age, a continuous variable measured in months. The dependent variable was dimensional change card sort (DCCS) score, which reflected cognitive flexibility, and was measured by the NIH Dimensional Change Card Sort. Ethnicity, sex, parental education, and marital status were the covariates.

RESULTS

Older age was associated with higher DCCS score, reflecting a higher card-sorting ability and cognitive flexibility. However, age showed a weaker association with DCCS for Black than for White children. This was documented by a significantly negative interaction between race and age on children's DCCS scores.

CONCLUSION

Age shows a weaker correlation with the cognitive flexibility of Black than of White children. A similar pattern can be seen when comparing low-income with high-income children. Conceptualizing race as a social factor that alters normal childhood development is a finding that is in line with MDRs. Marginalization due to social stratification and racism interfere with the normal age-related cognitive development of American children.

Diminished Health Returns of Educational Attainment Among Immigrant Adults in the United States

Objectives: Marginalization-related diminished returns (MDRs) refer to weaker health effects of educational attainment for socially marginalized groups compared to the socially privileged groups. Most of the existing literature on MDRs, however, has focused on marginalization due to race, ethnicity, and sexual orientation. Thus, very limited information exists on MDRs of educational attainment among immigrant populations in the United States. Aims: Building on the MDRs framework and using a nationally representative sample of US adults, we compared immigrant and native-born adults for the effects of educational attainment on psychological distress, self-rated health (SRH), and chronic diseases (CDs). Methods: The 2015 National Health Interview Survey (NHIS) has enrolled 33,672 individuals who were either immigrant (n = 6,225; 18.5%) or native born (n = 27,429; 81.5%). The independent variable (IV) was educational attainment, which was treated as a categorical variable. The dependent variables included psychological distress, SRH, and CDs, all of which were dichotomous variables. Age, gender, race, ethnicity, and region were confounders. Immigration (nativity status) was the moderator. Results: Higher educational attainment was associated with lower odds of psychological distress, poor SRH, and CDs. However, immigration showed a significant statistical interaction with college graduation on all outcomes, which were suggestive of smaller protective effects of college graduation on psychological distress, poor SRH, and CDs for immigrant than native-born adults. Conclusions: In the US, the associations between educational attainment and psychological distress, SRH, and CDs are all weaker for immigrant than native-born adults. To prevent health disparities, it is essential to decompose health inequalities that are due to low educational attainment from those that are due to diminished returns of educational attainment (i.e., MDRs). There is a need to help highly educated immigrant adults secure positive health outcomes, similar to their native-born counterparts. Such changes may require bold and innovative economic, public, and social policies that help immigrant adults to more effectively mobilize their educational attainment to secure tangible outcomes. Elimination of health disparities in the US requires efforts that go beyond equalizing access to education.

Self-Rated Health Predicts Mortality in Very Old Men-the Manitoba Follow-Up Study

Background

Self-rated health (SRH) predicts death, but there are few studies over long-time horizons that are able to explore the effect age may have on the relationship between SRH and mortality.

Objectives

1. To determine how SRH evolves over 20 years; and 2. To determine if SRH predicts death in very old men.

Methods

We analyzed a prospective cohort study of men who were fit for air crew training in the Second World War. In 1996, a regular questionnaire was administered to the 1,779 surviving participants. SRH was elicited with a 5-point Likert Scale with the categories: excellent, very good, good, fair and poor/bad. We examined the age-specific distribution of SRH in these categories from the age of 75 to 95 years, to the end of the follow-up period in 2018. We constructed age-specific Cox proportional hazard models with an outcome of time to death.

Results

SRH declined with age. The gradient in risk of death persisted across all ages; those with poor/fair/bad SRH had consistently higher mortality rates. However, the discrimination between good and excellent was less in those aged 85+.

Conclusions

SRH declines with advancing age, but continues to predict death in older men.

Gender differences in the effect of self-rated health (SRH) on all-cause mortality and specific causes of mortality among individuals aged 50 years and older

Although different gender associations between self-rated health (SRH) and mortality have been reported, the results of the respective studies have been inconsistent and little is known about the cause-specific relation of mortality with SRH by gender. Therefore, to evaluate the gender differences in all-cause or specific causes of mortality by SRH, this retrospective cohort study was conducted using the data of 19,770 Korean adults aged 50 years and over who underwent health screening at Seoul National University Hospital between March 1995 and December 2008. SRH was surveyed using a simple questionnaire, and the all-cause mortality and cause-specific mortality were followed up from baseline screening until December 31, 2016. Results showed that the relationship between SRH and all-cause mortality differed by gender, and the differences also varied depending on the cause of death. In men, the adjusted hazard ratio (aHR) of all-cause mortality was higher in the poor SRH group than the very good SRH groups even after adjustment for socio-demographic, clinical, and behavioral risk factors (aHR:1.97, 95% CI 1.51-2.56), and these results were similar to those for cancer, cardiovascular, and respiratory disease mortalities (aHR:1.52, 95% CI 0.93-2.50; aHR: 2.11, 95% CI 1.19-3.74; aHR:10.30, 95% CI 2.39-44.44, respectively). However, in women, the association between SRH and all-cause mortality was insignificant, and inverse relationships were found for cardiovascular and respiratory disease mortalities in the poor and very good SRH groups. Cancer mortality had a positive relation with SRH (aHR: 1.14, 95% CI 0.75-1.72; aHR: 2.58, 95% CI 1.03-6.48; aHR: 0.49, 95% CI 0.24-0.98; aHR: 0.15, 95% CI 0.04-0.57: all-cause, cancer, cardiovascular, and respiratory disease mortalities, respectively). Clinicians need to take these gender differences by SRH into account when evaluating the health status of over-middle aged adults.

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

OBJECTIVES

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

DESIGN

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

SETTING AND PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

Neuroticism polygenic risk score predicts 20-year burden of depressive symptoms for Whites but not Blacks

BACKGROUND

Black-White differences are reported in social, psychological, behavioral, medical, and biological correlates of depression. This study was conducted to compare Black and White older adults for the association between neuroticism polygenic risk score (N-PRS) and chronicity of depressive symptoms over 20 years.

METHODS

Data came from the Health and Retirement Study (HRS), 1990 - 2012, a nationally representative sample of Americans above age 50. Current analysis followed 9,249 individuals (7,924 Whites and 1,325 Blacks) for up to 22 years. Depressive symptoms were measured every two years between 1992 and 2012 using the 8-item Center for Epidemiological Studies-Depression Scale (CES-D-8). The independent variable was N-PRS. The dependent variable was average depressive symptoms between 1992 and 2012. Linear regression was used for data analysis.

RESULTS

In the pooled sample, higher N-PRS was associated with higher average depressive symptoms over the 20-year follow up period [b=0.01, 95%CI=0.00 to 0.04], net of all covariates. We also found an interaction between race and N-PRS [b=-0.02, 95%CI=-0.03 to 0.00], suggesting a stronger effect of N-PRS on 20-year average depressive symptoms for Whites than Blacks. Based on our race-specific linear regression models, higher N-PRS was associated with higher depressive symptoms from 1992 to 2012 for Whites [b=0.01, 95%CI=0.01 to 0.02] but not Blacks [b=0.00, 95%CI=-0.02 to 0.02].

CONCLUSION

Black and White older adults may differ in the salience of the existing N-PRS for depressive symptoms, which better reflects the burden of depression for Whites than Blacks. This may be because the existing PRSs are derived from mostly or exclusively White samples, limiting their applicability in other race groups. Racial variation in psychosocial, clinical, and biological correlates of depression needs further research.

Features and impact of missing values in the association of self-rated health with mortality in care homes: a longitudinal study

BACKGROUND

Self-rated health (SRH) is a health measure used in studies of older adults. The objective of this study is to analyze SRH as a predictor of mortality in the institutionalized older population and the characteristics of those who do not provide information about their SRH on health questionnaires.

METHODS

This is a 15-year follow-up study of older adult residents in nursing or care homes in of Madrid, Spain. SRH was measured on a 5-point Likert type scale. The association between answering the SRH question and socio-demographic and health characteristics was evaluated through prevalence ratio (PR), estimated by Poisson regression models. Survival rates associated with SRH were studied through a multivariate Cox regression.

RESULTS

The sample has a mean age of 83.4 (standard deviation, SD = 7.3), with 75.7% women. Twelve percent did not answer the SRH item. Those who did not answer showed a higher probability of disability (Barthel index, PR = 0.76, 95% confidence interval = 0.67-0.86) and/or dementia (PR = 8.03, 3.38-19.03). A trend for higher mortality was observed in those persons who did not respond (adjusted hazard ratio HR = 1.26, 0.75-2.11). The mortality rate was 32% higher for those who declared poor SRH in comparison with those who reported good SRH (adjusted HR = 1.32, 1.08-1.6).

CONCLUSIONS

There is an elevated number of people who do not respond to the SRH item, mainly those with disabilities and cognitive deterioration. Lack of response to SRH is a good indicator of 15-year mortality for persons institutionalized in care or nursing homes.

Obesity and Polypharmacy among African American Older Adults: Gender as the Moderator and Multimorbidity as the Mediator

Despite high prevalence of obesity and polypharmacy among African American (AA) older adults, little information exists on the associations between the two in this population. This study explored the association between obesity and polypharmacy among AA older adults who were residing in poor urban areas of South Los Angeles. We also investigated role of gender as the moderator and multimorbidity as the mediator of this association. In a community-based study in South Los Angeles, 308 AA older adults (age ≥ 55 years) were entered into this study. From this number, 112 (36.4%) were AA men and 196 (63.6%) were AA women. Polypharmacy (taking 5+ medications) was the dependent variable, obesity was the independent variable, gender was the moderator, and multimorbidity (number of chronic medical conditions) was the mediator. Age, educational attainment, financial difficulty (difficulty paying bills, etc.), income, marital status, self-rated health (SRH), and depression were the covariates. Logistic regressions were used for data analyses. In the absence of multimorbidity in the model, obesity was associated with higher odds of polypharmacy in the pooled sample. This association was not significant when we controlled for multimorbidity, suggesting that multimorbidity mediates the obesity-polypharmacy link. We found significant association between obesity and polypharmacy in AA women not AA men, suggesting that gender moderates such association. AA older women with obesity are at a higher risk of polypharmacy, an association which is mainly due to multimorbidity. There is a need for screening for inappropriate polypharmacy in AA older women with obesity and associated multimorbidity.

Depression Fully Mediates the Effect of Multimorbidity on Self-Rated Health for Economically Disadvantaged African American Men but Not Women

Background. Although chronic medical conditions (CMCs), depression, and self-rated health (SRH) are associated, their associations may depend on race, ethnicity, gender, and their intersections. In predominantly White samples, SRH is shown to better reflect the risk of mortality and multimorbidity for men than it is for women, which suggests that poor SRH among women may be caused not only by CMCs, but also by conditions like depression and social relations-a phenomenon known as "the sponge hypothesis." However, little is known about gender differences in the links between multimorbidity, depression, and SRH among African Americans (AAs). Objective. To study whether depression differently mediates the association between multimorbidity and SRH for economically disadvantaged AA men and women. Methods. This survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 AA older adults (age ≥ 55 years) were enrolled in this study, of which 266 were AA men and 474 were AA women. The independent variable was the number of CMCs. The dependent variable was SRH. Age and socioeconomic status (educational attainment and marital status) were covariates. Depression was the mediator. Gender was the moderator. Structural Equation Modeling (SEM) was used to analyze the data. Results. In the pooled sample that included both genders, depression partially mediated the effect of multimorbidity on SRH. In gender specific models, depression fully mediated the effects of multimorbidity on SRH for AA men but not AA women. For AA women but not AA men, social isolation was associated with depression. Conclusion. Gender differences exist in the role of depression as an underlying mechanism behind the effect of multimorbidity on the SRH of economically disadvantaged AA older adults. For AA men, depression may be the reason people with multimorbidity report worse SRH. For AA women, depression is only one of the many reasons individuals with multiple CMCs report poor SRH. Prevention of depression may differently influence the SRH of low-income AA men and women with multimorbidity.

Associations between Polypharmacy, Self-Rated Health, and Depression in African American Older Adults; Mediators and Moderators

Background. Despite the prevalence of multimorbidity among African American (AA) older adults, little information exists on correlates of polypharmacy (using 5+ medications) in AA older adults. There is more information available regarding the link between polypharmacy and physical aspects of health than subjective ones. Aims. In a local sample of AA older adults in Los Angeles, this study investigated the association of polypharmacy with self-rated health (SRH) and depression. We also explored gender differences in these links. Methods. This community-based study was conducted in south Los Angeles. A total number of 708 AA older adults (age ≥ 55 years) were entered into this study. From this number, 253 were AA men and 455 were AA women. Polypharmacy was the independent variable. Self-rated health (SRH) and depression were the dependent variables. Age, educational attainment, financial difficulty (difficulty paying bills, etc.), and marital status were covariates. Gender was the moderator. Multimorbidity, measured as the number of chronic diseases (CDs), was the mediator. Logistic regressions were applied for data analysis. Results. Polypharmacy was associated with worse SRH and depression. Multimorbidity fully mediated the association between polypharmacy and depressive symptoms. Multimorbidity only partially mediated the association between polypharmacy and poor SRH. Gender moderated the association between polypharmacy and SRH, as polypharmacy was associated with poor SRH in women but not men. Gender did not alter the association between polypharmacy and depression. Conclusions. AA older women with polypharmacy experience worse SRH and depression, an association which is partially due to the underlying multimorbidity. There is a need for preventing inappropriate polypharmacy in AA older adults, particularly when addressing poor SRH and depression in AA older women with multimorbidity.

Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences

Background: The association between age and health-related quality of life (HRQoL) is still under debate. While some research shows older age is associated with better HRQoL, other studies show no or negative association between age and HRQoL. In addition, while the association between age and HRQoL may depend on race, ethnicity, gender, and their intersections, most previous research on this link has been performed in predominantly White Middle Class. Objective: To explore gender differences in the association between age and mental and physical HRQoL in a sample of economically disadvantaged African American (AA) older adults. Methods: This cross-sectional survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 economically disadvantaged AA older adults (age ≥ 55 years) were enrolled in this study, using non-random sampling. This includes 266 AA men and 474 AA women. The independent variable of interest was age. Dependent variables of interest were physical component scores (PCS) and mental component scores (MCS), two main summary scores of the HRQoL, measured using Short Form-12 (SF-12). Gender was the moderator. Socioeconomic status (educational attainment and financial difficulty) were covariates. Linear regression models were used to analyze the data. Results: AA women reported worse PCS; however, gender did not impact MCS. In the pooled sample, high age was associated with better PCS and MCS. In the pooled sample, a significant interaction was found between gender and age on PCS, suggesting a stronger effect of age on PCS for AA men than AA women. In gender-stratified models, older age was associated with better PCS for AA men but not AA women. Older age was similarly and positively associated with better MCS for AA men and women. Conclusions: There may be some gender differences in the implications of ageing for the physical HRQoL of AA older adults. It is unclear how old age may have a boosting effect on physical HRQoL for AA men but not AA women. Future research should test gender differences in the effect of age on physical health indicators such as chronic disease as well as cognitive processes involved in the evaluation of own's health in AA men and women.

Polypharmacy in African American Adults: A National Epidemiological Study

Background: Despite the association between polypharmacy and undesired health outcomes being well established, very little is known about epidemiology of polypharmacy in the African American community. We are not aware of any nationally representative studies that have described the socioeconomic, behavioral, and health determinants of polypharmacy among African Americans. Aims: We aimed to investigate the socioeconomic and health correlates of polypharmacy in a national sample of African American adults in the US. Methods: The National Survey of American Life (NSAL, 2003⁻2004) included 3,570 African American adults. Gender, age, socioeconomic status (SES; education attainment, poverty index, and marital status), access to the healthcare system (health insurance and having a usual source of care), and health (self-rated health [SRH], chronic medical disease, and psychiatric disorders) in addition to polypharmacy (5 + medications) as well as hyper-polypharmacy (10 + medications) were measured. Logistic regressions were applied for statistical analysis. Results: that About 9% and 1% of all African American adults had polypharmacy and hyper-polypharmacy, respectively. Overall, higher age, higher SES (education and poverty index), and worse health (poor SRH, more chronic medical disease, and psychiatric disorders) were associated with polypharmacy and hyper-polypharmacy. Individuals with insurance and those with a routine place for healthcare also had higher odds of polypharmacy and hyper-polypharmacy. Conclusions: Given the health risks associated with polypharmacy, there is a need for systemic evaluation of medication use in older African Americans with multiple chronic conditions. Such policies may prevent medication errors and harmful drug interactions, however, they require effective strategies that are tailored to African Americans.

Trends in good self-rated health in Germany between 1995 and 2014: do age and gender matter?

OBJECTIVES

This study analyzes longitudinal trends in self-rated health (SRH) by taking age- and gender-specific differences into account.

METHODS

Data of 29,251 women and 26,967 men were obtained from the German Socio-Economic Panel between 1995 and 2014. Generalized Estimation Equation analysis for logistic regression was used to estimate changes in odds of (very) good SRH over time. Development of (un)healthy life expectancy was calculated by applying the Sullivan method.

RESULTS

While in women, the odds of good SRH increased significantly over time for the ages 41-50 to 71-80 years, improvements among men were most apparent for the ages 61-70 and 71-80 years. By contrast, for both genders, no improvements in SRH were found in the youngest (31-40 years) and eldest age group (81-90 years) and in men aging 51-60 years. Over time, healthy life expectancy at age 31 increased by 3 years in women and 2 years in men, leading to a reduced but not eliminated gender gap in SRH.

CONCLUSIONS

Our findings support the hypothesis of relative compression of morbidity. However, trends in SRH differed according to age and gender, calling for health promotion efforts that meet diverse needs at different stages of life.

Exploring ethnic differences in understanding of self-rated health among persons of Turkish, Bosnian and German origin

OBJECTIVE

Self-rated health (SRH) is a widely used indictor of the subjective health status in population-based studies. However, differences in the reporting style across ethnic groups may limit the predictive ability of SRH for objective health outcomes. As part of the preparation phase of the UPWEB (understanding the practice and developing the concept of welfare bricolage) project, this study explored ethnic differences in the understanding of self-rated health among persons of Turkish, Bosnian and German origin, living in two northern Germany cities, Bremen and Hamburg.

RESULTS

Thirty persons, 10 per ethnic group, aged 32-82 years, took part in the assessment based on cognitive interviewing. All three ethnic groups defined SRH as the absence or presence of visible or non-visible disturbances and/or deviations from the norm, the ability or limited ability to act as well as the result of specific behaviours. However, only participants from the two migrant groups referred to community cohesion and religious or traditional beliefs as aspects of their SRH, indicating a systematic difference in the understanding of this question.

Time spent on work-related activities, social activities and time pressure as intermediary determinants of health disparities among elderly women and men in 5 European countries: a structural equation model

BACKGROUND

Psychosocial factors shape the health of older adults through complex inter-relating pathways. Besides socioeconomic factors, time use activities may explain gender inequality in self-reported health. This study investigated the role of work-related and social time use activities as determinants of health in old age. Specifically, we analysed whether the impact of stress in terms of time pressure on health mediated the relationship between work-related time use activities (i.e. housework and paid work) on self-reported health.

METHODS

We applied structural equation models and a maximum-likelihood function to estimate the direct and indirect effects of psychosocial factors on health using pooled data from the Multinational Time Use Study on 11,168 men and 14,295 women aged 65+ from Italy, Spain, UK, France and the Netherlands.

RESULTS

The fit indices for the conceptual model indicated an acceptable fit for both men and women. The results showed that socioeconomic status (SES), demographic factors, stress and work-related time use activities after retirement had a significant direct influence on self-reported health among the elderly, but the magnitude of the effects varied by gender. Social activities had a positive impact on self-reported health but had no significant impact on stress among older men and women. The indirect standardized effects of work-related activities on self-reported health was statistically significant for housework (β = - 0.006; P < 0.001 among men and β = - 0.008; P < 0.001 among women) and paid work (β = 0.012; P < 0.01 among men and β = 0.000; P > 0.05 among women), which implied that the paths from paid work and housework on self-reported health via stress (mediator) was very weak because their indirect effects were close to zero.

CONCLUSIONS

Our findings suggest that although stress in terms of time pressure has a direct negative effect on health, it does not indirectly influence the positive effects of work-related time use activities on self-reported health among elderly men and women. The results support the time availability hypothesis that the elderly may not have the same time pressure as younger adults after retirement.

Self-Rated Health and Glycemic Control in Type 2 Diabetes: Race by Gender Differences

BACKGROUND

Although some studies have shown a link between self-rated health (SRH) and glycemic control in type 2 diabetes (DM), other studies have failed to support this association. The purpose of this study was to determine whether these equivocal findings can be explained by specific interactions between gender, race, and SRH, as suggested by the intersectionality literature.

METHODS

This cross-sectional study included 287 patients with DM (85 Black men, 78 Black women, 64 White men, and 60 White women). After adjusting for demographic and medical factors, we regressed HbA1c on SRH with and without interactions between gender, race, and SRH. We conducted additional subgroup analyses to further characterize gender by race group differences.

RESULTS

Although there was no main effect of SRH upon HbA1c (b = .16, 95% CI: .08-.39), we found a significant interaction between gender and SRH on HbA1c (b = -.50, 95% CI: -.97 to -.03). In race by gender-stratified models, SRH (b = .53, 95% CI: .00-1.07) was associated with HbA1c in Black men. SRH was not associated with HbA1c in White men, White women, or Black women.

CONCLUSION

Combined race and gender differences may exist in the link between SRH and glycemic control in DM. Specifically, Black men with DM may be more attuned to the relationship between their overall health and their glycemic control.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Gender inequality in self-reported health among the elderly in contemporary welfare countries: A cross-country analysis of time use activities, socioeconomic positions and family characteristics

Background

Paradoxically, despite their longer life expectancy, women report poorer health than men. Time devoted to differing social roles could be an explanation for the observed gender differences in health among the elderly. The objective of this study was to explain gender differences in self-reported health among the elderly by taking time use activities, socio-economic positions, family characteristics and cross-national differences into account.

Methods

Data from the Multinational Time Use Study (MTUS) on 13,223 men and 18,192 women from Germany, Italy, Spain, UK and the US were analyzed. Multiple binary logistic regression models were used to examine the association between social factors and health for men and women separately. We further identified the relative contribution of different factors to total gender inequality in health using the Blinder-Oaxaca decomposition method.

Results

Whereas time allocated to paid work, housework and active leisure activities were positively associated with health, time devoted to passive leisure and personal activities were negatively associated with health among both men and women, but the magnitude of the association varied by gender and country. We found significant gender differences in health in Germany, Italy and Spain, but not in the other countries. The decomposition showed that differences in the time allocated to active leisure and level of educational attainment accounted for the largest health gap.

Conclusions

Our study represents a first step in understanding cross-national differences in the association between health status and time devoted to role-related activities among elderly men and women. The results, therefore, demonstrate the need of using an integrated framework of social factors in analyzing and explaining the gender and cross-national differences in the health of the elderly population.

Racial Discrimination in Health Care Is Associated with Worse Glycemic Control among Black Men but Not Black Women with Type 2 Diabetes

BACKGROUND

A growing body of research suggests that racial discrimination may affect the health of Black men and Black women differently.

AIMS

This study examined Black patients with diabetes mellitus (DM) in order to test gender differences in (1) levels of perceived racial discrimination in health care and (2) how perceived discrimination relates to glycemic control.

METHODS

A total of 163 Black patients with type 2 DM (78 women and 85 men) provided data on demographics (age and gender), socioeconomic status, perceived racial discrimination in health care, self-rated health, and hemoglobin A1c (HbA1c). Data were analyzed using linear regression.

RESULTS

Black men reported more racial discrimination in health care than Black women. Although racial discrimination in health care was not significantly associated with HbA1c in the pooled sample (b = 0.20, 95% CI = -0.41 -0.80), gender-stratified analysis indicated an association between perceived discrimination and higher HbA1c levels for Black men (b = 0.86, 95% confidence intervals (CI) = 0.01-1.73) but not Black women (b = -0.31, 95% CI = -1.17 to -0.54).

CONCLUSION

Perceived racial discrimination in diabetes care may be more salient for glycemic control of Black men than Black women. Scholars and clinicians should take gender into account when considering the impacts of race-related discrimination experiences on health outcomes. Policies should reduce racial discrimination in the health care.

Which symptoms contribute the most to patients' perception of health in multiple sclerosis?

Background

Multiple sclerosis is a polysymptomatic disease. Little is known about relative contributions of the different multiple sclerosis symptoms to self-perception of health.

Objectives

To investigate the relationship between symptom severity in 11 domains affected by multiple sclerosis and self-rated health.

Methods

Multiple sclerosis patients in two multiple sclerosis centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by multiple sclerosis. Pearson correlations and multivariate linear regressions were used to investigate the relationship between symptoMScreen scores and self-rated health.

Results

Among 1865 multiple sclerosis outpatients (68% women, 78% with relapsing–remitting multiple sclerosis, mean age 46.38 ± 12.47 years, disease duration 13.43 ± 10.04 years), average self-rated health score was 2.30 (‘moderate to good’). Symptom burden (composite symptoMScreen score) highly correlated with self-rated health (r = 0.68, P < 0.0001) as did each of the symptoMScreen domain subscores. In regression analysis, pain (t = 7.00), ambulation (t = 6.91), and fatigue (t = 5.85) contributed the highest amount of variance in self-rated health (P < 0.001).

Conclusions

Pain contributed the most to multiple sclerosis outpatients’ perception of health, followed by gait dysfunction and fatigue. These findings suggest that ‘invisible disability’ may be more important to patients’ sense of wellbeing than physical disability, and challenge the notion that physical disability should be the primary outcome measure in multiple sclerosis.

Neighborhood Safety and Major Depressive Disorder in a National Sample of Black Youth; Gender by Ethnic Differences

Adolescence is a developmental period marked by increased stress, especially among Black youth. In addition to stress related to their developmental transition, social factors such as a perceived unsafe neighborhood impose additional risks. We examined gender and ethnic differences in the association between perceived neighborhood safety and major depressive disorder (MDD) among a national sample of Black youth. We used data from the National Survey of American Life - Adolescents (NSAL-A), 2003-2004. In total, 1170 Black adolescents entered the study. This number was composed of 810 African American and 360 Caribbean Black youth (age 13 to 17). Demographic factors, perceived neighborhood safety, and MDD (Composite International Diagnostic Interview, CIDI) were measured. Logistic regressions were used to test the association between neighborhood safety and MDD in the pooled sample, as well as based on ethnicity by gender groups. In the pooled sample of Black youth, those who perceived their neighborhoods to be unsafe were at higher risk of MDD (Odds Ratio [OR] = 1.25; 95% Confidence Interval [CI] = 1.02-1.51). The perception that one's neighborhood is unsafe was associated with a higher risk of MDD among African American males (OR=1.41; 95% CI = 1.03-1.93) but not African American females or Caribbean Black males and females. In conclusion, perceived neighborhood safety is not a universal psychological determinant of MDD across ethnic by gender groups of Black youth; however, policies and programs that enhance the sense of neighborhood safety may prevent MDD in male African American youth.