Abstract
BackgroundSelf-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea.MethodsCross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH.ResultsSRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations.ConclusionsWe conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.
Highlights
Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals
Data from the United States and Korean surveys were available as public use datasets, which were obtained through registration with the relevant organizations (The University of Michigan Institute for Social Research and the Korea Labor Institute respectively)
The Australian sample was older, more likely to be female, and less likely to be partnered than the other samples and education levels were higher in Western than Asian countries
Summary
Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Self-rated health (SRH) is used worldwide to assess health status with a single self-report item [1] It is considered by the World Health Organization (WHO) to be an important indicator of population health and healthy life expectancy, due to the finding that self-rated health predicts major health outcomes including health care medical diagnoses, symptoms and functional limitations), making a comparison with some other reference group, and deciding which of the available response options (typically excellent, very good, good, fair or poor) is the best match for their evaluation. National and cultural differences in self-reports of health A number of studies have compared SRH between countries or cultural groups. Such studies have investigated whether apparent differences in SRH can be attributed to individual differences in objective health and social indicators, or remain when these have been taken into account, termed the ‘residual regression’ approach [4]. Such a methodology may place too large a burden on respondents and is not feasible for population-based studies or when using existing datasets [6]
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