Abstract
BackgroundResearch into Russia's health crisis during the 1990s includes studies of both mortality and self-rated health, assuming that the determinants of the two are the same. In this paper, we tested this assumption, using data from a single study on both outcomes and socioeconomic, lifestyle and psychological predictor variables.MethodsWe analysed data from 7 rounds (1994–2001) of the Russia Longitudinal Monitoring Survey, a panel study of a general population sample (11,482 adults aged over 18 living in households of 2 or more people). Self-rated health was measured on a 5 point scale and dichotomised by combining responses "very poor" and "poor" into poor health. Deaths (n = 782) during a mean follow up of 4.1 years were reported by another household member. Associations between several predictor variables and poor or very poor self-rated health and mortality were measured using logistic regression and Cox proportional hazards analysis respectively.ResultsPoor self-rated health was significantly associated with mortality; hazard ratios, compared with very good, good or average health, were 1.69 (1.36-2.10) in men and 1.74 (1.38-2.20) in women. Low education predicted both mortality and poor self-rated health, but income predicted subjective health more strongly. Smoking doubled the risk of death but was unrelated to subjective wellbeing. Frequent drinkers experienced greater mortality than occasional drinkers, despite reporting better health. In contrast, dissatisfaction with life predicted poor self-rated health, but not mortality.ConclusionDifferences between the predictors of subjective health and mortality, even though these outcomes were strongly associated, suggest that influences on subjective health are not restricted to serious disease. These findings also suggest the presence of risk factors for relatively sudden deaths in apparently well people, although further research is required. Meanwhile, caution is required when using studies of self-rated health in Russia to understand the determinants of mortality.
Highlights
Research into Russia's health crisis during the 1990s includes studies of both mortality and self-rated health, assuming that the determinants of the two are the same
International Journal for Equity in Health 2008, 7:19 http://www.equityhealthj.com/content/7/1/19 unprecedented further decline [2], that became known as Russia's "mortality crisis"
We aim to test the association between self-rated health and mortality in Russia, to compare the associations of different predictor variables with these two measures, and to consider possible explanations for the findings
Summary
Research into Russia's health crisis during the 1990s includes studies of both mortality and self-rated health, assuming that the determinants of the two are the same. We tested this assumption, using data from a single study on both outcomes and socioeconomic, lifestyle and psychological predictor variables. International Journal for Equity in Health 2008, 7:19 http://www.equityhealthj.com/content/7/1/19 unprecedented further decline [2], that became known as Russia's "mortality crisis". We aim to test the association between self-rated health and mortality in Russia, to compare the associations of different predictor variables (socioeconomic, lifestyle and psychological) with these two measures, and to consider possible explanations for the findings. Research into the determinants of mortality in Russia to date includes very few prospective studies [4,6]. Studies using other designs, such as case-control studies [7], indirect methods using widowhood [8] or sibling [9] data, and population level studies based on census information [10], have identified education [4,6,9,10], alcohol [9,11], marital status [6] and smoking [9] as important determinants of mortality
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