Self-rated Health Trajectories Research Articles

Self-Rated Health among Older Adults: Longitudinal Analyses Examining Sex Differences across Different Birth Cohorts and Educational Levels

Introduction: Given the known female disadvantage in physical and mental health, this study aimed to investigate sex differences in self-rated health (SRH) among older adults, considering the longitudinal course by age, birth cohort, and educational level. Methods: Data from birth cohort 1911–1937 with baseline age 55–81 years (n = 3,107) and birth cohort 1938–1947 with baseline age 55–65 years (n = 1,002) from the Longitudinal Aging Study Amsterdam (LASA) were used. Mixed model analyses were used to examine sex differences in SRH (RAND General Health Perception Questionnaire [RAND-GHPQ], range 0–16) over the age course, testing for effect modification by the birth cohort and educational level (low, middle, high). Results: For both sexes, a decline in SRH was seen with increasing age. Over the age course, there was no significant sex difference in SRH within the older (1911–1937) birth cohort (0.13 lower score on SRH for women compared to men, 95% CI: −0.35 to 0.09) and only a small sex difference in the more recent (1938–1947) birth cohort (0.35 lower score on SRH for women compared to men [95% CI: −0.69 to −0.02], p = 0.04). There was no significant cohort difference in the size of the sex difference (p = 0.279). Those with a higher level of education reported a higher SRH, but between educational levels, there was no significant difference in the size of the sex difference in SRH. Discussion: In this study, no relevant sex difference in SRH over the age course was observed among older adults. Future research on SRH trajectories by sex during aging should take health-related, cognitive, psychosocial, and behavioral factors into account.

A National Longitudinal Study of Same-Sex Partnership and Self-Rated Health Trajectories

We know little about population-based patterns on same-sex partnership and health from a longitudinal perspective, largely due to data limitations. In this study, we analyzed nationally representative longitudinal data to compare changes in self-rated health trajectories for individuals in same-sex cohabitation, different-sex marriage, and different-sex cohabitation. Data were drawn from the 1996, 2001, 2004, and 2008 panels of the Survey of Income and Program Participation, with each panel including 2–4 years of follow-up information on self-rated health. The analytic sample included 103,995 respondents who contributed 294,944 person-period records. Results from growth curve models suggest that same-sex cohabitors experienced a slower rate of decline in self-rated health over time than both different-sex married and different-sex cohabiting respondents. Further analyses show that same-sex cohabitation is associated with a slower rate of health decline only for women but not for men. We discuss the implications of these findings in relation to the minority stress theory and the gender-as-relational perspective.

Abstract MP35: Long-Term Trajectories of Self-Rated Health Are Similar Following Incident Diabetic Foot Disease and Acute Myocardial Infarction Among Adults With Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Incident diabetic foot disease is associated with significant morbidity and mortality. However, data are lacking on long-term patient-reported outcomes. We aimed to evaluate trajectories of self-rated health among adults with diabetes before and after incident foot disease compared to incident acute myocardial infarction (MI), another major diabetes complication. Methods: We conducted a longitudinal analysis of participants in the ARIC Study with diabetes and incident diabetic foot disease (N=749 hospitalizations, N=73 outpatient encounters) or incident MI (N=703). Diagnosis and procedure codes from active hospitalization surveillance and Medicare claims were used to identify events; only MI events were adjudicated. Self-rated health was collected during annual telephone calls and rated from 1 (poor) to 4 (excellent); a score of 0 was assigned to deaths. We used linear regression to examine changes in self-rated health from 1 year pre-event (baseline). Relative effects of index event type over time were estimated by repeated-measures ANOVA. Results: Self-rated health was similar between groups at baseline ( Figure ). Participants with MI had sharper declines from baseline at 1 year post-event than those with diabetic foot disease (-0.93 vs -0.50 points, P<0.01), largely due to higher mortality (29.4% after MI vs 15.9% after diabetic foot disease). Self-rated health stabilized in the outpatient diabetic foot group after 2 years post-event, whereas it continued to decline over 10 years following both MI and inpatient diabetic foot disease ( Figure ). Conclusions: Our findings suggest outpatient diabetic foot disease is primarily associated with a short-term drop in self-rated health, but inpatient diabetic foot disease is associated with long-term declines in self-rated health similar to those experienced after MI. These results reinforce the importance of early diagnosis and treatment of foot disease and of including patient-reported outcomes to measure sequelae of diabetes complications.

Abstract P166: Social Isolation and Social Support Are Associated With Self-Rated Health and Heart Failure Outcomes in the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Social isolation (SI) and social support (SS) are associated with incidence of heart failure (HF). Few studies investigate how SI, SS, and subtypes of SS (appraisal, belonging, self-esteem, and tangible) measured before HF are related to morbidity and mortality after HF. Objective: Assess whether SI, SS, and subtypes of SS are associated with self-rated health trajectories and HF outcomes among participants with incident HF hospitalizations, and if results differ by sex or race. Methods: We included 2967 ARIC participants (51% female, 27% Black, mean age 59 (SD 6) years) with incident HF hospitalization after Visit 2 (1990-1992). We identified incident HF hospitalization as ICD-9 code 428 in any position and physician adjudicated events; on average HF occurred 17 (SD 8) years after Visit 2. We measured predefined SI categories and tertiles of SS at Visit 2 using the 10-item Lubben Social Network Scale and the 16-item Interpersonal Support Evaluation List, which were assessed as separate exposures. We assessed associations with trajectories of annually measured self-rated health in the 4 years prior to and after incident HF hospitalization, measured by the probability of being in excellent/good self-rated health (0-100% scale), using linear mixed effects models. We calculated hazard ratios (HR) and 95% confidence intervals (CIs) for associations with time to first all-cause rehospitalization and all-cause mortality using Cox proportional hazard models. Models were adjusted for age, sex, race-center, employment status, years of education, prior use of mental health medications, and time between Visit 2 and HF. Results: Over mean follow-up of 5 (SD 5) years after initial HF hospitalization, 90% of participants experienced rehospitalization and there were 2378 deaths. Low overall SS had a 5.8% (95% CI 7.8%, 3.8%) lower probability of excellent/good self-rated health over time than high SS; associations of subtypes of SS with this outcome were similar. Low belonging SS was associated with greater days to first rehospitalization (HR 0.85; 95% CI 0.79, 0.96) compared to the highest tertile, however belonging SS was not associated with mortality (HR 1.05; 95% CI 0.95, 1.17). Low tangible SS was associated with greater mortality among White (HR 1.14; 95% CI 1.01, 1.28) but not Black participants (HR 0.95; 95% CI 0.78, 1.16), compared to the highest tertile. Being socially isolated/high risk for SI was associated with greater hazard of all-cause mortality among females (HR 1.57; 95% CI 1.20, 2.06) but not males (HR 0.95; 95% CI 0.75, 1.19), compared to low SI. Conclusions: SI and SS measured before HF were relevant to HF outcomes, but relevance may vary by sex and race. In particular, greater SI was only associated with greater mortality among females, and lower tangible SS with greater mortality among White participants only. Belonging support was associated with some HF outcomes but not others.

A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes

Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants’ age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children’s educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth.

Are trajectories of self-rated health and physical working capacity during the retirement transition predicted by work-related factors and social class?

Abstract We aimed to identify short and long-term trajectories of self-rated health (SRH) and physical working capacity during the retirement transition, and investigate whether work-related factors and social class predict belonging to these trajectories. We used the representative, biennial Swedish Longitudinal Occupational Survey of Health (SLOSH) 2006–2018. We applied group-based trajectory modeling with B-spline smoothers to model trajectories of SRH (n = 2,183) and physical working capacity (n = 2,152) during the retirement transition. Multinomial logistic regression analyses were conducted to investigate trajectory belonging by work-related factors and social class. There was a small “honeymoon effect” in SRH for the total sample. We found four trajectories of SRH and five of physical working capacity. The large majority sustained excellent or good SRH and physical working capacity throughout the study period. Almost 6% had Fairly poor SRH and physical working capacity starting from years before retirement, which remained throughout the study period. High job demands, low job control, adverse physical working conditions, and being in manual occupation increased the likelihood of belonging to the trajectory groups Deteriorating or Fairly poor when compared with the Excellent trajectory group for both SRH and physical working capacity. Our findings suggest that for most people health status is already established some years’ preretirement and maintained for years after retirement, except a short improvement in SRH in accordance with a honeymoon effect. In order to improve health and employability, interventions focusing on working environment should be aimed at younger and midlife employees as well as older workers.

The work-family conflict and self-rated health trajectories among ELSA-Brasil workers: the modifier effect roll of education

The work-family conflict and self-rated health trajectories among ELSA-Brasil workers: the modifier effect roll of education

Trajectories of Self-Rated Health Among Industrially Disabled Individuals: A Latent Class Growth Analysis.

Understanding the self-rated health of industrially disabled individuals is an important variable that significantly affects their quality of life, satisfaction, and return to work after an industrial accident. Since the health of people with industrial disabilities is affected by various environments and variables, interventions and policies that are suitable for their characteristics are needed. This study aimed to identify changes in self-rated health among industrially disabled individuals, distinguish between different latent classes, and verify predictive factors for each latent class. Four time-point datasets from the 2018-2021 panel study of Korean workers' compensation insurance were used. Using the latent growth curve model, an overall trajectory of self-rated health of industrially disabled individuals was confirmed, and the number and characteristics of different trajectories were identified using the latent class growth model. Multinomial logistic regression analysis was used to identify the predictive factors for each class. Four classes of self-rated health trajectories were identified: low-decreasing (21.7%), moderate-increasing (15.7%), high-decreasing (56.1%), and low-stable (6.5%) classes. A multinomial logistic regression analysis revealed that significant determinants (age, capacity, type of industrial accident, grade of disability, mental activity, outdoor activity, and social relationships) were different for each latent class. Capacity level affected all potential class classifications. To improve the self-rated health of industrially disabled individuals, it is necessary to develop an appropriate strategy that considers the characteristics of the latent class.

Joint trajectories of physical activity, self-rated health and income in Finnish statutory retirees

Abstract Background Health behaviours, health and socioeconomic position, particularly income, are known to change during ageing. However, no previous study has examined how they develop together over statutory retirement transition. We aimed to examine this joint development and to identify determinants of distinct groups. Methods We examined former employees of the City of Helsinki, Finland, who retired statutorily 2000-2022 (n = 4384, 79% women). We used five repeated questionnaire surveys to examine the joint developmental patterns in key indicators of healthy ageing and wellbeing: self-rated health, leisure-time physical activity and household income. We used joint group-based trajectory analysis to identify latent developmental groups and average marginal effects to examine determinants of the trajectory group membership. Results We found four distinct groups describing the joint developmental patterns. Group 1 (23%) had consistently poor health, little physical activity, and low, although slightly increasing income levels. Group 2 (34%) had first good but then declining health, average physical activity, and low but slightly increasing income. Group 3 (13%) had good health and very high level of physical activity, but average and fluctuating income. Group 4 (30%) had first good but then declining health, stable rather low physical activity and sharply increasing and high income. People with obesity had 23% (95% CI 22-26) higher likelihood of belonging to the Group 1 as compared to people with normal weight. They were also more likely with low education. Conclusions Over a follow-up of more than 20 years, we identified distinct groups among statutory retirees regarding their development of physical activity, self-rated health and income. Public health interventions to improve well-being and narrow health inequalities during ageing need to consider this heterogeneity and target policies considering people with different developmental patterns in their well-being. Key messages • Changes in income did not develop jointly with changes in health. Most statutory retirees had relatively good health, despite the development in leisure-time physical activity and household income. • Decline in physical activity could reflect decreasing intensity. Social and health-related factors show associations with the trajectory memberships, reflecting the known inequalities in health.

Trajectories of self-rated health among community-dwelling individuals with depressive symptoms: A latent class growth analysis

BackgroundThis study identified differences between individuals with and without depression regarding demographic and socioeconomic variables, health behavior, health status, health care utilization, and self-rated health (SRH) to identify the depressed group's SRH trajectories. MethodsData of individuals with (n = 589) and without (n = 6856) depression aged ≥20 from the 2013–2017 Korean Health Panel were analyzed. A chi-square test and t-tests examined differences in demographic and socioeconomic variables, health behaviors, health status, health care utilization, and the mean of SRH. Latent Growth Curve and Latent Class Growth Modeling identified SRH development trajectories and the most suitable latent classes explaining the trajectories, respectively. Multinomial logistic regression determined the predicting factors that classified latent classes. ResultsThe depressed group had a lower mean SRH than the non-depressed group among most variables. Three latent classes were identified, each showing different SRH trajectories. Body-mass index and pain/discomfort were predicting factors for the “poor” classes compared with the “moderate-stable” class; older age, less national health insurance, less physical activity, more pain/discomfort, and more hospitalization were predictors for the “poor-stable” class. The depressed group's mean SRH was “poor.” LimitationsLatent Class Growth Modeling in individuals with depression was based on experimental data; however, it needed to review other sample data to identify similar types of latent classes to those suggested in the current study. ConclusionsPredictors of the “poor-stable” class that were identified in this study can contribute to the formulation of intervention plans for the health and welfare of individuals with depression.

The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994–2020

BackgroundBased on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality.MethodsThis is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows follow-up of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60–99 (53% women). Primary outcome measures: Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020. Predictor: Average weekly alcohol consumption (non-drinker, < 100 g/week, ≥100 g/week). We fitted two-level logistic random effects models to examine how alcohol consumption was related to SRH, and Cox proportional hazards models to examine its relation to all-cause mortality. Both models were stratified by sex and adjusted for sociodemographic factors, pathology, biometrics, smoking and physical activity. In addition, all the confounders were examined for whether they moderate the relationship between alcohol and the health-related outcomes through interaction analyses.ResultsWe found that women who consumed ≥100 g/week had better SRH than those who consumed < 100 g/week; OR 1.85 (1.46–2.34). This pattern was not found in men OR 1.18 (0.99–1.42). We identified an equal mortality risk in both women and men who exceeded 100 g/week compared with those who consumed less than 100 g/week; HR 0.95 (0.73–1.22) and HR 0.89 (0.77–1.03), respectively.ConclusionsThere was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100 g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specific risk factors in combination with the highest level of alcohol consumption led to adverse effects on self-rated health. In men it was the use of sleeping pills or tranquilisers and ≥ 20 years of smoking, in women it was physical illness and older age.

The impact of the school-to-work transition on self-rated health &amp; subjective well-being in Germany

Abstract Background During the school-to-work transition (STWT), young people enter different states as vocational training, university or unemployment that may have immediate or long-term effects on health. Since research has not paid much attention to this, we investigate the development of self-rated health (SRH) and subjective well-being (SWB) during the STWT. Methods We used data from Starting Cohort 4 of the German National Educational Panel Study (NEPS), a nationally representative cohort of 11,098 ninth graders (50.5% girls) followed over nine years. Linear panel regression analysis with fixed-effects (FE) was used to explore intra-individual changes in SRH and SWB when moving between different STWT states (school, prevocational program, vocational training, university, employment, unemployment, inactivity). FE impact functions were used to compare trajectories of SRH and SWB by states reached after school-leave. Time-varying control variables were age, household composition, and residential area. Results School-leave was linked to increases in SRH and SWB, whereas no impact was found for job entry after vocational training or university. Upward transitions (e.g. from a prevocational program to vocational training, from vocational training to university or from unemployment to employment) increased SRH or SWB, while downward transitions (e.g. from vocational training or employment to unemployment) were related to decreases. Over the years after school-leave, we found a decline in SRH and SWB, which was faster in case of transitions to unemployment or prevocational programs directly after school. Conclusions Findings suggest that a smooth STWT is key for good health in youth and adulthood. Health and labour market intervention programs should focus on the time after school-leave, especially on those who are not able to find an academic or vocational training position.

Concurrent trajectories of self-rated health and working hour patterns in health care shift workers: A longitudinal analysis with 8-year follow-up.

BackgroundThe association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working <35 h/week and working night shifts) and the extent to which these trajectories were predicted by employees' lifestyle and mental health.MethodsParticipants of this cohort study with a 8-year follow-up were 5,947 health care shift workers. We linked self-reports of health from three repeated surveys with objective pay-roll based data on working hours. Using group-based multi-trajectory analysis we identified concurrent trajectories for self-rated health and working hour patterns. We examined their associations with baseline lifestyle-related factors (smoking, at-risk alcohol use, obesity, and physical inactivity) and mental health (sleep problems and psychological distress) using multinomial regression analysis.ResultsThree combined trajectories of self-rated health and working <35 h/week and four combined trajectories of self-rated health and night work were identified. Unhealthy lifestyle and poor mental health were associated with trajectories of moderate and declining health. Sleep problems were linked with working <35 h/week. Younger age and good mental health were associated with a combined trajectory of good health and continued night shift work.ConclusionTrajectories of suboptimal and declining health are associated with trajectories of reducing working hours and leaving night work, and are more common in employees with unhealthy lifestyle, sleep problems, and psychological distress.

Health and labor force participation among older workers in Switzerland: a growth curve analysis

This study investigated how individual trajectories of self-rated health (SRH) and working hours among older workers in Switzerland are interrelated and how this relationship varies based on occupation. We used data from the Swiss Household Panel to analyze the long-term trajectories of older workers measured in terms of working hours and SRH. The sample included more than 4000 workers aged 50 to 65(men)/64(women). We ran a bivariate response multilevel model for growth that allowed the examination of between- and within-individual changes over time. On a between-individual level, we found that the upper non-manual workers were the most heterogeneous occupational group in terms of working hours and the lower non-manual workers were the most heterogeneous occupational group in terms of health. Within all occupational groups, we found a significant relationship between the level of working hours and level of SRH. The individual-level statistics showed consistently strongest effects for manual workers. This result confirms our hypothesis that labor force participation in individuals of the manual occupational group is more sensitive to their health status. Our findings contribute to the debate regarding the importance of older workers’ health in the context of the extension of working life.

Trajectory of aging following diagnosis of cancer.

12087 Background: Aging is a nebulous concept with several definitions, but they all generally include physical and cognitive decline in function as a key component. We hypothesized that following cancer diagnosis, patients decline in physical and cognitive function would correspond with accelerated and/or accentuated aging trajectories. The magnitude of the functional changes could inform strategies to minimize impact of cancer diagnosis on trajectory of aging. Methods: We analyzed 32,935 participants &gt;50 years enrolled between 1995-2018 in the Health and Retirement Study (HRS), a population-based, biennial longitudinal health interview survey of older adults in the United States. We assessed the changes in physical and cognitive function among cancer patients controlling for their pre-cancer trajectories and comparing it with aged population with no cancer diagnosis as control. The primary outcomes were change in physical function (Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL): range 0–11) and global cognitive function (Telephone Interview for Cognitive Status (TICS): range 0–27). The secondary outcome was change in self-rated health (SRH: range 1-5). We estimated the effect of acute change based on the immediate post-cancer outcome measurements compared to the trajectories before cancer; and the long-term effect as the per-year change in outcome decline post cancer compared to aging of cancer-free respondents adjusting covariates by linear mixed models. Results: 5,101 developed incident cancer: 1,514 in the 50-64 age group, 1,901 in the 65-74 age group, and 1,686 in the 75+ age group. 27,834 participants were cancer-free throughout. Cancer was associated with acute declines in physical function (0.06 [0.01– 0.10] and 0.25 [0.14– 0.36] points), cognitive function (0.22 [0.04–0.39] and 0.24 [0.01– 0.46] points), and SRH (0.19 [0.14–0.23] and 0.22 [0.12–0.33] points) for age of onset groups 50- and 75+ respectively. Moreover, participants with cancer demonstrated accelerated decline in physical function (0.02 [0.01–0.03], and 0.06 [0.05–0.07] points per year faster for 50-74 and 75+ age-of-onset groups respectively) compared to cancer-free participants, but not in cognitive and SRH. Lung, colorectal &amp; breast cancer were associated with the highest acute and accelerated decline in functions, while prostate cancer was associated with moderate and insignificant decline. Conclusions: Using 24 years of nationally representative longitudinal data, this study provides, for the first time, evidence for the heterogeneous aging trajectories of cancer patients across varying age-of-onset and cancer types. Our results supported an accelerated aging trajectory of physical function with increased acceleration with increasing age-of-onset compared to the non-cancer population. It also provides evidence for accentuated aging trajectories of cognitive function and self-rated health.

Do changes in income and social networks influence self-rated oral health trajectories among civil servants in Brazil? Evidence from the longitudinal Pr\xf3-Sa\xfade study

BackgroundSocial factors are important determinants of health. However, evidence from longitudinal studies on the possible role of changes in socioeconomic circumstances on adult’s oral health is scarce. This study aimed to test whether changes in income and changes in social networks of family members and friends were associated with trajectories of self-rated oral health (SROH) among adults over a 13-year period.MethodsA prospective cohort study (Pro-Saude Study) was conducted involving non-faculty civil servants at university campi in Rio de Janeiro, Brazil. Individual data was collected through self-completed questionnaires in four waves (1999, 2001, 2007 and 2012). SROH trajectories between 2001 and 2012 were “Good-stable SROH”, “Changed SROH”, “Poor-stable SROH”. Per capita family income and social networks of family members and friends data obtained in 1999 and 2012 were grouped into “High stable”, “Increase”, “Decrease”, “Low stable”. Ordinal logistic regression using complete data of 2118 participants was used to estimate odds ratio (OR) and 95% CIs of changes in income and changes in social networks with SROH trajectories, adjusted for age, sex, skin colour and marital status.ResultsParticipants in the low income-stable and small social networks-stable groups showed 2.44 (95% CI 1.68–3.55) and 1.98 (95% CI 1.38–2.85) higher odds for worst trajectory of SRHO than those in the respective high-stable groups. Those in the decrease income group and decrease social networks group were 78% (95% CI 1.25–2.54) and 58% (95% CI 1.07–2.34) more likely to worst trajectory of SRHO than those in the high income-stable and high social networks-stable groups.ConclusionsAdults reporting low income and low social networks of family members and friends over 13 years and those with income and social networks decrease during the study period were at higher risk of having worsened their self-rated oral health.

Are there gender differences in the trajectories of self-rated health among chinese older adults? an analysis of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BackgroundSelf-rated health (SRH) is a good predictor of morbidity and mortality. Extensive research has shown that females generally report poorer SRH than males but still tend to live longer. Previous studies used cross-sectional or pooled data for their analyses while ignoring the dynamic changes in males’ and females’ SRH statuses over time. Furthermore, longitudinal studies, especially those that focus on older adults, typically suffer from the incompleteness of data. As such, the effect of dropout data on the trajectories of SRH is still unknown. Our objective is to examine whether there are any gender differences in the trajectories of SRH statuses in Chinese older adults.MethodsThe trajectories of SRH were estimated using the pattern-mixture model (PMM), a special latent growth model, under non-ignorable dropout data assumption. We analyzed the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data of 15,613 older adults aged 65 years and above, collected from 2005 to 2014.ResultsThe results demonstrated the effect of non-ignorable dropout data assumptions in this study. The previous SRH score was negatively associated with the likelihood of dropping out of the study at the next follow-up survey. Our results showed that both males and females in China perceive their SRH as decreasing over time. A significant gender difference was found in the average SRH score (female SRH was lower than male SRH) in this study. Nonetheless, based on the results obtained using the PMM, there are no gender differences in the trajectories of SRH at baseline as well as in the rate of decline among the total sample. The results also show that males and females respond to SRH predictors similarly, except that current drinking has a more pronounced positive effect on males and healthcare accessibility has a more pronounced positive effect on females.ConclusionsOur results suggest that missing data have an impact on the trajectory of SRH among Chinese older adults. Under the non-ignorable dropout data assumptions, no gender differences were found in trajectories of SRH among Chinese older adults. Males and females respond to SRH predictors similarly, except for current drinking habit and healthcare accessibility.

Age differences in trajectories of self-rated health of young people with Multiple Sclerosis

BackgroundRecent evidence has suggested an existence of a multiple sclerosis (MS) prodrome. Hence, some young adults with MS are very likely to have had symptoms in childhood or adolescence. It is, therefore, reasonable to assume that people aged under 25 years with MS might have had pediatric-onset. In contrast, young people aged between 26 and 35 are less likely to have had pediatric-onset. Contrasting these two groups of people could lead to valuable information about the impact of MS over time. The purpose of this study is to characterize how self-rated health (SRH) in young people with MS changed over time and to estimate the extent to which SRH differs between age groups (18 to 25 years and 26 to 35 years) and sex. MethodsThis study utilized placebo arm data from the Multiple Sclerosis Outcome Assessment Consortium database. Responses to the RAND-36 SRH item of 393 participants were included. Group-based trajectory models (GBTM) were used to identify patterns of change over two years. Ordinal regression was performed to estimate whether these trajectory groups differed by age group, sex, and relapse event. ResultsResults of GBTM showed that all groups were stable over time except one progressing from a rating of “very good” to “excellent”. Posterior probabilities showed that 35% of people consistently rated their health “very good or excellent” and 2% consistently rated their health as “poor”. Health perceptions differed across age groups (β = 0.5, OR: 1.7 CI: 1.1, 2.6) but not sex (β = -0.1, OR: 0.9 CI: 0.6 1.3). Compared to the younger group, people aged 26 to 35 years are 1.7 times more likely to rate their health poorer. People with relapses are also 2.2 times more likely to rate their health poorer (β = 0.8, OR: 2.2 CI: 1.5, 3.2). ConclusionTrajectories of SRH of young people with MS were relatively stable. In the absence of drug treatment, people in the younger group (<25 years) rated their health better than those in a slightly older group which is consistent with lower disability.

Self-rated health trajectories: A dynamic time warp analysis

Self-rated health (SRH), individuals’ overall perception of their health, is a key predictor of health events. To target disease prevention efforts, it is important to understand how SRH develops over time. The goal of this short communication is to find prototypic SRH trajectories by applying dynamic time warping, a time series comparison technique initially developed for speech recognition. Revealing prototypic SRH trajectories can help direct disease prevention efforts towards trajectories that are more likely to result in adverse health events. Based on data from a Dutch representative sample of 2,154 individuals, our dynamic time warp analysis suggests that Dutch individuals do not typically show a steady growth or decline in SRH. Instead, we identified four relatively stable SRH trajectories that differed in average SRH. One of these trajectories is a path of consistent low SRH.

Self-rated health trajectory and frailty among community-dwelling older adults: evidence from the Taiwan Longitudinal Study on Aging (TLSA)

ObjectivesSelf-rated health (SRH) is an assessment and predictor of health based on an individual’s general condition; however, evidence of the value of SRH for predicting frailty remains scarce for older...