Changes In Self-rated Health Research Articles

Exposure to discrimination and subsequent changes in self-rated health: prospective evidence from the UK's Life Opportunities Survey

ObjectivesWe sought to estimate risk of poor self-rated health (SRH) following exposure to disability-related and other forms of overt discrimination in a cohort of working age adults. Study designThe study design is a population-based cohort survey. MethodsSecondary analysis of data collected in Waves 1 and 2 of the UK's Life Opportunities Survey which at Wave 2 involved the participation of 12,789 working age adults. Adjusted prevalence rate ratios were used to estimate the impact of exposure to disability and non-disability discrimination on two measures of SRH at Wave 2, controlling for SRH status at Wave 1. ResultsExposure to disability discrimination in the previous year was reported by 3.9% of working age British adults. Other forms of discrimination were reported less frequently (age: 3.7%, ethnicity: 2.5%, gender: 1.6%, religion: 0.8%, sexual orientation: 0.4%). In all analyses, there were stronger associations between exposure to disability discrimination and poor SRH at Wave 2 when compared with exposure to other forms of discrimination. ConclusionsDisability discrimination represents a violation of human rights. It is also likely to be a major contributor to the health inequities experienced by working age adults with disability.

Changes in Self-Rated Health After Sepsis in Older Adults: A Retrospective Cohort Study

As more individuals survive sepsis, there is an urgent need to understand its effects on patient-reported outcomes. What is the effect of sepsis on self-rated health, and what role, if any, does functional disability play in mediating this effect? We conducted a survey- and administrative claims-based retrospective cohort study using the US Health and Retirement Study, a nationally representative cohort-based survey of older adults in the United States, from 2000 through 2016. We matched Medicare beneficiaries hospitalized with sepsis in 2000 to 2008 to nonhospitalized individuals. Self-rated health and functional disability were tracked biannually for 8 years. Differences in self-rated health between the cohorts were measured using mixed models with and without controlling for changes in functional disability. Seven hundred fifty-eight individuals with sepsis were matched 1:1 to 758 nonhospitalized individuals, all aged 65 years and older. Among survivors, sepsis was associated with worse self-rated health in years 2 and 4 (adjusted absolute difference in self-rated health on a 5-point scale in year 2: -0.24 [95%CI, -0.38 to -0.10] and year 4: -0.17 [95%CI, -0.33 to -0.02]) but not in years 6 or 8. After accounting for changes in functional status, the association between sepsis and self-rated health was still present but reduced in year 2 (adjusted absolute difference in self-rated health, -0.18 [95%CI, -0.31 to -0.05]) and was not present in years 4, 6, or8. Self-rated health worsened initially after sepsis but returned to the level of that of nonhospitalized control subjects by year 6. Mitigating sepsis-related functional disability may play a key role in improving self-rated health after sepsis.

Income and housing satisfaction and their association with self-rated health in different life stages. A fixed effects analysis using a German panel study.

ObjectiveWe aim to investigate the effect of income and housing satisfaction on self-rated health in different life stages.DesignA population-based panel study (German Socio-Economic Panel).ParticipantsThe final sample consisted of 384 280 observations from 50 004 persons covering the period between 1994 and 2016.Outcome measuresAverage marginal effects were calculated based on fixed effects regressions to obtain the effect of changes in income and housing satisfaction on changes in self-rated health for each year of age. Self-rated health was assessed on a 5-point scale, with higher values indicating better health.ResultsChanges in income and housing satisfaction showed a small association with changes in self-rated health. The association was stronger for income, where it also varied considerably in different life stages. The average marginal effects for income satisfaction varied between 0.02 and 0.05 in men and 0.02 and 0.04 in women and peaked between the ages of 55–60. For housing satisfaction, average marginal effects ranged from 0.02 to 0.04 (men) and from 0.02 to 0.03 (women).ConclusionHigher satisfaction with housing and income was associated with better self-rated health. Therefore, studies on the social determinants of health should not only focus on objective material conditions but also on how individuals perceive and evaluate their situation.

Changing family structures and self-rated health of India's older population (1995-96 to 2014).

A common view within academia and Indian society is that older Indians are cared for by their families less than in the past. Children are a key source of support in later life and alternatives are limited, therefore declining fertility appears to corroborate this. However, the situation may be more complex. Having many children may be physiologically burdensome for women, sons and daughters have distinct care roles, social trends could affect support provision, and spouses also provide support. We assessed whether the changing structure of families has negatively affected health of the older population using three cross-sectional and nationally representative surveys of India's 60-plus population (1995–96, 2004 and 2014). We described changes in self-rated health and family structure (number of children, sons, and daughters, and marital status) and, using ordinal regression modelling, determined the association between family structure and self-rated health, stratified by survey year and gender. Our results indicate that family structure changes that occurred between 1995-96 and 2014 were largely associated with better health. Though family sizes declined, there were no health gains from having more than two children. In fact, having many children (particularly daughters) was associated with worse health for both men and women. There was some evidence that being sonless or childless was associated with worse health, but it remained rare to not have a son or child. Being currently married was associated with better health and became more common over the inter-survey period. Although our results suggest that demographic trends have not adversely affected health of the older population thus far, we propose that the largest changes in family structure are yet to come. The support available in coming years (and potential health impact) will rely on flexibility of the current system.

How is health associated with employment during later working life in Croatia?

This paper investigates how self-rated health (SRH), as a measure of general health, is associated with employment during later working life in Croatia. Using data from Wave 6 of the SHARE Survey, we estimate logistic regression models and study whether and to what extent the effects of SRH change with the inclusion of objective health measures. Worse SRH significantly decreases the probability of employment, but this effect becomes insignificant after account is taken of the objective health-related variables. This suggests that in Croatia, SRH and (a combination of) objective health indicators behave as substitutes, and either SRH or objective health measures can be adopted for the study of labour market participation. As worse health lowers the probability of employment during later working life in Croatia, in order to improve the working capacity of older adults, policymakers should strive for more efficient health promotion strategies and public health initiatives.

Self-rated health and risk of incident non-alcoholic fatty liver disease: A cohort study

Although self-rated health (SRH), a subjective measure of overall health status, associates with metabolic abnormalities, studies on the relationship between SRH and non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of metabolic syndrome, are limited. In this study, we evaluated whether or not SRH predicts the risk of incident NAFLD. This cohort study was performed in a sample of 148,313 Korean adults free of ultrasound-diagnosed NAFLD at baseline with annual or biennial follow-up for a median of 3.7 years. SRH and NAFLD were measured at baseline and follow-up visits. NAFLD was determined based on the ultrasound-diagnosed fatty liver without excessive alcohol consumption or any other cause. Hazard ratios with 95% confidence intervals were estimated via a parametric proportional hazards model. During 522,696.1 person-years of follow-up, 23,855 individuals with new-onset NAFLD were identified (incidence rate, 45.6 per 1,000 person-years). After adjustments for possible confounders including total calorie intake, sleep duration, and depressive symptoms, the multivariate-adjusted hazard ratios (95% confidence intervals) for incident NAFLD comparing good, fair, and poor or very poor SRH to very good SRH were 1.06 (0.97–1.14), 1.18 (1.09–1.27), and 1.24 (1.13–1.37), respectively. This association of SRH with incident NAFLD remained significant after accounting for changes in SRH and confounders during follow-up and was similar across clinically relevant subgroups. In a large-scale cohort study of apparently healthy Korean adults, poor SRH was independently and positively associated with incident NAFLD risk, indicating a predictive role of SRH as a health measure in NAFLD.

Age groups changes in self-rated health: A prospective longitudinal study over a 20-year period using Health Survey of North Trøndelag data.

Background: The aim of the study was to investigate changes in self-rated health (SRH) between different age groups and sexes over a 20-year period. Methods: Data were retrieved from the large longitudinal Health Survey of North Trøndelag, Norway, which includes data collected from more than 190,000 participants aged 20-70+ years between the years 1984 and 2008. Data were analysed using logistic regression and adjusted for sex. Results: From 1984 to 2008, the odds of scoring higher on SRH decreased by 46% in the youngest age group (20-29 years) and increased by approximately 35% in the middle-aged and older age groups (40-70+ years). When considering sex differences, women in most age groups scored lower than the men on their SRH. Conclusions: Our finding suggest a trending shift in SRH, with a reduction in the youngest age group (20-29 years) and an increase in the middle-aged and older age groups (40-70+ years). Despite the sex differences being small, our data indicate that in most age groups, women tend to score lower than men on their SRH. Future studies should focus on these trends to understand better the mechanisms underlying these changes in SRH and to follow future trends to see if the trend is reinforced or diminished.

Family income and self-rated health in Canada: Using fixed effects models to control for unobserved confounders and investigate causal temporality.

The objective of this study was to investigate whether the association between family income and adult self-rated health in Canada is causal in nature. The data came from the 2012, 2014 and 2016 waves of the Longitudinal and International Study of Adults linked to current and historical family income data from the Canada Revenue Agency. We used fixed effects models to describe associations between changes in self-rated health between 2012, 2014 and 2016 and changes in equivalized family income between (i) 2011, 2013 and 2015, (ii) 2008, 2009 and 2010, (iii) 2005, 2006 and 2007, (iv) 2002, 2003 and 2004 and (v) 1999, 2000 and 2001. We identified weak negative associations between family income and self-rated health operative over fourteen years or so for both women and men. These associations may be causal in nature. In addition, the implementation of models where changes in income preceded changes in self-rated health suggests that the associations reflect the causal effect of family income on self-rated health rather than the converse. These results make a contribution to the Canadian literature where nearly all previous research on associations between income and self-rated health is cross-sectional in nature and therefore incapable of establishing causal directionality.

Addressing Inequity: Evaluation of an Intervention to Improve Accessibility and Quality of a Green Space.

Green space areas offer several benefits that support our physical, psychological, and social health. However, the level of engagement with green space areas may not be the same across population groups. Using a mixed-method research design, we investigated the use of a green space area and whether and how the area was beneficial for health, social inclusion, and physical activity for all socioeconomic groups in a suburban area in Norway. The study showed significantly increased use of the area from 2015–2018 and that users belonged to different socioeconomic groups. The motivation for using the area was the opportunity to experience nature and to interact socially. While no significant changes in self-rated health, life satisfaction, or levels of physical activity were found, the study indicates that factors such as location, availability, and designated places for social interaction are important motivating factors for use. Users from the lower socioeconomic groups were among the frequent users but were also the least satisfied with the quality and availability of the path. Our findings call for closer consideration of the location and availability of green spaces and that including places for social interaction and relaxation can contribute to increased use of green spaces.

INTERNAL MIGRATION AND HEALTH CHANGES: A LONGITUDINAL STUDY OF CHINESE ADULTS IN MID AND LATER LIFE

Objectives: This study examines the effects of internal migration on health status and health changes among middle-aged and older migrants in China. Methods: Using longitudinal data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS), this study compares non-migrants with those of recent migrants and earlier migrants in regard to their self-rated health and mental health. OLS and a series of fixed effects models were conducted to examine the effects of migration on health status and health changes. Results: Compared with non-migrants, earlier migrants report better self-rated health but no difference in depression. Our findings demonstrate that recent migrants show better self-rated health changes than non-migrants. In addition, for recent migrants, there are significant changes in self-rated health among rural-to-urban migrants and rural-to-rural migrants, while urban-to-rural migrants and urban-to-urban migrants are not significantly different from non-migrations. Discussion: There are associations between internal migration and self-rated health in China. The effects of migration on health appear to differ by the type of migration. Those who migrated from rural area are mostly likely to be affected by migration. However, migrants from urban area are less affected.

Assessment of self-rated health 5 years after Roux-en-Y gastric bypass for severe obesity.

BackgroundPatients' perceptions of health change after bariatric surgery are complex. The aim of this study was to explore whether self‐rated health (SRH), a widely used tool in public health research, might be relevant as an outcome measure after Roux‐en‐Y gastric bypass (RYGB) for severe obesity.MethodsThis was a single‐centre retrospective study of a local quality registry. SRH score was registered at baseline and 5 years after RYGB. SRH, one of the 36 items in the quality‐of‐life Short Form 36 (SF‐36®) questionnaire, is the answer to this single question: ‘In general, would you say your health is excellent (1), very good (2), good (3), fair (4) or poor (5)?’ Change in SRH was analysed in relation to change in weight, co‐morbidities and quality of life after 5 years.ResultsOf a total of 359 patients who underwent RYGB between September 2006 and February 2011, 233 (64·9 per cent) reported on SRH before and 5 years after surgery. Of these, 180 (77·3 per cent) were women, and the mean(s.d.) age was 40(9) years. Some 154 patients (66·1 per cent) reported an improvement in SRH, 60 (25·8 per cent) had no change, and SRH decreased in 19 patients (8·2 per cent). SRH in improvers was related to better scores in all SF‐36® domains, whereas SRH in non‐improvers was related to unchanged or worsened scores in all SF‐36® domains except physical function.ConclusionTwo‐thirds of patients reported improved SRH 5 years after RYGB for severe obesity. In view of its simplicity, SRH may be an easy‐to‐use outcome measure in bariatric surgery.

Changes in Self-Rated Health Right After Immigration: A Panel Study of Economic, Social, Cultural, and Emotional Explanations of Self-Rated Health Among Immigrants in the Netherlands.

Immigrants are often found to rate their health better than the native population does. It is, however, suggested that this healthy immigrant effect declines with an enduring length of stay. With Dutch panel data, we investigate which patterns in self-rated health can be found among immigrants shortly after their migration. We test to what extent economic, social, cultural and emotional explanations affect the changes that immigrants report in self-rated health. Based on a four-wave panel, our results support the immigrants' health decline hypothesis, since the self-rated health decreases in the first years after immigration to the Netherlands. The major change occurs between immigrants rating their health no longer as “very good,” but as “good.” Shortly after immigration, self-rated health is associated with being employed and a higher income. Hazardous work and physically heavy work decrease self-rated health. Notwithstanding these effects, social, cultural, and emotional explanations turn out to be stronger. A lack of Dutch friends, perceptions of discrimination, perceived cultural distance, and feelings of homesickness strongly affect self-rated health. Furthermore, in understanding changes in self-rated health, the effects of making contact with Dutch people and changes in the perception of discrimination are definitive. However, contact with Dutch people did not decrease and discrimination did not increase over time, making them ineligible as an explanation for overall health decrease. Only the small effect that first-borns have may count as a reason for decreased self-rated health, since many of the recent immigrants we followed started families in the first years after immigration. Our findings leave room for the coined “acculturation to an unhealthier lifestyle thesis,” and we see promise in a stronger focus on the role of unmet expectations in the first years after immigration.

Internal migration and the health of Indigenous Mexicans: A longitudinal study

RationaleIndigenous peoples have historically comprised a substantial part of migration streams around the world, yet our understanding of the effects of migration on indigenous health is limited.ObjectiveTo explore the migration-indigenous health relationship by assessing the impact of internal migration on the self-rated health trajectories of indigenous Mexicans.Data and methodUsing three waves of data (2002–2012) from the Mexican Family Life Survey, I estimated linear growth curves to examine differences in initial self-rated health and changes in self-rated health between indigenous and non-indigenous respondents (N = 12,533). Then, I investigated whether migrating domestically during the study period shaped indigenous health trajectories.ResultsAt the baseline interview (before migration), indigenous migrants reported significantly better self-rated health than indigenous non-migrants and than all non-indigenous respondents. In spite of their better initial health, indigenous migrants’ health deteriorated substantially after migration, such that by the time of the last interview they reported the worst health. The self-rated health of all other groups improved during the same period.ConclusionFindings provide evidence of pre-migration health selection and post-migration health deterioration among Mexican indigenous migrants. These results suggest that internal migration is a risk factor that has an independent effect on indigenous health even after adjusting for personal, family, socioeconomic, and health care factors.

Positive Development and Changes in Self-Rated Health Among Young Sexual Minority Males: The P18 Cohort Study

We seek to move beyond a deficits-based approach, which has dominated our understanding of health and wellbeing in in young sexual minority males (YSMM), by examining how indicators of positive development are associated with development of positive self-rated health in YSMM. Using data from a prospective cohort study of YSMM (n = 514; 18–22 years old; 36.9% Hispanic/Latino, 15.6% non-Hispanic Black, 30.2% White, 16.9% other/multi-racial), we examined how three measures of positive development–the Life Orientation Test, the Satisfaction with Life Scale (SWLS) and the Social Responsibility Scale (SRS) were associated with self-rated health (SRH), a valid and reliable measure of self-assessed general health status. Findings suggest that YSMM who self-identified as homosexual reported higher SRH while those who reported higher levels of substance use and mental health burdens reported lower SRH. Second, in linear growth models controlling for mental health burdens and substance use, higher scores on all measures of positive development were associated with higher ratings of SRH over time. In conclusion, the presence of positive development characteristics, specifically generalized optimism, life satisfaction and social responsibility, may buffer against negative SRH assessments. Health promotion programs focusing on positive development may more effectively promote health and well-being among YSMM.

Retrospective memories of parental care and health from mid- to late life.

Perceptions of early caregiving experiences are hypothesized to be influential across the life span. However, previous research testing this hypothesis focuses primarily on young adults and use mostly cross-sectional designs. The current study examined associations between memories of early caregiving experiences and trajectories of depressive symptoms and physical health in 2 large samples of middle-aged and older adults. Sample 1 consisted of participants from the National Survey of Midlife Development in the United States (n = 7,108) followed for 18 years (from 1995/1996 until 2013/2014). Sample 2 consisted of participants from the Health and Retirement Study (n = 15,234) followed over a 6-year period. Memories of caregiver support before age 18 were retrospectively assessed in middle and older adulthood; associations between these memories and changes in self-rated health, chronic health conditions, and depressive symptoms over time were examined. Memories of higher parental affection in early childhood were associated with better self-rated health and lower depressive symptoms over intervals of approximately 6 and 18 years, in both samples; the results for chronic health conditions was more mixed. These associations persisted over time and were not moderated by time. Associations between perceptions of caregiver support and health persisted over time, underscoring the importance of memories of close relationships for health and depressive symptoms across the life span, even into late life. Findings are discussed in relation to models that link perceptions of early life experiences to later life outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The paradox of self-rated health following joint replacement surgery.

Self-rated health is a commonly used patient-reported outcome, but its responsiveness to is not well documented. We examined the ability of self-rated health to capture health changes attributable to a highly effective surgical intervention. Prospective study of patients with severe osteoarthritis of the hip (N = 990) or knee (N = 907) who underwent total hip replacement (THA) or total knee replacement (TKA). Self-rated health was assessed pre-operatively and 1year after surgery on a scale between "excellent" and "poor," along with other health items (other 11 items of the SF12 questionnaire) and multi-item Pain and Function scales. On average, self-rated health was unchanged by surgery. In both THA and TKA cohorts, of 10 patients, 6 rated their health the same after surgery as before, 2 gave a higher rating, and 2 gave a lower rating. In contrast, major improvements were observed for all other SF12 items, and for the Pain and Function scales, in both cohorts of patients. Nevertheless, both before and after surgery, self-rated health was associated with the other SF12 items and with Pain and Function scores. These associations were stronger after surgery than before. Self-rated health was not responsive to major improvements in health, documented by other instruments, attributable to joint replacement surgery. However, self-rated health was even more strongly associated with concurrent assessments of more specific health problems after surgery than before. Caution is advised in interpreting changes in self-rated health following health-altering interventions.

Self-rated health among migrants from the former Soviet Union in Germany: a cross-sectional study

ObjectivesTo assess the status and change in self-rated health among Aussiedler, ethnic German immigrants from the former Soviet Union, as a predictor for premature death 10 years after first assessment....

Inching Up and Socio-economic Differentiation: Exploring Self-rated Health of China's Rural-to-Urban Migrants from 2005 to 2015.

Objective Large-scale rural-to-urban migration in China has stimulated heated discussion about rural migrants' poor health status. This article reports the first study in China that compares the aggregate-level change in self-rated health of rural migrants between 2005 and 2015, and explores whether the difference, if any, can be explained by their different public health insurance enrollment status due to China's health reforms in the late 2000s. It also explores whether the aggregate-level change in migrants' self-rated health differs across different education levels. Methods Logistic regression models using pooled repeated cross-sectional data of the 2005 and 2015 China General Social Survey from 2688 rural-to-urban migrants. Results Rural migrants' self-rated health has significantly improved from 2005 to 2015. This can be by explained by their different health insurance enrollment status. However, such improvement is particularly pronounced for migrants with higher education levels. Conclusion Whereas China's recent health reforms have been overall effective in improving rural migrants' health, these policies might lead to health inequalities within rural migrants in favor of those with higher education levels.

Multidimensional factors of determining trajectories in self-rated health and depressive symptoms among Korean children and adolescents

ABSTRACTUnderstanding health disparities in the early stage of life is complicated by the complex interplay of psychosocial and environment factors. Despite these complexities, few studies have investigated multidimensional aspects of determining health trajectories of Korean children and adolescents. Thus, this study aims to investigate the impact of intrapersonal, interpersonal, and environmental factors on trajectories in self-rated health and depressive symptoms. Totally, 2378 Korean student samples were selected from the Korean Children and Young Panel Survey for data analysis. The findings indicated that higher levels of self-esteem, attachment to parents, and relationship with friends predicted better self-rated health and less depressive symptoms at baseline. Perception on community only predicted better self-rated health but not depressive symptoms at baseline. Among multidimensional factors, only self-esteem predicted the rate of changes in self-rated health and depressive symptoms. This study suggested that enhancing self-esteem and supportive environment should be provided throughout childhood and adolescence.

Changes in health but not in the general evaluation? The sensitivity of self-rated health to changes

Introduction Since many studies in epidemiology rely on self-rated health (SRH) as a generic measure of health status, studying this indicator is highly relevant for epidemiological research. Problematically, due to SRH's vagueness and the great room for interpretation for respondents, researchers usually do not know what exactly they measure when using this indicator. Firstly, if SRH, as studies suggest, is based on diverging aspects in different social groups (e.g., age-groups or cohorts), interpretations of respective group-differences are called into question. If, for example, younger respondents lay more weight on mental health than older respondents in rating their health, a comparison of SRH for these groups is disputable. Secondly, it is still unclear whether a (lack of) change in subjective health is due to real changes in health or changes in health aspirations. Accordingly, respondents might provide stable health-ratings despite deteriorating health because of lowered standards or changing frames of reference due to older age. For both reasons, more research on group-differences in response behavior and the sensitivity of SRH to changes in health is needed. Method In order to shed light on these issues, this paper analyzes data from the Canadian National Population Health Survey (NPHS). In the NPHS, around 17,000 people have been extensively surveyed biannually from 1994/1995 till 2012 regarding their health. This allows for a detailed analysis of which health-indicators and health-domains respondents use in rating their health and how reported changes in health over time affect changes in SRH. Utilizing dominance analyses, the contribution of five health-domains to R2 in explaining SRH are quantified: functioning, diseases, pain, depression, and risk-behavior. Employing both cross-sectional (OLS-regression models) and longitudinal methods (FE-regression models), this paper analyzes which health-domains are relevant for both SRH at a point in time as well as for their changes in SRH over time. Results Both cross-sectionally (R2 = 0.32 for women and 0.27 for men) and longitudinally (R2 = 0.12 for women and 0.11 for men), functioning was the most important health domain in explaining SRH, followed by diseases and pain. Depression and risk-behavior only played a minor role in evaluating one's current health status as well as changes. There were no meaningful differences in this ranking by gender. However, separate cross-sectional analyses by birth cohort show clear disparities in that functioning and diseases steadily increase in relevance for explaining SRH for older cohorts. The same is true, albeit to a lesser extent, for assessing changes in health. Conclusions This paper shows that there is a clear pattern in how respondents rate their health and that this pattern applies both to rating one's health at a point in time as well as to evaluating changes in health. However, the analyses also show that there are marked differences in how birth cohorts rate their health, highlighting the need to take these differences in rating behavior into account. The results are of great relevance to meaningfully measure generic health status via SRH and thus analyze health trajectories and health inequality.