Differences In Self-reported Health Research Articles

Gender and social differences in self-reported health in 31 countries in Europe

Gender and social differences in self-reported health in 31 countries in Europe

Differences in Self-Reported Health in the Osteoarthritis Initiative (OAI) and Third National Health and Nutrition Examination Survey (NHANES-III)

ObjectiveTo assess self-reported health status (SRHS) in two cohorts of participants with radiographic knee osteoarthritis (OA) and examine the extent that differences in SRHS are due to study design.MethodWe used data from the Third National Health and Nutritional Examination Survey (NHANES-III; population-based national survey) and the Osteoarthritis Initiative (OAI; prospective cohort study). Inclusion criteria for this analysis were age 60–79 and presence of radiographic knee OA. SRHS, elicited as a five-item domain (excellent, very good, good, fair, poor), was analyzed by dichotomizing the general health status measure as “fair/poor” versus all other states. We estimated the proportion of participants in fair/poor health from each study. Propensity score methodology was used to adjust for the differences in sampling strategies between the two studies.ResultsThirty-four percent (N = 1,608) of OAI and 29% (N = 756) of NHANES-III participants satisfied inclusion criteria. The proportion in fair/poor health was higher in NHANES-III (28%) than in OAI (5%). After adjusting for the propensity score, the proportion in fair/poor health was four times higher in NHANES-III than in OAI.ConclusionSRHS was substantially better in OAI than in NHANES-III. Self-selection bias may contribute to overestimation of SRHS in prospective cohort studies such as OAI.

Health inequalities among older men and women in Africa and Asia: evidence from eight Health and Demographic Surveillance System sites in the INDEPTH WHO-SAGE Study

Background: Declining rates of fertility and mortality are driving demographic transition in all regions of the world, leading to global population ageing and consequently changing patterns of global morbidity and mortality. Understanding sex-related health differences, recognising groups at risk of poor health and identifying determinants of poor health are therefore very important for both improving health trajectories and planning for the health needs of ageing populations.Objectives: To determine the extent to which demographic and socio-economic factors impact upon measures of health in older populations in Africa and Asia; to examine sex differences in health and further explain how these differences can be attributed to demographic and socio-economic determinants.Methods: A total of 46,269 individuals aged 50 years and over in eight Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network were studied during 2006–2007 using an abbreviated version of the WHO Study on global AGEing and adult health (SAGE) Wave I instrument. The survey data were then linked to longitudinal HDSS background information. A health score was calculated based on self-reported health derived from eight health domains. Multivariable regression and post-regression decomposition provide ways of measuring and explaining the health score gap between men and women.Results: Older men have better self-reported health than older women. Differences in household socio-economic levels, age, education levels, marital status and living arrangements explained from about 82% and 71% of the gaps in health score observed between men and women in South Africa and Kenya, respectively, to almost nothing in Bangladesh. Different health domains contributed differently to the overall health scores for men and women in each country.Conclusion: This study confirmed the existence of sex differences in self-reported health in low- and middle-income countries even after adjustments for differences in demographic and socio-economic factors. A decomposition analysis suggested that sex differences in health differed across the HDSS sites, with the greatest level of inequality found in Bangladesh. The analysis showed considerable variation in how differences in socio-demographic and economic characteristics explained the gaps in self-reported health observed between older men and women in African and Asian settings. The overall health score was a robust indicator of health, with two domains, pain and sleep/energy, contributing consistently across the HDSS sites. Further studies are warranted to understand other significant individual and contextual determinants to which these sex differences in health can be attributed. This will lay a foundation for a more evidence-based approach to resource allocation, and to developing health promotion programmes for older men and women in these settings.Access the supplementary material to this article: INDEPTH WHO-SAGE questionnaire (including variants of vignettes), a data dictionary and a password-protected dataset (see Supplementary files under Reading Tools online). To obtain a password for the dataset, please send a request with ‘SAGE data’ as its subject, detailing how you propose to use the data, to global.health@epiph.umu.se

Educational level is a crucial factor for good perceived health in the local community

Educational level is a strong determinant of perceived health, and also an important component in the socioeconomic concept. The aim of this study was to analyze a number of social conditions and lifestyle factors that might explain differences in self-reported health between the populations in two different social environments, one white-collar city and one blue-collar city. These ''twin cities'' are served by the same healthcare organisation, but differ in terms of social history and current social structure. The material consisted of responses to a community-based survey of individuals aged between 20 and 64 years, with an overall response rate of 49%. Differences in self-reported health status were tested with chi-square tests and regression analysis. We found significant differences in perceived health between the two populations. These differences in self-reported health could not be explained by differences in demographic factors, lifestyles, or living conditions. However, when the educational level of the respondents was taken into account, the differences in perceived health diminished. Public health in local communities tends to reflect the social history and social heritage of the population. In this study, we found that educational level appears to be a vital factor for good perceived health of the individual in a community.

Socio-economic position, family demands and reported health in working men and women

This study evaluates the extent to which domestic workload explains socio-economic differences in poor self-reported health in women and men. In total, 6284 men and women who were employed and living with a partner were selected from the 2003 Spanish Health Interview Survey. The indicators of family demands investigated were person responsible for housework, number of persons in the household and the presence of at least one child under 15 years of age in the household. The measures of socio-economic position were educational level and household income, and the measures of health status were poor perceived health and limitation of activity due to disease. Household size and presence of a child under 15 in the home were not related with the measures of health status. The indicator about the person who does the housework was related with poor perceived health and with activity limitation. Specifically, the worst health status was seen in respondents who lived in homes where the partner or other family members did the housework. In general, the relation between indicators of socio-economic position and measures of health status was not modified after taking into account the person who does the housework. Among working people with a partner, persons who work and do their own housework do not have poorer perceived health than those living in homes where other people do the housework. This indicator of family demands does not explain the socio-economic differences in self-reported health.

Origin differences in self-reported health among older migrants living in France

Little is known about the health status of older migrants living in Europe. Using detailed data collected in 2003, this study investigated differences in health status by country of origin within the older immigrant population living in France using a self-rated health measure. The database used in this research was the Passage à la Retraite des Immigrés survey, conducted from November 2002 to February 2003 on a sample of 6211 migrants aged 45-70 years and living in France at the time of the survey. A difficulty with a self-rated outcome is that it may not be comparable between different origin groups, particularly because of cultural and linguistic differences. Therefore, generalized ordered Probit models were estimated, and an indicator of health, net of cross-cultural effects was constructed for each respondent. This study found that male immigrants from southern Africa and Asia, and female immigrants from northern Europe, southern Africa and Asia are more likely to be in good health, while the health status is lower among immigrants from Eastern Europe living in France. The diversity in health status within the immigrant population is large in France. These results are helpful in order to target the more disadvantaged origin groups and to adjust the provision of health care.

An analysis of gender differences in self-reported health, use of medicines and access to information sources about medicines among adolescents

Adolescence is a key period in the emergence of gender differences in health that persist into adulthood. Knowledge about health-related gender differences among adolescents could be instrumental in informing policy and practice to effect health improvement among this age group. The main objectives of this study were therefore to investigate gender differences in self-reported health complaints and use of medicines during the preceding 3 months and access to information sources about medicines among adolescents in Malta. A self-administered questionnaire was distributed among adolescents attending secondary schools in Malta. A stratified random sample design generated a sample size of 514 students. Common health complaints, use of medicines, and sources of information about medicines were investigated by means of author-designed checklists. The analytical sample was formed from 474 usable questionnaires collected from students aged 14-16 years, of which 53.8% were females. In general, a female excess emerged for health complaints and use of medicines except for sport injuries and use of vitamins. Gender differences were statistically significant for a female excess in the retrieval of information from the package insert (p < .001), parents or adult relatives (p < .01) and friends or schoolmates (p < .05). The findings of this study underscore the need for awareness of gender differences in the health of adolescents among health care providers, policy makers, and educators. An important implication of the findings is that the health needs of adolescents could be more equitably addressed by adopting a holistic patient-oriented approach particular to the health needs of each individual.

Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary?

Background:Several models have been proposed to explain the association between ethnicity and health. It was investigated whether the association between Roma ethnicity and health is fully mediated by socioeconomic status...

People, places and policies – trying to account for health inequalities in impoverished neighbourhoods

We consider associations between individual, household and area-level characteristics and self-reported health. Data is taken from baseline surveys undertaken in 13 socio-economically disadvantaged neighbourhoods in Victoria (n=3,944). The neighbourhoods are sites undergoing Neighbourhood Renewal (NR), a State government initiative redressing place-based disadvantage. This focused on the relationship between area and compositional factors and self-reported health. Area was coded into three categories; LGA, NR residents living in public housing (NRPU) and NR residents who lived in private housing (NRPR). Compositional factors included age, gender, marital status, identifying as a person with a disability, level of education, unemployment and receipt of pensions/benefits. There was a gradient in socio-economic disadvantage on all measures. People living in NR public housing were more disadvantaged than people living in NR private housing who, in turn, were more disadvantaged than people in the same LGA. NR public housing residents reported the worst health status and LGA residents reported the best. Associations between compositional characteristics of disability, educational achievement and unemployment income and poorer self-reported health were shown. They suggested that area characteristics, with housing policies, may be contributing to differences in self-reported health at the neighbourhood level. The clustering of socio-economic disadvantage and health outcomes requires the integration of health and social support interventions that address the circumstances of people and places.

The Impact of Occupation on Self-Rated Health: Cross-Sectional and Longitudinal Evidence from the Health and Retirement Survey

The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals. We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working. Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout. Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

Anthrax vaccination in a military population before the war in Iraq: Side effects and informed choice

Background To assess any health consequences of the anthrax vaccination programme in UK Armed Forces deployed to Iraq. Methods Data were collected from two samples simultaneously. The first was 5302 randomly selected UK service personnel. The second was 607 service personnel involved in a longitudinal study, where pre-vaccination health had previously been collected. Both samples were offered the anthrax vaccination before they deployed to Iraq in 2003 and subsequently following their service in Iraq. Participants completed a detailed questionnaire, including a range of health outcomes, receipt of the anthrax vaccination and quality of choice. Results Seventy-two percent of the combined sample had the anthrax vaccination. Being a member of the Army, a commissioned officer or a reservist was associated with higher uptake. No differences in self-reported health were observed between those who did and did not receive the vaccination. For participants who accepted the vaccination, we found an association between making an uninformed choice and adverse health. After adjustment for baseline health in the longitudinal cohort these associations remained significant. Conclusions Anthrax vaccination used by the UK Armed Forces in preparation for the Iraq War has not resulted in adverse health outcomes. However, of those who did accept the vaccination, reported side effects were related to whether acceptance of vaccination was perceived to be informed. Improving the quality of choice may improve self-reported ill health.

Differences in Self-Reported Health Among Asians, Latinos, and Non-Hispanic Whites: The Role of Language and Nativity

Self-reported overall health (SROH) is often used to compare the health status of multi-ethnic populations in the United States. SROH may not be comparable across cultural groups. We assessed if differences in SROH between non-Hispanic whites (NHW), Latinos, and Asians were explained primarily by differences in socioeconomic status (SES) or language and nativity. We used cross-sectional data on 36,660 NHW, 9399 Latinos, 1298 Chinese, 944 Filipinos, 803 Koreans, 857 Vietnamese, and 1036 "other Asians" from the 2001 California Health Interview Survey. Compared with NHW, all ethnic groups were less likely to report "excellent" or "very good" health. Latinos, Chinese, Filipinos, Koreans, and Vietnamese were also more likely to report "fair" or "poor" health. Adjusting for SES attenuated these differences for Latinos but did not explain the effect of being Asian on SROH. Among all ethnicities, individuals with limited English proficiency had worse SROH than individuals who were English-proficient. Differences in SROH between Asians and NHW do not appear to be mediated by SES and may be due to different perceptions of health that are rooted in culture and language. There remains a need for health status measures less susceptible to cultural bias in Asian and Latino populations.

Impact of health literacy on socioeconomic and racial differences in health in an elderly population

Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence. To examine the extent to which low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations. Retrospective cohort study. PARTICIPANTS (OR PATIENTS OR SUBJECTS): Three thousand two hundred and sixty noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, OH; Houston, TX; South Florida; and Tampa, FL. Dependent variables were physical health SF-12 score, mental health SF-12 score, self-reported health status, receipt of influenza vaccine, and receipt of pneumococcal vaccine. Independent variables included health literacy, educational attainment, race, income, age, sex, chronic health conditions, and smoking status. After adjusting for demographic and health-related variables, individuals without a high school education had worse physical and mental health and worse self-reported health status than those with a high school degree. Accounting for health literacy reduced these differences by 22% to 41%. Black individuals had worse self-reported health status and lower influenza and pneumococcal vaccination rates. Accounting for health literacy reduced the observed difference in self-reported health by 25% but did not affect differences in vaccination rates. We found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

Low‐birthweight adolescents: Quality of life and parent–child relations

To explore the effect of low birthweight on quality of life, the parent-child relationship and the parents' mental health. DESIGN/STUDY GROUPS: A population-based follow-up of 56 very-low-birthweight (<or=1500 g), 60 term small-for-gestational-age (birthweight<10th centile) and 83 term control adolescents (birthweight>or=10th centile) at 14 y of age. Child Health Questionnaire (Child Form, Parent Form), Parental Bonding Instrument rated by adolescents and parents; Symptom Checklist-90-Revised rated by mothers and fathers. There were no group differences in self-reported health or self-esteem. Parents reported more behavioural problems and lower psychosocial health for very-low-birthweight adolescents (p<0.001) compared with controls. Results did not differ significantly between small-for-gestational-age and control adolescents. The youngsters, their mothers and fathers perceived the same amount of relational warmth in all three groups. Very-low-birthweight parents reported more emotional impact than control parents, especially in the presence of psychiatric problems and cerebral palsy. There were no group differences in mothers' or fathers' mental health. The low-birthweight adolescents perceived quality of life as others did, but the parents reported functional disadvantages for the very-low-birthweight group. Birthweight did not influence the warmth in the parent-child relationship. Parents of very-low-birthweight adolescents experienced increased emotional burden, but they did not have more mental health problems than others.

The impact of family members on the self-reported health of older men and women in a rural area of Bangladesh

The purpose of this study is to examine whether the co-residence of spouses and children affects self-reported general health among older men and women in a rural area of Bangladesh. Binary logistic regression has been used to explore the impact of spouses and children on self-reported health, with particular attention to the gender of children and interactions with chronic disease. The data are from the Matlab Health and Socio-Economic Survey. A sample of 765 women and 979 men aged 60 or more years with at least one surviving child was available. The principal result is that for an older woman, optimum self-reported health is most likely when a spouse and at least one son and one daughter are present. Any deviation from this family pattern (either no spouse or children of only one sex) leads to a significantly increased risk of poor self-reported health. On the other hand, among older men there were no differences in self-reported health among the various spouse-child combinations. The relationship between a balanced gender distribution of children and optimum self-reported health among older women may explain the levelling out of fertility at roughly three children per women despite intensive family planning promotion in the area. Further reductions in fertility (an important policy concern) may depend on improving the substitutability of sons and daughters in the support of their elderly mothers.

Health and well-being among 70-year-old migrants living in Sweden--results from the H 70 gerontological and geriatric population studies in Göteborg.

Comparative epidemiological studies in migrants in Sweden have shown increased prevalence of psychosocial morbidity in young adults, but there is paucity of information on health in people aged 65 years and over. We aim to compare prevalence of mental, physical and social health problems, rates of hospital admission, and mortality in Swedish and non-Swedish born people aged 70 years living in Göteborg, Sweden, and examine associations between social factors, physical health, mood and life satisfaction in the ethnic groups. In addition, we aim to test for the hypothesis that differences in mental health between migrants and natives are explained by social disadvantages rather than ethnicity. Semi-structured interviews were administered to 84 migrants (47 women and 37 men randomly selected) with the help of bilingual interpreters, and 409 Swedes (183 males and 226 females) used as "controls". Complementary health and social data obtained from official sources on the total sample (N = 764, including non-participants in overall medical interviews) were used in comparative analyses of in-patient care and mortality and to check for the possibility of sampling bias. Migrants--originating mainly from Estonia, Poland, Yugoslavia, Germany, Italy and Nordic countries other than Sweden--reported more dizziness, poor vision and urinary problems, and fewer gall bladder problems than indigenous people (p < 0.05). Migrants also had higher levels of anxiety and depression and bodily pain, and lower levels of general health, social and emotional functioning, satisfaction with physical health status, family contacts, housing conditions and economic status than natives (p <0.05). Satisfaction with physical health seemed to be one of the strongest factors related to a lower prevalence of anxiety and depression together with family support and time spent in leisure pursuits. No significant differences in inpatient care in several ICD categories and all-cause mortality were found between overall migrants and the control group notwithstanding differences in self-reported health. The results indicate poorer subjective health in older migrants than natives in Göteborg, and also point to a "healthy migrant" effect on survival.

The Contribution of Intermediary Factors to Marital Status Differences in Self-Reported Health

I. M. A. JOUNG, K. STRONKS, & H. VAN DE MHEEN Erasmus University Rotterdam F. W. A. VAN POPPEL Netherlands Interdisciplinary Demographic Institute* J. B. W. VAN DER MEER AND J. P. MACKENBACH Erasmus University Rotterdam The aim of this study is to estimate the relative contributions of psychosocial conditions, material circumstances, and health behaviors to differences in physical and mental health by marital status. Data on 3,510 Dutch persons who were part of the GLOBE study, aged 25-74 years, are used. Multiple logistic regression models show that never-married, divorced, and widowed men have higher morbidity rates than married men. For women, the health differences are almost solely due to excess morbidity among divorced women. We found that psychosocial conditions contributed most to the explanation of morbidity differences among men (25%-SO%), but material circumstances contributed most among women (50%-100%). Key Words: health behaviors, marital status, material circumstances, psychosocial factors, self-reported health, social causation. Mortality differences among marital status groups were first described in the previous century (Farr, 1858) and have been the focus of many studies since (Ben-Shlomo, Davey Smith, Shipley, & Marmot, 1993; Carter & Glick, 1976; Gove, 1973; Hu & Goldman, 1990; Rogers, 1995; Rosengren, Wedel, & Wilhelmsen, 1989; Trovato & Lauris, 1989). Morbidity differences among marital status groups also have been studied (Anson, 1989; Morgan, 1980; Verbrugge, 1979; Wyke & Ford, 1992). Results from these studies show that morbidity differentials largely have patterns similar to mortality differentials: Married persons have the lowest rates, divorced persons have the highest rates, and never-married and widowed persons have rates in between. Several longitudinal studies have provided evidence that marital status is causally related to health outcomes (Ben-Shlomo et al., 1993; Ebrahim, Wannamethee, McCallum, Walker, & Shaper, 1995; Goldman, Korenman, & Weinstein, 1995; Jagger & Sutton, 1991; Martikainen & Valkonen, 1996; Schaefer, Quesenberry, & Wi, 1995; Tucker, Wingard, Friedman, & Schwartz, 1996). In these studies, researchers found that, after controlling for initial health status, married persons have a longer survival time and a lower incidence of health problems than unmarried persons. The effect of marital status on health generally is assumed to be mediated by psychosocial factors, material circumstances, and health behaviors (Gerstel, Riessman, & Rosenfield, 1985; Goldman et al., 1995; Lillard & Waite, 1995; Ross, 1995; Umberson, 1992; Wyke & Ford, 1992). The aim of this study is to estimate the relative contribution of these three intermediary factors to health differences among marital status groups. Marital status groups are assumed to differ in both their exposure and vulnerability to psychosocial stress (Pearlin & Johnson, 1977). Bereavement and divorce are the most obvious sources of differences in psychosocial stress. On the social readjustment rating scale of Holmes and Rahe (1967), 43 life events are ordered on the basis of the assumed intensity and length of time necessary to adjust to a life event; bereavement and divorce rank first and second, respectively. Results from longitudinal studies of mortality after bereavement and morbidity after divorce suggest that a crisis model appropriately describes the health effects of bereavement and divorce (Booth & Amato, 1991; Ebrahim et al., 1995; Jagger & Sutton, 1991; Schaefer et al., 1995). Bereavement and divorce often are accompanied by other stressful life events, such as changes in parental responsibilities and a forced move to other housing, which add to the psychosocial stress (Bloom, Asher, & White, 1978; Stroebe & Stroebe, 1993). Social support is assumed to buffer the negative health effects of stress (House, Umberson, & Landis, 1988). …

Age differences in cognitive performance in later life: relationships to self-reported health and activity life style.

The predictive relationships among individual differences in self-reported physical health and activity life style and performance on an array of information processing and intellectual ability measures were examined. A sample of 484 men and women aged 55 to 86 years completed a battery of cognitive tasks measuring verbal processing time, working memory, vocabulary, verbal fluency, world knowledge, word recall, and text recall. Hierarchical regression was used to predict performance on these tasks from measures of self-reported physical health, alcohol and tobacco use, and level of participation in everyday activities. The results indicated: (a) individual differences in self-reported health and activity predicted performance on multiple cognitive measures; (b) self-reported health was more predictive of processing resource variables than knowledge-based abilities; (c) interaction effects indicated that participation in cognitively demanding activities was more highly related to performance on some measures for older adults than for middle-aged adults; and (d) age-related differences in performance on multiple measures were attenuated by partialing individual differences in self-reported health and activity.

Relationships Between Self-reported Physical and Mental Health and Intelligence Performance Across Adulthood

One hundred and twenty-seven adults between 20 and 90 years of age were tested on the Wechsler Adult Intelligence Scale for their digit span memory (forward and backward), fluid intelligence (block design and digit symbol), and crystallized intelligence (vocabulary and information), as well as assessed for self-reported health (Cornell Medical Index, Zung Depression Scale, health habits, and self-ratings of physical and mental health). As expected, across the entire age range there was no correlation between age and digit span memory (r = .03), a strong negative correlation between age and fluid intelligence (r = -.78), and a modest positive correlation between age and crystallized intelligence (r = .27). In addition, older adults reported more physical (r = .36) and mental (r = .32) health problems than did younger adults. Of special interest was the finding that both self-reported physical and mental health accounted for significant variance in intelligence performance, particularly in older adults. Moreover, self-reported health accounted for a considerable portion of observed variance, even when age differences in self-reported health were statistically controlled.

Stress in racial differences in self-reported health among the elderly.

Stress in racial differences in self-reported health among the elderly.