Abstract
BackgroundSelf-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.MethodsWe 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.ResultsAfter 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.ConclusionsSex 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.
Highlights
Self-rated health (SRH) is a widely validated measure of the general health of older adults
Conceptualization of self-rated health The overarching question we examine in this study is what individual and contextual characteristics shape the subjective rating of health among older adults
Frequencies of reporting good SRH varied significantly across all other characteristics considered with the exception of physical activity at work, country of birth, province of residence and rural/urban status (Table 2)
Summary
Self-rated health (SRH) is a widely validated measure of the general health of older adults. Individual expectations and standards of good health evolve Both perceptions of normal health status for a particular age and awareness of diagnoses that lack symptoms but raise the spectre of illness (eg hypertension) play important roles as reference points for an individual’s selfrating. Older adults may rate their health relative to their age cohort and related expectation rather than to some absolute standard [7]. This shift in comparative baseline may be a way of coping with and adapting to declining health, and makes tracking of SRH across the life-course and its reliability as an indicator of older adults’ objective health challenging. Still others have contested these presumed, age-related measurement modifications [7]
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