Deterioration Of Self-rated Health Research Articles

Work and health during the COVID-19 crisis among Dutch workers and jobseekers with (partial) work disabilities: a mixed methods study

BackgroundThe consequences of restrictive measures during the COVID-19 outbreak have potentially been enormous, especially for those in a vulnerable position in the labour market. This study aims to describe the impact of the COVID-19 crisis on work status, working conditions and health among people with (partial) work disabilities—with and in search of work—during the COVID-19 pandemic in the Netherlands.MethodsA mixed methods design was used, combining a cross-sectional online survey and ten semi-structured interviews with people with a (partial) work disability. The quantitative data included responses to job-related questions, self-reported health, and demographics. The qualitative data consisted of participants’ perceptions about work, vocational rehabilitation, and health. We used descriptive statistics to summarize the responses, conducted logistic and linear regression and integrated our qualitative findings with the quantitative findings, aiming at complementarity.ResultsFive hundred and eighty-four participants (response rate 30.2%) completed the online survey. The majority of participants experienced no change in work status: 39 percent remained employed, 45 percent remained unemployed, six percent of respondents lost their job, and ten percent became employed during the COVID-19 crisis. In general, the results showed a deterioration in self-rated health during the COVID-19 outbreak, both for participants at work and in search of work. Participants who lost their job during the COVID-19 crisis reported the highest deterioration in self-rated health. Interview findings revealed that loneliness and social isolation were persistent during the COVID-19 crisis, especially among those in search of work. Additionally, employed participants identified a safe work environment and the possibility to work at the office as important factors for overall health.ConclusionsThe vast majority of study participants (84.2%) experienced no change in work status during the COVID-19 crisis. Nonetheless, people at work and in search of work encountered barriers to maintaining or (re)gaining employment. People with a (partial) work disability who lost their job during the crisis appeared to be most affected in terms of health. Employment and health protections could be strengthened for persons with (partial) work disabilities in order to build resilience in times of crisis.

Evolutions of Self-Rated Health and Social Interactions during the COVID-19 Pandemic Affected by Pre-Pandemic Conditions: Evidence from a Four-Wave Survey

The Coronavirus disease 2019 (COVID-19) pandemic has affected individuals' self-rated health (SRH) and social interactions, but their evolution during the pandemic needs further investigation. The present study addressed this issue using longitudinal data from 13,887 observations of 4177 individuals obtained from a four-wave nationwide, population-based survey conducted between January and February 2019 (before the pandemic) and November 2022. We compared the evolutions of SRH and social interactions during the pandemic between individuals who interacted with others before the pandemic and those who did not. Three noteworthy findings were obtained. First, deterioration in SRH in response to the declared state of emergency was concentrated on individuals with no pre-pandemic interaction with others. Second, SRH generally improved during the pandemic, although the improvement was more remarkable among previously isolated individuals. Third, the pandemic has promoted social interactions among previously isolated individuals and reduced such chances among those who previously interacted with others. These findings underscore the importance of pre-pandemic social interactions as key determinants of responding to pandemic-related shocks.

A Change for the Worse: Negative Social Exchanges are Associated with an Accelerated Decline in Self-Rated Health Over Time

Age-associated accelerated declines in physical health vary across individuals, and researchers have suggested that individual differences in decline may vary as a function of stressors. The relation of one such stressor, negative social exchanges, to accelerated declines in self-rated health is investigated. Participants are from a 2-year, 5-wave, national, longitudinal study of social relationships among older adults. Growth curve analyses are used to examine the relation of negative and positive social exchanges to accelerated changes in self-rated health, controlling for age, sex, race/ethnicity, education, and depressive symptoms. Individuals reporting more frequent negative social exchanges showed significantly accelerated declines in physical health. Positive social exchanges were not related to linear or accelerated declines in self-rated health over time. The association between negative social exchanges and accelerated deterioration in self-rated health provides general support for hypotheses that interpersonal stressors play an important role age-related physical health decline.

Declines in Sexual Activity and Function Predict Incident Health Problems in Older Adults: Prospective Findings from the English Longitudinal Study of Ageing

The objective of this study was to investigate cross-sectional and longitudinal associations between declines in sexual activity and function and health outcomes in a large population-based sample of older adults. Data were from 2577 men and 3195 women aged ≥ 50 years participating in the English Longitudinal Study of Ageing. Past-year changes in sexual desire, frequency of sexual activity, and ability to have an erection (men)/become sexually aroused (women) were assessed at baseline by self-completion questionnaire. Health outcomes (self-rated health, limiting long-standing illness, doctor-diagnosed diseases of the vascular system, and cancer) were self-reported at baseline (2012/2013) and 4-year follow-up (2016/2017). Data were analyzed using logistic regression, adjusted for sociodemographics, health behaviors, and depressive symptoms. Prospectively, men who reported a decline in sexual desire had higher odds of incident limiting long-standing illness (OR 1.41, 95% CI 1.04–1.91) and incident cancer (OR 1.63, 95% CI 1.06–2.50) than those who maintained their sexual desire. Men who reported a decline in the frequency of sexual activities had higher odds of deterioration in self-rated health (OR 1.47, 95% CI 1.04–2.08) and incident limiting long-standing illness (OR 1.69, 95% CI 1.20–2.37). In women, a decline in frequency of sexual activities was associated with deterioration of self-rated health (OR 1.64, 95% CI 1.07–2.51). Erectile dysfunction was longitudinally associated with poorer health outcomes including incident cancer (OR 1.73, 95% CI 1.11–2.70), coronary heart disease (OR 2.29, 95% CI 1.29–4.07), and fair/poor self-rated health (OR 1.66, 95% CI 1.19–2.32). Practitioners should be mindful that a decline in sexual activity, desire, or function in older age may be an important indicator of future adverse health outcomes.

Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English Longitudinal Study of Ageing

Age discrimination (or ageism) is pervasive in society. Other forms of discrimination (such as racism) have been linked with adverse health outcomes, but age discrimination has not been well studied in public health. We aimed to examine associations between perceived age discrimination and health and wellbeing in England. We did a longitudinal observational population study with data from the English Longitudinal Study of Ageing, a nationally representative sample of older men and women. Participants were aged 50 years or older and reported experiences of age discrimination via a face-to-face computer-assisted personal interview and a self-completed questionnaire between July, 2010, and June, 2011. Self-rated health, chronic health conditions, and depressive symptoms were assessed between July, 2010, and June, 2011, and between May, 2016, and June, 2017. We used logistic regression to test cross-sectional associations between perceived age discrimination and baseline health status and prospective associations between perceived age discrimination and incident ill health over 6 years. Analyses were adjusted for age, sex, and wealth. Our sample for cross-sectional analyses of 2010-11 data comprised 7731 people who took part in the face-to-face interview, returned the self-completion questionnaire, and had available data for age discrimination. Perceived age discrimination was reported by 1943 (25·1%) participants. Patients who perceived age discrimination were more likely to self-report fair or poor health (odds ratio [OR] 1·32 [95% CI 1·17-1·48]) and to have coronary heart disease (1·33 [1·14-1·54]), chronic lung disease (1·37 [1·11-1·69]), arthritis (1·27 [1·14-1·41]), limiting long-standing illness (1·35 [1·21-1·51]), and depressive symptoms (1·81 [1·57-2·08]) than those who did not perceive age discrimination. Follow-up data collected 6 years after the baseline assessment were available for 5595 participants. Longitudinally, perceived age discrimination was associated with the deterioration of self-rated health (OR 1·32 [95% CI 1·10-1·58]) and incident coronary heart disease (1·66 [1·18-2·35]), stroke (1·48 [1·08-2·10]), diabetes (1·33 [1·01-1·75]), chronic lung disease (1·50 [1·10-2·04]), limiting long-standing illness (1·32 [1·10-1·57]), and depressive symptoms (1·47 [1·16-1·86]) over 6 years. Among older adults living in England, perceived age discrimination was associated with increased odds of poor self-rated health and risk of incident serious health problems over a 6-year period. These findings underscore the need for effective interventions at the population level to combat age stigma and discrimination. UK Economic and Social Research Council.

Effect of Radiological Countermeasures on Subjective Well-Being and Radiation Anxiety after the 2011 Disaster: The Fukushima Health Management Survey.

After the Fukushima Daiichi Nuclear Power Station accident in 2011, concerns about radiation exposure and decline in subjective well-being have been reported. To tackle these problems, various countermeasures in relation to radiation have been implemented. In this study, we comprehensively evaluated the effects of radiological countermeasures on subjective well-being (e.g., satisfaction with life (SWL) and emotional well-being) and radiation anxiety, through a questionnaire survey targeting Fukushima residents (N = 1023). Propensity scores matching was applied to evaluate significant effects of radiological countermeasures on subjective well-being and radiation anxiety. Among the radiological countermeasures, thyroid examination, whole body counter, and air dose monitoring showed the highest proportions of participation, utilization, and useful evaluation, suggesting a high degree of public attention focused on these countermeasures. The basic survey was associated with significant increases in SWL and self-rated health (SH). Thyroid examination was significantly associated with not only a reduction in radiation anxiety but also an increase of emotional stress, suggesting the importance of careful design of system and detailed communication. Food inspection was associated with deterioration in SH. Those who utilized explanatory meetings showed increases in sadness, worry, and radiation anxiety, indicating that additional attention is required of the experts and authorities involved in explanatory meetings.

The impact of the 2008 recession on the health of older workers: data from 13 European countries.

Fluctuations in the national economy shape labour market opportunities and outcomes, which in turn influence the health conditions of older workers. This study examined whether overall economic shifts during the 2008 recession was associated with four health indicators among older workers. Data came from 4917 respondents (16 090 contacts) aged 50-70 in 13 European countries (Austria, Belgium, Czech Republic, Denmark, France, Germany, Israel, Italy, Netherlands, Poland, Spain, Sweden, Switzerland) participating in the Survey of Health, Ageing and Retirement in Europe. Health and employment assessments from 2004-13 were linked to annual data on fluctuations in Gross Domestic Product (GDP) per capita, life expectancy and unemployment rates for each country. Using fixed effects models, we assessed the recession's implications on four individual health outcomes: body mass index (BMI), drinking alcohol, depression and general health, while isolating cyclical variation within countries and individual changes over time. Overall economic shifts had an effect on older workers: decreases in GDP were associated with a decline in average BMI, consumption of alcohol and deterioration in self-rated health; country-level unemployment rate had no effect on health outcomes, while life expectancy at birth was significant but not consistently across models. Being employed or retired were associated with fewer depressive symptoms and better self-rated health. Overall economic shifts during recessions affect certain health outcomes of older workers, and better health conditions together with being employed or retired may limit the negative health consequences of a recession.

Correlated probit analysis of repeatedly measured ordinal and continuous outcomes with application to the Health and Retirement Study.

The Health and Retirement Study was designed to evaluate changes in health and labor force participation during and after the transition from working to retirement. Every 2years, participants provided information about their self-rated health (SRH), body mass index (BMI), smoking status, and other characteristics. Our goal was to assess the effects of smoking and gender on trajectories of change in BMI and SRH over time. Joint longitudinal analysis of outcome measures is preferable to separate analyses because it allows to account for the correlation between the measures, to test the effects of predictors while controlling type I error, and potentially to improve efficiency. However, because SRH is an ordinal measure while BMI is continuous, formulating a joint model and parameter estimation is challenging. A joint correlated probit model allowed us to seamlessly account for the correlations between the measures over time. Established estimating procedures for such models are based on quasi-likelihood or numerical approximations that may be biased or fail to converge. Therefore, we proposed a novel expectation-maximization algorithm for parameter estimation and a Monte Carlo bootstrap approach for standard errors approximation. Expectation-maximization algorithms have been previously considered for combinations of binary and/or continuous repeated measures; however, modifications were needed to handle combinations of ordinal and continuous responses. A simulation study demonstrated that the algorithm converged and provided approximately unbiased estimates with sufficiently large sample sizes. In the Health and Retirement Study, male gender and smoking were independently associated with steeper deterioration in self-rated health and with lower average BMI. Copyright © 2016 John Wiley & Sons, Ltd.

Pain-related psychological distress, self-rated health and significance of neuropathic pain in Danish soldiers injured in Afghanistan.

Pain and mental health concerns are prevalent among veterans. While the majority of research has focused on chronic pain as an entity, there has been little work directed towards investigating the role of neuropathic pain in relation to psychological comorbidity. As such, we hypothesised that participants with signs of neuropathic pain would report higher levels of psychological distress and diminished self-rated health compared to those without a neuropathic component. A retrospective review of standardised questionnaires (PainDETECT Questionnaire, Post-traumatic Stress Disorder Checklist-Civilian, the Hospital Anxiety and Depression Scale, and EuroQOL Visual Analogue Scale) administered to injured soldiers. The participants were classified into three groups according to the PainDETECT questionnaire: non-neuropathic pain, possible neuropathic pain and definite neuropathic pain. Fifty-three participants were included. The Post-traumatic Stress Disorder Checklist-Civilian score was in median (interquartile range) 26 (22-31), the Hospital Anxiety and Depression Scale score was 4 (2-6.5) and 2 (1-5) for anxiety and depression respectively. Evidence of neuropathic pain correlated positively with the Post-traumatic Stress Disorder Checklist-Civilian score (rho=0.469, P<0.001) and Hospital Anxiety and Depression Scale subscale for anxiety score (rho=0.357, P=0.009), and inversely with the EuroQOL Visual Analogue Scale score (rho=-0.361, P=0.008). In multivariate regression analyses, the associations remained when adjustingforsocio-demographics and clinical characteristics. The results from the present study suggest that neuropathic pain is related to increased psychological distress and deterioration in self-rated health in injured soldiers.

Medicare spending, managed care and pre-Medicare insurance coverage and associated risks of mortality, deterioration of self-rated health and mental health after four years of Medicare coverage

National spending on Medicare keeps growing and managed care is reimbursed differently in the United States. Health returns from Medicare spending are not certain. This study aims to quantify the effects of Medicare spending in the first two years of Medicare coverage, managed care and insurance coverage before Medicare (pre-Medicare) on mortality, mental health and self-rated health status after first four years of Medicare coverage. Individuals, who were interviewed from age 65 to 68 years, without Medicare coverage before age 65 years, were included. Health spending (out-of-pocket, OOP) in the first two years of Medicare coverage, their pre-Medicare characteristics and Medicare managed care were used to predict associated risks of mortality, self-rated health status and mental health (Center for Epidemiologic Studies-Depression, CESD scale). Eligible Medicare enrollees (N = 3,503) in the Health and Retirement Study from 1992 to 2011 were chosen. Total health spending was associated with higher likelihood of worse mental health and self-rated health, but OOP spending was associated with risks of health deterioration (p &lt; .05 for all). More OOP health spending in the first two years of Medicare coverage was associated with slightly higher chance of more mental problems, but the magnitude of this association became smaller over time. Medicare managed care did not seem to be beneficial for mortality, mental health or self-rated health status. Expanding pre-Medicare health coverage (through the Affordable Care Act) may not influence health status after first four years of Medicare coverage. Preventing pre-Medicare health conditions may be the priority.

Longitudinal and Cross-Sectional Relationships of Circulating Reproductive Hormone Levels to Self-Rated Health and Health-Related Quality of Life in Community-Dwelling Older Men

Self-rated health and health-related quality of life are inversely associated with increased morbidity and mortality; however, the temporal relationship with reproductive hormones is poorly understood. The objective of the study was to examine relationships between reproductive hormones, self-rated health, and quality of life in older men at baseline as well as changes over a 2-year follow-up. One thousand six hundred thirty-seven men aged 70 years and older from the Concord Health and Ageing in Men Project were assessed at baseline and 1316 men returned for the 2-year follow-up. Serum T, dihydrotestosterone, estradiol, and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry and SHBG, LH, and FSH by immunoassay. Logistic regression and multivariate linear regression models were performed. Self-rated health and health-related quality of life measures (12-Item Short Form Health Survey) were determined. In the cross-sectional baseline data, univariate analyses revealed significant associations between many of the hormones and quality-of-life scores and self-rated health. In a multivariable analysis, the associations between T, E1, and calculated free T and self-rated health remained statistically significant. Compared with men in the highest T quartile, men in the lowest T quartile had an odds ratio of 1.47 (95% confidence interval 1.04-2.06) for reporting fair, poor, or very poor health vs excellent or good health. The findings for E1 and calculated free T were similar. In the longitudinal data, the only significant relationship was that between E1 and self-rated health. Compared with those in the highest E1 quartile, those in the lowest quartile experienced deterioration in self-rated health: adjusted odds ratio of 1.84 (95% confidence interval 1.10-3.06). Low serum T and E1 are associated with poorer self-rated health in older men, whereas lower serum levels of E1 are predictive of subsequent deterioration in self-rated health over time. Therefore, serum E1 is a novel potential risk factor for poor self-rated health in older men that warrants further investigation.

Self-management support needs of patients with chronic illness: Do needs for support differ according to the course of illness?

ObjectiveTo determine whether chronically ill patients’ needs for self-management support depend on their course of illness. MethodsCross-sectional and longitudinal linear regression analyses were conducted using data from 1300 patients with chronic disease(s) who participated in a nationwide Dutch panel-study. Self-management support needs were assessed by the Patient Assessment of Self-management Tasks questionnaire (PAST). Course of illness was operationalized as: illness duration, patients’ perception of the course of illness and changes in self-rated general health (RAND-36). ResultsSelf-management support needs are not related to illness duration. Patients who perceive their illness as episodic and/or progressively deteriorating have greater self-management support needs than patients who perceive their illness as stable. Deterioration of self-rated health is related to increased support needs. The effect of the course of illness on support needs depends on the type of self-management activities. ConclusionHow chronically ill patients perceive the course of illness and actual changes in self-rated health are predictive for their need for support for self-management activities. Illness duration is not. Practice implicationsHelping patients to self-manage should not be confined to the first years after diagnosis. Healthcare providers should be alert to patients’ own perceptions of their course of illness and health status.

Determinants of changes in income-related health inequalities among working-age adults in Japan, 1986–2007: Time-trend study

This study aimed to quantify the contributions of the factors that have influenced changes in income-related health inequalities. We used data from a nationally representative sample of Japanese men and women aged 20–59 years who participated in eight repeated cross-sectional surveys between 1986 and 2007. A concentration index (CI) was used to measure income-related inequalities in self-rated health (SRH) and decomposed into contributing factors. We then examined temporal changes in CIs and their contributing factors. Results showed that income-related inequalities in SRH, unfavourable to low-income groups, persisted throughout the study period. Despite widening income inequalities, inequalities in SRH narrowed during the period of economic stagnation since the late 1990s because of the profound deterioration in SRH among middle- to high-income groups. Decomposition analysis showed that income itself and unemployment or economic inactivity were the most important contributors to inequalities in SRH for both sexes at almost all time points. However, from 1986 to 2007, the relative contribution of income to these inequalities decreased from 78% to 14% in men and from 85% to 38% in women. By contrast, the relative contribution of unemployment or economic inactivity increased from 18% to 77% in men and from 10% to 31% in women. Our results suggest that a reduction in avoidable health inequalities could be achieved by reducing the influence of unemployment or economic inactivity on health.

Health‐Promoting Interventions for Persons Aged 80 and Older Are Successful in the Short Term—Results from the Randomized and Three‐Armed Elderly Persons in the Risk Zone Study

To examine the outcomes of the Elderly Persons in the Risk Zone study, which was designed to evaluate whether it is possible to delay deterioration if a health-promoting intervention is made when an older adult (≥80) is at risk of becoming frail and whether a multiprofessional group intervention is more effective in delaying deterioration than a single preventive home visit with regard to frailty, self-rated health, and activities of daily living (ADLs) at 3-month follow-up. Randomized, three-armed, single-blind, controlled trial performed between November 2007 and May 2011. Two urban districts of Gothenburg, Sweden. Four hundred fifty-nine community-living adults aged 80 and older not dependent on the municipal home help service. A preventive home visit or four weekly multiprofessional senior group meetings with one follow-up home visit. Change in frailty, self-rated health, and ADLs between baseline and 3-month follow-up. Both interventions delayed deterioration of self-rated health (odds ratio (OR) = 1.99, 95% confidence interval (CI) = 1.12-3.54). Senior meetings were the most beneficial intervention for postponing dependence in ADLs (OR = 1.95, 95% CI = 1.14-3.33). No effect on frailty could be demonstrated. Health-promoting interventions made when older adults are at risk of becoming frail can delay deterioration in self-rated health and ADLs in the short term. A multiprofessional group intervention such as the senior meetings described seems to have a greater effect on delaying deterioration in ADLs than a single preventive home visit. Further research is needed to examine the outcome in the long term and in different contexts.

Adolescents’ experiences of coping with domestic violence

This paper is a report of a study of experiences of domestic violence and coping among ninth-grade (14-17 years old) adolescents. Domestic violence is commonplace and adolescents are involved in it either as witnesses or victims. Research has shown that different degrees of domestic violence play a major role in adolescent well-being and coping. A survey of ninth graders in one municipality in Finland was conducted in 2007. A total of 1393 adolescents participated, giving a 78% response rate. The survey included two validated scales, the Violence Scale and the Adolescent Coping Scale. Logistic regression analysis was performed to determine coping among adolescents with and without experience of domestic violence. Sixty-seven per cent of adolescents had experienced parental symbolic aggression, 55% mild violence and 9% serious violence. The multivariate logistic regression model showed that experiences of violence were associated with deterioration in self-rated health, life satisfaction, adolescent giving in when in a conflict situation, approval of corporal punishment and coping by seeking to belong and self-blame. Those with experience of domestic violence did not seek professional help. Adolescents experiencing domestic violence do not seek help and care providers should therefore take active measures to help them. These adolescents reported that they were satisfied with life, which makes it difficult to identify their need for help. Resources should be developed to identify and help these adolescents.

Deterioration is not the only prospect for adolescents' health: improvement in self-reported health status among boys and girls from age 15 to age 19.

To assess changes in the mental and physical health of adolescents between the ages of 15 and 19. The study included a four-year follow-up of 844 students from 31 secondary schools located in Kosice, Slovakia (response rate 45.6%). The 36-item short form (SF-36) scales were used to assess vitality and mental health, self-rated health, long-term well-being, long-standing illness, and the number of perceived health complaints at the age of 15 and four years later. Both boys and girls reported significant deterioration in vitality (mean difference boys 5.3; girls 3.3; P=0.001) and mental health (mean difference boys 7.7; girls 5.7; P=0.001), while only boys reported deterioration in self-rated health (P=0.047). The proportion of boys who reported an improvement ranged from 8%-40%, while the proportion of girls who reported an improvement ranged from 8%-45%. Significantly more girls than boys reported an improvement in mental health (27% of boys vs 34% of girls) and vitality (32% of boys vs 39% of girls), while more boys than girls reported a deterioration in vitality(55% of boys vs 48% of girls)). These differences were trivial according to the effect size (Cohen's H<0.20). Although significant deterioration in mental health and vitality was detected among both genders, with boys deteriorating more substantially in self-rated health than girls, the differences between the proportion of those with improved and those with deteriorated status were trivial in size.

Development in self-rated health among older people as determinant of social relations

The purpose of this study was to analyse whether development in self-rated health (SRH) over four years was associated with the structure of and satisfaction with social relations, at four and eight years follow-up, among elderly women and men. A longitudinal questionnaire-based study was undertaken of non-institutionalized Danes, aged 70-95 years, with baseline in 1986. The response rate at baseline was 69%, n= 1,231. First follow-up was carried out in 1990, with 91% of eligible individuals participating (n=911). Second follow-up took place in 1994, where 83% of eligible individuals participated (n= 542). The association was studied between development in SRH from 1986 to 1990 and social relations in 1990 and in 1994. A sustained poor SRH predicted low contact frequency OR= 1.7 (1.1-2.6), small contact diversity OR= 1.6 (1.0-2.6) and low contact satisfaction OR=3.4 (2.3-5.2) in the two-point analyses. Furthermore, a deterioration in SRH predicted poor contact satisfaction OR=2.8 (1.7-4.5). All analyses were adjusted for age, gender, mental health, functional ability, cohabitation status, and a measure of social relations at baseline. Results for the three-point analyses were similar to those for the two-point analyses. The associations were weaker for contact satisfaction OR=2.8 (1.7-4.7), but stronger for contact frequency OR=2.5 (1.4-4.4) and diversity OR=2.1 (1.2-3.6). Sustained poor SRH and, to some degree, deterioration in SRH were predictors of poor social relations after four and eight years.

The impact of salient role stress on trajectories of health in late life among survivors of a seven-year panel study: analyses of individual growth curves.

The purpose this study is twofold: 1) to model changes in health over time among older adults; and 2) to assess the degree to which stress arising in salient social roles accounts for individual variation in these changes. Individual growth curve analyses using Hierarchical Linear Modeling (HLM) software were employed with longitudinal data collected from a nationwide sample of 465 older adults between 1992-1999. The data suggest that, throughout the course of the study, the sample as a whole experienced linear deterioration in self-rated health. After accounting for the effects of non-salient role stress and demographic characteristics, variance in health changes was not accounted for significantly by salient role stress in an additive model. However, the inclusion of a multiplicative term showed that as respondent age increased, the association between salient role stress and adverse changes in health strengthened significantly. These results support the idea that the oldest-old may be particularly vulnerable to the effects of stress. This finding has important implications for targeting interventions and should stimulate further study regarding how and why responses to stress change progressively with age.

Social class and self-rated health: can the gradient be explained by differences in life style or work environment?

The purpose of the present paper is to describe differences in work environment and life style factors between social classes in Denmark and to investigate to what extent these factors can explain social class differences with regard to changes in self-rated health (SRH) over a 5 year period. We used data from a prospective study of a random sample of 5001 Danish employees, 18–59 years of age, interviewed at baseline in 1990 and again in 1995. At baseline we found higher prevalence in the lower classes of repetitive work, low skill discretion, low influence at work, high job insecurity, and ergonomic, physical, chemical, and climatic exposures. High psychological demands and conflicts at work were more prevalent in the higher classes. With regard to life style factors, we found more obese people and more smokers among the lower classes. The proportion with poor SRH increased with decreasing social class at baseline. The follow-up analyses showed a clear association between social class and worsening of SRH: The lower the social class, the higher the proportion with deterioration of SRH. There was no social gradient with regard to improved SRH over time. Approximately two thirds of the social gradient with regard to worsening of SRH could be explained by the work environment and life style factors. The largest contribution came from the work environment factors.