Self-rated Health Trajectories Research Articles

Self-rated health in the last 12 years of life compared to matched surviving controls: the Health and Retirement Study.

Self-rated health (SRH) is a valid measure of health status and associated with mortality. Based on individual-level biannual repeat data on SRH we sought to characterize the natural history of poor SRH during the 12 years prior to death in men and women in different age groups. We conducted a retrospective analysis of the Health and Retirement Study participants who died between 1998 and 2010 and had at least two SRH measurements in the 12 years prior to death. We used a nested case-control design to compare SRH trajectories of deceased men and women aged 30–64, 65–79 and 80 years versus surviving participants. The cases comprised 3,350 deceased participants who were matched to surviving controls (n = 8,127). SRH was dichotomized into good vs. poor health. Men and women dying at age 65–79 and ≥80 years had 1.5 to 3 times higher prevalence of poor SRH already 11–12 years prior to death compared to surviving controls. The risk estimates remained statistically significant even after adjusting for life-style related risk factors and diagnosed diseases. Prevalence of poor SRH before death was lowest among those aged ≥80 years and highest in 30–64 year-olds. In conclusion, men and women who subsequently die perceive their health worse already 11–12 years prior to death compared to their surviving controls.

Neighborhood racial composition and trajectories of child self-rated health: An application of longitudinal propensity scores

Children function within multiple socio-environmental contexts including family, school, and neighborhood. The role each of these contexts play in determining well-being is dynamic and changes throughout early-middle childhood. Recent literature on neighborhood context and health suggests that the life-course processes involved in building trajectories of health are not adequately captured in cross-sectional analysis, which has been the empirical focus of much of the research in this area. In this study we use a nationally representative longitudinal sample of approximately 21,400 United States school children derived from the Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K) survey to examine the impact of longitudinal measures of neighborhood racial composition on child self-rated health between kindergarten and 8th grade. We employ two-level multilevel longitudinal logistic regression models with time-varying propensity scores to examine variation in the initial status and trajectories of child self-rated health between kindergarten and 8th grade. Since the ECLS-K tracked child mobility over time, we are able to model the impact of changes in neighborhood racial composition. We find significant differences in initial poor self-rated health by child race, household socioeconomic status and parental marital status but no evidence of a change in trajectory of health over time. Using time-varying propensity scores, we find no effect of neighborhood racial composition on initial health status or health status trajectories.

Age at migration and self-rated health trajectories after age 50: understanding the older immigrant health paradox.

This research contributes to the "immigrant health paradox" debate by testing the hypothesis that older age at migration is associated with the increased risk of poor health in later life. Using the 1992-2008 Health and Retirement Study, I construct linear random-intercept models to estimate self-rated health (SRH) trajectories after age 50 for the native and foreign born by age at migration. At age 50, both Hispanic and non-Hispanic foreign born report better SRH compared with their native-born counterparts, net of race, gender, and education. Non-Hispanic foreign born who migrated after age 35 and Hispanic foreign born who migrated after age 18, however, experience steeper decline in SRH after age 50, which results in a health disadvantage vis-à-vis the native born in old age. Education has a smaller protective effect on SRH for the foreign born, especially those who migrated as adults. Age at migration is an important factor for understanding health status of older immigrants. Steeper health decline in later life of the foreign born who migrated in advanced ages may be related to longer exposure to unfavorable conditions in home countries and limited opportunities for incorporation in the United States.

The influence of work-family conflict trajectories on self-rated health trajectories in Switzerland: A life course approach

Self-rated health (SRH) trajectories tend to decline over a lifetime. Moreover, the Cumulative Advantage and Disadvantage (CAD) model indicates that SRH trajectories are known to consistently diverge along socioeconomic positions (SEP) over the life course. However, studies of working adults to consider the influence of work and family conflict (WFC) on SRH trajectories are scarce. We test the CAD model and hypothesise that SRH trajectories diverge over time according to socioeconomic positions and WFC trajectories accentuate this divergence. Using longitudinal data from the Swiss Household Panel (N = 2327 working respondents surveyed from 2004 to 2010), we first examine trajectories of SRH and potential divergence over time across age, gender, SEP and family status using latent growth curve analysis. Second, we assess changes in SRH trajectories in relation to changes in WFC trajectories and divergence in SRH trajectories according to gender, SEP and family status using parallel latent growth curve analysis. Three measures of WFC are used: exhaustion after work, difficulty disconnecting from work, and work interference in private family obligations. The results show that SRH trajectories slowly decline over time and that the rate of change is not influenced by age, gender or SEP, a result which does not support the CAD model. SRH trajectories are significantly correlated with exhaustion after work trajectories but not the other two WFC measures. When exhaustion after work trajectories are taken into account, SRH trajectories of higher educated people decline slower compared to less educated people, supporting the CAD hypothesis.

Gender Differences in Trajectories of Self-Rated Health in Middle and Old Age

This research examined gender differences in self-rated health (SRH) using the differential exposure and differential vulnerability explanations of gender differences in health. Trajectories of SRH were estimated using data that spanned 12 years (1992-2004) from the Health and Retirement Study. There was no gender difference in SRH at baseline, but SRH declined faster for males over time. Factors that mediated the gender difference included changes in employment status, smoking behavior, and the onset of health conditions. Moreover, were it not for gender differences in various structural and health status factors, females would have better SRH at baseline and over time. Our results differ from previous research, which often shows a female disadvantage that is reduced or disappears at older ages. Furthermore, gender differences in the predictors of SRH (exposure) contribute more to understanding gender differences in SRH than different responses to the predictors (vulnerability).

Trajectories of Self-Rated Health in People with Diabetes: Associations with Functioning in a Prospective Community Sample

BackgroundSelf-rated health (SRH) is a single-item measure that is one of the most widely used measures of general health in population health research. Relatively little is known about changes and the trajectories of SRH in people with chronic medical conditions. The aims of the present study were to identify and describe longitudinal trajectories of self-rated health (SRH) status in people with diabetes.MethodsA prospective community study was carried out between 2008 and 2011. SRH was assessed at baseline and yearly at follow-ups (n=1288). Analysis was carried out through trajectory modeling. The trajectory groups were subsequently compared at 4 years follow-up with respect to functioning.ResultsFour distinct trajectories of SRH were identified: 1) 72.2% of the participants were assigned to a persistently good SRH trajectory; 2) 10.1% were assigned to a persistently poor SRH trajectory; 3) mean SRH scores changed from good to poor for one group (7.3%); while 4) mean SRH scores changed from poor to medium/good for another group (10.4%). Those with a persistently poor perception of health status were at higher risk for poor functioning at 4 years follow-up than those whose SRH scores decreased from good to poor.ConclusionsSRH is an important predictor for poor functioning in diabetes, but the trajectory of SRH seems to be even more important. Health professionals should pay attention to not only SRH per se, but also changes in SRH over time.

Effect of Social Engagement on Self-rated Health Trajectory among Korean Older Adults

Effect of Social Engagement on Self-rated Health Trajectory among Korean Older Adults

Factors of change and cumulative factors in self-rated health trajectories: a systematic review.

In Western societies, self-rated health (SRH) inequalities have increased over the past decades. Longitudinal studies suggest that the SRH trajectories of disadvantaged populations are declining at a faster rate than those of advantaged populations, resulting in an accumulation of (dis)advantages over the life course, as postulated by the Cumulative Advantage/Disadvantage (CAD) model. The objectives of this study are to conduct a systematic review of the factors influencing SRH trajectories in the adult population and to assess to what extent the findings support the CAD model. Based on the inclusion criteria, 36 articles, using 15 nationally representative databases, were reviewed. The results show that young age, high socioeconomic position and marital transitions (entering a partnership) are advantageous factors of change in SRH trajectories. However, evidence for cumulative influences supporting the CAD model remains limited: gender, ethnicity, education and employment status are only moderately associated with growing influences over time, and the cumulative influences of income, occupation, age and marital status are weak. In conclusion, this systematic review provides consolidated evidence on the factors influencing SRH trajectories, though the inclusion of only 15 nationally representative databases may limit the generalization of the results.

The effect of health behavior change on self-rated health across the adult life course: A longitudinal cohort study

ObjectiveWhile it is clear that health behaviors are related to self-rated health (SRH), it is less clear if maintaining positive behaviors, or improving, can protect SRH over time. MethodSRH trajectories were modeled in a large representative Australian sample (n=7485 at baseline), of three age cohorts (20–24, 40–44 and 60–64years at baseline; 1999, 2000 & 2001 respectively), over an 8year period. Change in smoking, alcohol consumption and physical activity on SRH trajectories were examined, controlling for demographic, physical and mental health factors. ResultsSRH became poorer over time across the sample. Being a non-smoker was associated with more positive SRH levels across all groups. Maintaining or increasing moderate physical activity was associated with less decline in SRH. ConclusionsFindings highlight the benefits of positive health behaviors, particularly performing regular physical activity over time, for reducing the risk of subjective health becoming poorer across the adult life course.

Ethnicity and Postmigration Health Trajectory in New Immigrants to Canada

In this prospective cohort study, we examined the trajectory of general health during the first 4 years after new immigrants' arrival in Canada. We focused on the change in self-rated health trajectories and their gender and ethnic disparities. Data were derived from the Longitudinal Survey of Immigrants to Canada and were collected between April 2001 and November 2005 by Statistics Canada. We used weighted samples of 3309 men and 3351 women aged between 20 and 59 years. At arrival, only 3.5% of new immigrants rated their general health as poor. Significant and steady increases in poor health were revealed during the following 4 years, especially among ethnic minorities and women. Specifically, we found a higher risk of poor health among West Asian and Chinese men and among South Asian and Chinese women than among their European counterparts. Newly arrived immigrants are extremely healthy, but the health advantage dissipates rapidly during the initial years of settlement in Canada. Women and minority ethnic groups may be more vulnerable to social changes and postmigration settlement.

Self-Rated Health Trajectories in the African American Health Cohort

BackgroundSelf-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans.Materials/MethodsData on 998 African American men and women aged 50–64 years old were taken from a probability-based community sample that was first assessed in 2000–2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later. Using an innovative approach for including decedents in the analysis, semi-parametric group-based mixture models were used to identify person-centered group trajectories of self-rated health over time. Multivariable multinomial logistic regression analysis was then used to differentiate the characteristics of AAH participants classified into the different group trajectories.ResultsFour self-rated health group trajectories were identified: persistently good health, good but declining health, persistently fair health, and fair but declining health. The main characteristics that differentiated the self-rated health trajectory groups from each other were age, education, smoking, morbidity (angina, congestive heart failure, diabetes, and kidney disease), having been hospitalized in the year prior to baseline, depressive symptoms, mobility limitations, and initial self-rated health.ConclusionsThis is the first study to examine self-rated health trajectories separately among African Americans. Four qualitatively distinct self-rated health group trajectories were identified that call into question the accuracy of prior reports that a single, average self-rated health trajectory for African Americans adequately captures their within-group heterogeneity.

Five‐Factor Personality Traits and Age Trajectories of Self‐Rated Health: The Role of Question Framing

We examined the influence of personality traits on mean levels and age trends in 4 single-item measures of self-rated health: general rating, comparison to age peers, comparison to past health, and expectations for future health. Community-dwelling participants (N = 1,683) completed 7,474 self-rated health assessments over a period of up to 19 years. In hierarchical linear modeling analyses, age-associated declines differed across the 4 health items. Across age groups, high Neuroticism and low Conscientiousness, low Extraversion, and low Openness were associated with worse health ratings, with notable differences across the 4 health items. Furthermore, high Neuroticism predicted steeper declines in health ratings involving temporal comparisons. We consider theoretical implications regarding the mechanisms behind associations among personality traits and self-rated health.

Testing Healthy Immigrant Effects Among Late Life Immigrants in the United States

Objectives: This study tested a healthy immigrant effect (HIE) and postimmigration health status changes among late life immigrants. Methods: Using three waves of the Second Longitudinal Study of Aging (1994-2000) and the linked mortality file through 2006, this study compared (a) chronic health conditions, (b) longitudinal trajectories of self-rated health, (c) longitudinal trajectories of functional impairments, and (d) mortality between three groups (age 70+): (i) late life immigrants with less than 15 years in the United States ( n = 133), (ii) longer term immigrants ( n = 672), and (iii) U.S.-born individuals ( n = 8,642). Logistic and Poisson regression, hierarchical generalized linear modeling, and survival analyses were conducted. Results: Late life immigrants were less likely to suffer from cancer, had lower numbers of chronic conditions at baseline, and displayed lower hazards of mortality during the 12-year follow-up. However, their self-rated health and functional status were worse than those of their counterparts over time. Conclusion: A HIE was only partially supported among older adults.

Factors affecting trajectory patterns of self-rated health (SRH) in an older population—A community-based longitudinal study

Self-rated health (SRH) is considered a relevant and important predictor for major health outcomes in the older population. SRH status may interact with certain factors and change over a person's lifetime. In this study, we sought to characterize profiles of older people over time by constructing prototypical trajectories of the variable of interest, namely SRH. The underlying assumption was that the collection of observed individual trajectories could be efficiently summarized by a smaller set of latent clusters of those trajectories. Data was obtained from the Longitudinal Survey of Health and Living Status of the Elderly in Taiwan, which was conducted between 1989 and 2003 and included five separate waves of survey. A total of 3937 subjects aged 60 or older (2251 males and 1686 females) comprised the major analytic cohort. Latent Class Growth Analysis (LCGA) was used to identify developmental classes of trajectory patterns in SRH. The results showed that during a 14-year period, SRH developed five major longitudinal trajectories. Less than one-third of the older population was able to maintain their formerly good or moderate health status; when change occurred, decline was more likely than improvement. In addition, LCGA indicated that many demographic characteristics, as well as physical and psychological propensities, were associated with poor SRH in the older population. Specifically, these factors played a role in involving baseline SRH level and its trend toward deterioration in later life. Health care professionals must understand the various longitudinal patterns and factors affecting SRH trajectories if they are to develop programs aimed at maintaining the older population's health and well-being.

Socioeconomic status and the trajectory of self-rated health

self-rated health (SRH) likely reflects both mental and physical health domains, and is assessed by asking individuals to describe their health status. Poor SRH is associated with disease incidence and subsequent mortality. Changes in SRH across time in persons with different incident diseases are uncharacterised. SRH was assessed in the Atherosclerosis Risk in Communities study via annual telephone interviews over a median of 17.6 years. Individual quadratic growth models were used for repeated measures of SRH in persons who remained disease-free during follow-up (n = 11,188), as well as among those who were diagnosed with myocardial infarction (MI; n = 1,071), stroke (n = 809), heart failure (HF; n = 1,592) or lung cancer (n = 433) and those who underwent a cardiac revascularisation procedure (n = 1,340) during follow-up. among disease-free participants and across time, there was a trend for lowest mean SRH among persons living in low socioeconomic areas and highest mean SRH among persons living in high socioeconomic areas. Factors contributing to the decline in SRH over time included advanced age, lower educational attainment, smoking and obesity. addressing factors related to poor SRH trajectories among patients pre- and post-incident disease may favourably affect health outcomes among patients regardless of type of disease.

Socioeconomic status and the trajectory of self-rated health

Socioeconomic status and the trajectory of self-rated health

Health Trajectories Among Older Movers

To examine health trajectories among older migrants by reason for move. Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves. There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups. The results are consistent with the predictions of Litwak and Longino's (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

Body Weight and Health from Early to Mid-Adulthood

We analyze the influence of body weight in early adulthood, and changes in weight over time, on self-rated health as people age into middle adulthood. While prior research has focused on cross-sectional samples of older adults, we use longitudinal data from the NHANES I Epidemiologic Follow-up Study and double-trajectory latent growth models to study the association between body mass index (BMI) and self-rated health trajectories over 20 years. Results indicate that high BMI in early adulthood and gaining more weight over time are both associated with a faster decline in health ratings. Among white women only, those with a higher BMI at the baseline also report lower initial self-rated health. A small part of the weight-health association is due to sociodemographic factors, but not baseline health behaviors or medical conditions. The findings provide new support for the cumulative disadvantage perspective, documenting the increasing health inequalities in a cohort of young adults.

Social influences on trajectories of self-rated health: evidence from Britain, Germany, Denmark and the USA

BackgroundThis study investigates social inequalities in self-rated health dynamics for working-aged adults in four nations, representing distinct welfare regime types. The aims are to describe average national trajectories of self-rated...

Self-rated health before and after retirement in France (GAZEL): a cohort study

Governments need to increase the proportion of the population in work in most developed countries because of ageing populations. We investigated longitudinally how self-perceived health is affected by work and retirement in older workers. We examined trajectories of self-rated health in 14 714 employees (11 581 [79%] men) from the French national gas and electricity company, the GAZEL cohort, for up to 7 years before and 7 years after retirement, with yearly measurements from 1989 to 2007. We analysed data by use of repeated-measures logistic regression with generalised estimating equations. Overall, suboptimum health increased with age. However, between the year before retirement and the year after, the estimated prevalence of suboptimum health fell from 19.2% (95% CI 18.5-19.9) to 14.3% (13.7-14.9), corresponding to a gain in health of 8-10 years. We noted this retirement-related improvement in men (odds ratio 0.68, 95% CI 0.64-0.73) and women (0.74, 0.67-0.83), and across occupational grades (low 0.72, 0.63-0.82; high 0.70, 0.63-0.77), and it was maintained throughout the 7 years after retirement. A poor work environment and health complaints before retirement were associated with a steeper yearly increase in the prevalence of suboptimum health while still in work, and a greater retirement-related improvement; however, people with a combination of high occupational grade, low demands, and high satisfaction at work showed no such retirement-related improvement. These findings suggest that the burden of ill-health, in terms of perceived health problems, is substantially relieved by retirement for all groups of workers apart from those with ideal working conditions, and that working life for older workers needs to be redesigned to achieve higher labour-market participation. Swedish Council for Working Life and Social Research, Academy of Finland, INSERM (France), BUPA Foundation (UK), European Science Foundation, and Economic and Social Research Council (UK).