Self-perceived health among adult and elderly users of Primary Health Care

Autopercepção de saúde em idosos de baixa escolaridade: fatores demográficos, sociais e de comportamentos em saúde relacionados

Resumo Objetivo Verificar a relação entre a autopercepção de saúde positiva (AS positiva) em idosos de baixa escolaridade com variáveis demográficas, de participação social e comportamentais. Método Tratou-se de um estudo transversal (n=12.367), com idosos de mais de 60 anos de ambos os sexos, com até quatro anos de estudo de diversas cidades do Brasil entrevistados pela Pesquisa Nacional de Saúde do ano de 2019. Para a análise de dados, inicialmente, realizou-se a descrição das prevalências e, posteriormente, construíram-se três modelos de regressão de Poisson com ajuste robusto para variância, sendo as análises estratificadas por sexo. Resultados A prevalência de AS positiva foi de 38,8% nos homens e 34,8% nas mulheres. No último modelo de regressão construído foram encontradas associações com menores prevalências de AS positiva nas mulheres pretas ou pardas, enquanto maiores prevalências foram encontradas nas solteiras, com renda mais elevada, que participam de alguma associação, de atividades religiosas, iam ao médico com mais frequência, eram fisicamente ativas e consumiam regularmente frutas e hortaliças. Nos homens, foram encontradas menores prevalências nos pretos ou pardos e nos viúvos, já maiores prevalências foram encontradas naqueles que participavam de atividades religiosas e iam ao médico mais frequentemente. Conclusões O estudo reforça a importância de políticas para a melhoria de renda, bem como para promoção de comportamentos saudáveis e estímulo a participação social.

Self-perceived health in older adults with low education: demographic, social and health-related behavior factors

Abstract Objective To verify the relationship between positive self-perception of health (positive SPH) in less-educated older adults and demographic, social participation, and behavioral variables. Methods This was a cross-sectional study (n=12,367), with elderly people over 60 years old of both sexes, with up to four years of study from several cities in Brazil, interviewed by the National Health Survey of the year 2019. For the analysis of data, the prevalence was initially described, and later, three Poisson regression models with robust adjustment for variance were constructed, with the analyzes being stratified by sex Results The prevalence of positive SPH was 38.8% in men and 34.8% in women. The last regression model built revealed associations with a lower positive SPH prevalence in black or brown women. In contrast, higher prevalence levels were found in single women, with higher income, participating in some associations, engaged in religious activities, visiting the doctor more often, physically active, and regularly consuming fruits and vegetables. In men, relationships with lower prevalence were found in blacks or browns and widowers, and higher prevalence levels were found in those engaging in religious activities and visiting the doctor more often. Conclusions The study reinforces the importance of policies aimed at improving income, promoting healthy behaviors and encouraging social participation.

Biopsychosocial inequality, active lifestyle and chronic health conditions: a cross-sectional National Health Survey 2013 in Brazil

This study estimated the biopsychosocial factors related to active physical behavior in the Brazilian population with and without chronic non-transmissible disease (NCD). Cross-sectional study of the National Health Survey (NHS) in Brazil, with 60,202 individuals in 2013. Participants were randomly selected by complex sampling. The outcome was physically active behavior measured by performing a minimum of 150 min of physical exercise per week. The independent variables were social and psychological characteristics, lifestyle and health. Cox regression was applied to estimate the prevalence ratio (PR). There are 29,666 (48.3%; 95% CI 47.0–50.0) participants reported having NCD. Not being a smoker or alcoholic, living in an urban area (PR = 1.44; CI95% 1.23–1.68/PR = 1.38; CI95% 1.08–1.75), having informal social support (PR = 1.26; CI95% 1.10–1.44/PR = 1.19; CI95% 1.05–1.34), A social class (PR = 0.43; CI95% 0.25–0.73/PR = 0.46; CI95% 0.26–0.80), high schooling (PR = 0.34; CI95% 0.23–0.51/PR = 0.33; CI95% 0.24–0.46) as well as paid work (PR = 0.87; CI95% 0.78–0.96/PR = 0.89; CI95% 0.79–0.99) are more associated with active lifestyle in both groups. However, only in the group without NCD, the male sex (PR = 1.42; CI95% 1.28–1.57), no having some disability (PR = 1.31; CI95% 1.03–1.66) and having private health insurance (PR = 1.26; CI95% 1.13–1.41) were more associated with active behavior, while in the group with NCD, being elderly (PR = 1.22; CI95% 1.05–1.42), not be white (PR = 0.85; CI95% 0.77–0.95) and not having restful sleep (PR = 1.23; CI95% 1.08–1.40) are associated with active lifestyle. People with and without NCD in Brazil have very close active behavior, however, some biopsychosocial factors such as: sex, age, lifestyle, socioeconomic level are unevenly associated with the active lifestyle in the groups. Thus, therapeutic or preventive proposals as well as public policies for health promotion must observe these distinctions when elaborating their actions.

Positive self-perception of health among non-long-lived and long-lived older adults and associated factors

This work aimed to identify the prevalence of positive self-perceived health among non-long-lived and long-lived older adults and associated factors. This is a study with older adults in the Family Health Strategy of Montes Claros. The Brazilian Older Americans Resources and Services Multidimensional Function Assessment Questionnaire was used. Bivariate and multiple analyses were performed using Poisson Regression. A total of 1,750 older adults participated in the study, of which 1,420 were non-long-lived older adults, and 330 were long-lived older adults. Positive self-perception was reported among 71.9% of the non-long-lived older adults and 67.8% of the long-lived older adults. Among the non-long-lived, positive self-perceived health was associated with five years of schooling (PR=1.12); household income from two to less than three minimum wages (PR=1.13) and ≥three minimum wages (PR=1.12); preserved vision (PR=1.13); proper chewing (PR=1.16); preserved sleep (PR=1.23); absence of polypathologies (PR=1.29); absence of diabetes (PR=1.15); falls in the last year (PR=1.13); and physical activity (PR=1.11). Among the long-lived older adults, it was associated with the use of prosthesis, sleeping disorders, and polypathologies and physical activities. Positive self-perception of health is associated with social and health determinants.

The intersectional impact of sex and social factors on subjective health: analysis of the Canadian longitudinal study on aging (CLSA)

Background

Self-rated health (SRH) is a widely validated measure of the general health of older adults. Our aim was to understand what factors shape individual perceptions of health and, in particular, whether those perceptions vary for men and women and across social locations.

Methods

We used data from the Canadian Longitudinal Study on Aging (CLSA) of community-dwelling adults aged 45 to 85. SRH was measured via a standard single question. Multiple Poisson regression identified individual, behavioural, and social factors related to SRH. Intersections between sex, education, wealth, and rural/urban status, and individual and joint cluster effects on SRH were quantified using multilevel models.

Results

After adjustment for relevant confounders, women were 43% less likely to report poor SRH. The strongest cluster effect was for groupings by wealth (21%). When wealth clusters were subdivided by sex or education the overall effect on SRH reduced to 15%. The largest variation in SRH (13.6%) was observed for intersections of sex, wealth, and rural/urban status. In contrast, interactions between sex and social factors were not significant, demonstrating that the complex interplay of sex and social location was only revealed when intersectional methods were employed.

Conclusions

Sex and social factors affected older adults’ perceptions of health in complex ways that only became apparent when multilevel analyses were carried out. Utilizing intersectionality analysis is a novel and nuanced approach for disentangling explanations for subjective health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02412-6.