Abstract
BackgroundSelf-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries. However, no studies have been performed in Central Asia. The aim of the study was to assess gender-, ethnic-, and social inequalities in SRH in Almaty, Kazakhstan.MethodsAltogether, 1500 randomly selected adults aged 45 years or older were invited to participate in a cross-sectional study and 1199 agreed (response rate 80%). SRH was classified as poor, satisfactory, good and excellent. Multinomial logistic regression was applied to study associations between SRH and socio-demographic characteristics. Crude and adjusted odds ratios (OR) for poor vs. good and for satisfactory vs. good health were calculated with 95% confidence intervals (CI).ResultsAltogether, poor, satisfactory, good and excellent health was reported by 11.8%, 53.7%, 31.0% and 3.2% of the responders, respectively. Clear gradients in SRH were observed by age, education and self-reported material deprivation in both crude and adjusted analyses. Women were more likely to report poor (OR = 1.9, 95% CI: 1.2-3.1) or satisfactory (OR = 1.6, 95% CI: 1.2-2.1) than good health. Ethnic Russians and unmarried participants had greater odds for poor vs. good health (OR = 2.3, 95% CI: 1.5-3.7 and OR = 4.0, 95% CI: 2.7-6.1, respectively) and for satisfactory vs. good health (OR = 1.4, 95% CI: 1.1-1.9 and OR = 1.9, 95% CI: 1.4-2.5, respectively) in crude analysis, but the estimates were reduced to non-significant levels after adjustment. Unemployed and pensioners were less likely to report good health than white-collar workers while no difference in SRH was observed between white- and blue-collar workers.ConclusionConsiderable levels of inequalities in SRH by age, gender, education and particularly self-reported material deprivation, but not by ethnicity or marital status were found in Almaty, Kazakhstan. Further research is warranted to identify the factors behind the observed associations in Kazakhstan.
Highlights
Self-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries
Given that SRH is considered to be a simple, valid and reliable health indicator for use in population-based epidemiological studies as a predictor of overall morbidity and mortality [1,2,3], one may speculate that the general health status of the population in Almaty is poorer than in most developed countries, which is reflected by the fact that Kazakhstan has one of the lowest life expectancies in the European WHO region [4]
Compared to the latest data on the prevalence of poor SRH measured in 2003–2004 in 13 former communist European countries, our estimates are close to what was observed in Slovenia and are more favorable than the results obtained in all other countries, where the prevalence of poor SRH ranged from 10.4% in Slovenia and 24.3% in Ukraine [14], but the sample in these countries included participants 18 years and older
Summary
The aim of the study was to assess gender-, ethnic-, and social inequalities in SRH in Almaty, Kazakhstan. Self-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries. Former republics of the Soviet Union have experienced a profound economic and social crisis during the 1990s, which was accompanied by increase in income and health inequalities. While economic indicators show rapid economic growth in most of these countries during 2000s, they were not accompanied by either reduction of inequalities or considerable improvements in population health [4]. To Western societies, in former Communist countries of Eastern Europe, education and material deprivation are strongly associated with SHR [11]
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