Abstract
BackgroundStudies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups.Methodology/Principal FindingsThe analyses in the study were based on the Aichi Gerontological Evaluation Study's (AGES) 2003 Cohort Study in Chita Peninsula, Japan, which followed the four-year survival status of 14,668 community-dwelling people who were at least 65 years old at the start of the study. We first examined sex/gender and education-level differences in association with fair/poor SRH. We then estimated the sex/gender- and education-specific hazard ratios (HRs) of mortality associated with lower SRH using Cox models. Control variables, including health behaviors (smoking and drinking), symptoms of depression, and chronic co-morbid conditions, were added to sequential regression models. The results showed men and women reported a similar prevalence of lower SRH. However, lower SRH was a stronger predictor of mortality in men (HR = 2.44 [95% confidence interval (CI): 2.14–2.80]) than in women (HR = 1.88 [95% CI: 1.44–2.47]; p for sex/gender interaction = 0.018). The sex/gender difference in the predictive ability of SRH was progressively attenuated with the additional introduction of other co-morbid conditions. The predictive ability among individuals with high school education (HR = 2.39 [95% CI: 1.74–3.30]) was similar to that among individuals with less than a high school education (HR = 2.14 [95% CI: 1.83–2.50]; p for education interaction = 0.549).ConclusionsThe sex/gender difference in the predictive ability of SRH for mortality among this elderly Japanese population may be explained by male/female differences in what goes into an individual's assessment of their SRH, with males apparently weighting depressive symptoms more than females.
Highlights
The single-item measure of self-rated health (SRH) (‘‘In general, how do you rate your overall health? Excellent, good, fair, or poor?’’) is perhaps the most widely adopted health-status assessment approach in studies around the world [1,2,3]
As expected, increasing age was associated with higher levels of depression, an increase in non-life-threatening health conditions, and a higher prevalence of fair/poor SRH among both men and women (Table 1)
Subsequent models that adjusted for sex/gender differences in pre-existing co-morbid conditions resulted in a higher odds ratio for poor SRH among men compared to women
Summary
The single-item measure of self-rated health (SRH) (‘‘In general, how do you rate your overall health? Excellent, good, fair, or poor?’’) is perhaps the most widely adopted health-status assessment approach in studies around the world [1,2,3]. If women are overly sensitive to their somatic symptoms and exaggerate their health problems — while, men deny and downplay their problems if they are not severe or life-threatening — one would expect to see a stronger association between SRH and mortality among men. Spiers and her colleagues suggest that the sex/gender difference in the SRH-mortality relationship is due to ‘‘variation in the definitions that individuals call upon when rating their health,’’ rather than to actual differences in physical conditions [14]. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups
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