Variance In Self-rated Health Research Articles

IMPACT OF ENVIRONMENTAL CHARACTERISTICS ON SELF-RATED HEALTH AMONG THE VERY OLD IN GERMANY DURING THE COVID-19 PANDEMIC

Abstract Current research demonstrates negative impact of COVID-19 pandemic on health. Nevertheless, there is evidence that older population might be more resilient against the effect of pandemic than younger adults. Since very old adults are often underrepresented or excluded from these studies, the aim of this paper was to examine the link between environmental characteristics and self-reported health in very old population in Germany during COVID-19 pandemic. Data from the representative survey “Old Age in Germany” of the population aged 80 and older were used. The study sample included 10,578 community-dwelling as well as institutionalized persons. Multilevel analysis was conducted to investigate the association of environment characteristics on individual, and community level with self-rated health. The results showed that higher perceived walkability of outdoor environment, better housing condition, being closer attached to home environment, higher neighborhood trust, and living in a house increased self-rated health (individual level). On community level, residency in one of the communities in western Germany (compared to eastern Germany) was associated with better self-rated health. 35% of the variance in self-rated health was explained at individual and 21% at community level. The findings revealed that very old adults who lived in better home environment experienced better health during the COVID-19 pandemic in Germany. These findings may indicate that the capacity of the very old to adapt to health losses depends on available environmental resources. Therefore, improvements of home environment inside and outside of houses and apartments (e.g., ensuring barrier-free accessibility) may strengthen the resilience in later life.

Time to look at self-rated health: Do time attitudes scores explain variance in self-rated health beyond health indicators?

Time attitudes refer to the way in which individuals feel about the past, present, and future and are associated with a range of health outcomes. In the present study, we examined the relationship between time attitudes and self-rated health, adjusted for a range of health indicators, sex, and a proxy for socio-economic status. Participants were school children (N = 3447; 58.8 % female) in the United Kingdom. Time attitudes scores were used to yield clusters, which were entered as factors in Multinomial Logistic Regression models, along with sex and free school meal entitlement (yes/no). Self-rated health was the dependent variable, and other health indicators were entered as covariates. Results showed that most health measures were significantly related to self-rated health. Higher self-rated health was also significantly associated with being male and having higher socio-economic status. Time attitudes clusters explained variance in self-rated health beyond that explained by health-related variables. The results add to a growing literature on a relationship between time attitudes and health outcomes. Based on existing work, it is suggested that interventions focused on time attitudes might be a viable way of promoting health behaviours. However, investigating this claim will require future longitudinal, behaviour change studies.

Associations between area- and individual-level community belonging and self-rated health

Abstract Background Previous studies point to the importance of individuals’ sense of community belonging to multiple measures of health and well-being. However, the extent to which collective sense of belonging within neighbourhoods might influence individual health has not been characterized. The objectives of this study are to describe variations in self-rated health by a novel area-level measure of community belonging and determine the impact of including these measures in models of individual-level community belonging and self-rated health. Methods We conducted a cross-sectional study of respondents of the 2020 Canadian Community Health Survey (CCHS) living in census tracts. These data were merged with novel small area estimates of community belonging derived by Statistics Canada from the CCHS 2016-2019. Multinomial logistic regression models were used to analyse associations of individual- and area-level community belonging, and self-rated health. We adjusted for sex, age, recent immigrant status, visible minority status, province, marital status, presence of children in the household, smoking status, presence of chronic conditions, income, and employment status. All results were generated using survey weights and bootstraps representing a subpopulation of 21 million people. Results A greater proportion of CCHS respondents living in neighbourhoods with the strongest collective sense of community belonging reported being in good, very good, or excellent health. Models indicate that living in a neighbourhood with low collective sense of community belonging is associated with higher odds of reporting being in poor or fair health (OR = 1.44, 95% CI 1.15-1.81) even after adjusting for other factors, including individual-level sense of community belonging, which also remained independently associated with self-rated health. Conclusions Both area- and individual-level sense of community belonging are independently associated with self-rated health. Key messages • The collective sense of belonging within neighbourhoods may influence health outcomes. • Measures of area-level and individual-level community belonging may capture different aspects of social connections with respect to health.

Social capital and health outcomes among older adults in India: a multilevel analysis

PurposeThe social capital theory is increasingly being looked at as a valuable paradigm to understand if community socioeconomic factors influence health behaviours and outcomes. This requires an understanding of the forms in which social capital manifests and the levels at which it operates.Design/methodology/approachThus, the purpose of this paper is to study if social capital is associated with health outcomes among older adults in India and providing an estimate of the extent to which the neighbourhood differences in health outcomes among the older adults can be attributed to social capital.FindingsThe authors find several forms of social capital to be associated with health outcomes among older adults. The results show that community-level social capital variables collectively explain 12.81% unexplained neighbourhood variation in self-rated health, 2.5% variation in psychological well-being and 11.32% variation in the ability to perform activities of daily living, respectively.Originality/valueThe findings highlight the role social capital plays in serving as a coping mechanism for older adults to survive deteriorating health and social exclusion and call for conscious investment in building social capital.

Like ripples on a pond: The long-term consequences of parental separation and conflicts in childhood on adult children's self-rated health

ObjectiveThe aim of the study was to explore how different forms of conflict in childhood and parental separation additively and interactively predict self-rated health (SRH) in adulthood. Furthermore, a subsample analysis investigated how different family conflicts predict SRH in adulthood within the group of separated families, controlling for post-separation circumstances. BackgroundPrevious research shows that adult children from separated families have worse health compared to peers from intact families. Additionally, inter-parental conflicts are closely associated with parental separation and known to negatively influence children's health. Few studies have taken a broader perspective on conflicts and included conflicts beyond the inter-parental subsystem, such as within other family subsystems, into their analysis. MethodsData were based on Swedish Level of Living Survey (LNU). Using linear probability modelling the first analysis shows that SRH in adulthood varies depending on family type and the occurrence of conflict in childhood (n = 6,638). The study then explored variations in SRH within separated families (n = 934). ResultsThe results show that adult children from separated families and families with different types of conflicts have worse SRH compared to their peers in intact families and families with no conflicts. ConclusionParental separation has long-term consequences on children's SRH and this relationship is partly predicted by parent-child conflicts. ImplicationsThe results underline the importance of considering children's involvement when studying the separation process and its outcomes. They also suggest that interventions to help parents and children through a separation would benefit from a focus, not only on inter-parental conflicts but also, on parent-child conflicts, as well as parents' role modelling to prevent children from experiencing negative long-term health outcomes.

Assessment of self-rated health: The relative importance of physiological, mental, and socioeconomic factors.

The general self-rated health (SRH) question is the most common health measure employed in large population surveys. This study contributes to research on the concurrent validity of SRH using representative data with biomarkers from the Czech Republic, a population not previously used to assess the SRH measure. This work determines the relative contribution of biomedical and social characteristics to an individual's SRH assessment. Studies have already explored the associations between SRH and markers of physical health. However, according to a PubMed systematic literature search, the issue of the relative importance of physiological and psychosocial factors that affect individuals' assessments of their SRH has generally been neglected. Using data from a specialized epidemiological survey of the Czech population (N = 1021), this study adopted ordinary least squares regression to analyze the extent to which variance in SRH is explained by biomedical measures, mental health, health behavior, and socioeconomic characteristics. This analysis showed that SRH variance can be largely attributed to biomedical and psychological measures. Socioeconomic characteristics (i.e. marital status, education, economic activity, and household income) contributed to around 5% of the total variance. After controlling for age, sex, location, and socioeconomic status, biomarkers (i.e. C-reactive protein, blood glucose, triglyceride, low-density lipoprotein, and high-density lipoprotein), number of medical conditions, and current medications explained 11% of the total SRH variance. Mental health indicators contributed to an additional 9% of the variance. Body mass index and health behaviors (i.e. smoking and alcohol consumption) explained less than 2% of the variance. The results suggested that SRH was a valid measure of physiological and mental health in the Czech sample, and the observed differences were likely to have reflected inequalities in bodily and mental functions between social groups.

Financial strain moderates genetic influences on self-rated health: support for diathesis–stress model of gene–environment interplay

ABSTRACT Data from the Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium were used to examine predictions of different models of gene-by-environment interaction to understand how genetic variance in self-rated health (SRH) varies at different levels of financial strain. A total of 11,359 individuals from 10 twin studies in Australia, Sweden, and the United States contributed relevant data, including 2,074 monozygotic and 2,623 dizygotic twin pairs. Age ranged from 22 to 98 years, with a mean age of 61.05 (SD = 13.24). A factor model was used to create a harmonized measure of financial strain across studies and items. Twin analyses of genetic and environmental variance for SRH incorporating age, age2, sex, and financial strain moderators indicated significant financial strain moderation of genetic influences on self-rated health. Moderation results did not differ across sex or country. Genetic variance for SRH increased as financial strain increased, matching the predictions of the diathesis–stress and social comparison models for components of variance. Under these models, environmental improvements would be expected to reduce genetically based health disparities.

Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study.

Studies of migration and health focus on a “healthy migrant effect” whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (β = 0.32; 95% CI = 0.22, 0.43) and at 1-year (β = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.

A longitudinal study monitoring the quality of life in a national cohort of older adults in Chile before and during the COVID-19 outbreak

BackgroundConfinement during the COVID-19 pandemic has placed great stress on older adults, which may be affecting their quality of life. Thus, this study aims to describe the changes in mental and physical health, isolation and loneliness, residence and socioeconomic resources in a national cohort of Chilean older adults before and during the COVID-19 outbreak. It also analyzes the changes in depressive symptoms by changes in the other quality of life indicators before and during the COVID-19 outbreak. Possible methodological biases of telephone surveys in older adults living in non-developed countries are also discussed.MethodsBetween June and September 2020, a random subsample of 720 people who had participated in the face-to-face V National Survey on Quality of Life in Older Adults in Chile conducted at the end of 2019 was followed up by telephone. Descriptive bivariate analyses were performed using t-test and non-parametric tests for independent variables, comparing the baseline sample with the current 2020 follow-up sample during the peak of the pandemic outbreak in Latin America. Furthermore, descriptive bivariate analysis through t-test and non-parametric test for paired samples compared the follow-up subsample at baseline with the not-included sample, examining possible biases of the telephone interview compared with the face-to-face interview.ResultsIn the panel, there was no variation in self-rated health. The health symptoms that worsened were memory, stomach, and mood problems. Depressive symptoms and anxiety increased; similarly, smartphone users, social contacts, intergenerational co-residence and resilience increased. The telephone follow-up sample had a higher educational level and greater smartphone use than those not included in the subsample.ConclusionsAlthough some physical and mental health indicators have worsened during the pandemic, older adults mobilized resources that could allow them to maintain their quality of life, such as improved resilience. Thus, these findings can guide future research and the development of efficient strategies to improve these resources among older adults to ensure wellbeing.

Physical activity and self-rated health: role of contexts

ABSTRACT The purpose of this study is to examine how much variance in self-rated health is attributable to household and administrative-area levels. Additionally, the study investigates the association between physical activity and self-rated health while adjusting for various covariates at the individual, household, and district levels in Seoul, South Korea. A cross-sectional study of the 2009 Seoul Welfare Panel Study conducted by Seoul Welfare Foundation was utilized. The final sample included 7,761 individuals within 3,617 households in 25 administrative areas. Three-level random intercept logistic models were fitted. The results showed that a small proportion (3.52%) of variance in self-rated health was attributed to the administrative-area level, while a relatively large proportion (33.78%) was attributed to the household level. This study also found a positive association between physical activity and self-rated health, even after controlling for covariates at multiple levels. The results indicated that public health interventions promoting physical activity may have a beneficial effect on individual health. Additionally, public health interventions for improving individual health may not be efficient if directed only at the administrative-area level, as only a small portion of variance in self-rated health was attributable to this level.

Socioeconomic Inequalities in Health Through Lifestyles: Analysing Gender and Age Differences in Andalusia, Spain.

This research aims to analyse the association between socioeconomic status (SES) and self-rated health (SRH) through its relationship with lifestyle factors, as well as examining these effects stratified by gender and age groups. A cross-sectional study was performed with a representative sample from Andalusia (Southern Spain) composed of 1200 adults. The study analysed several variables related to lifestyle (healthy diet, physical activity and tobacco and alcohol consumption) and SES (education and income), along with SRH. The joint effects of SRH and the set of variables were studied by using a hierarchical linear regression analysis. Later a path analysis was carried out to test the impact of gender and age group on these associations. The results show that a better SRH was reported by men with lower age, higher SES, more frequent physical activity, healthy diet, and lower alcohol use compared with their counterparts. Income was directly related to better SRH through more physical activity, a healthier diet and less alcohol consumption. SES had a greater positive relationship with women's health than with men's health. In addition, a greater explained variance in SRH was observed in older women based on SES and lifestyle factors. Our findings provide some cross-sectional evidence of the social inequalities in health mediated through lifestyle factors, with gender and age differences. Therefore, socioeconomic inequalities should be addressed by public and social policies considering the gender and age gaps.

Does Organization Matter for Health? The Association Between Workplace Social Capital and Self-Rated Health.

This study aimed to investigate the association between workplace social capital at the individual and government organizational levels, and self-rated health among public employees in South Korea. We conducted a cross-sectional survey of public employees at government organizations in South Korea from June 2018 to December 2018. In total, 815 respondents in 31 government organizations were analyzed. We fitted two-level random intercept logistic regression models. We found that the vertical component of workplace social capital at the individual and organizational levels was positively associated with good self-rated health. Our results suggest that decision-makers targeting public interventions at the government organizational level to improve employee health are unlikely to observe an appreciable impact since a relatively small proportion of the variation in self-rated health was attributed to this level.

Geographical variations in self-rated health and functional limitations among older Chinese in eight WHO-SAGE provinces

BackgroundThe proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes.MethodsWe investigate geographical variations in self-rated overall health and functional limitations in a national representative sample of Chinese aged 50 years and older (n = 13,175) using the WHO Study on global AGEing and adult health (WHO SAGE). We used multivariable logistic regression to investigate urban-rural inequalities across regions, adjusting for sociodemographic and health covariates. Two main outcomes were self-rated overall health and functional limitations based on the WHO Disability Assessment Schedule 2.0 for a range of daily activities.ResultsThe largest urban-rural differences in adverse health outcomes were in Shandong (AORs for urban versus rural of 6.32 [95% Confidence Interval 4.53–8.82] for poor or very poor self-rated overall health and 5.14 [CI 3.55–7.44] for functional limitations), followed by Jilin (AORs 2.71 [CI 2.04–3.61] and 4.72 [CI 3.43–6.49]), and Hubei (AORs 2.36 [CI 1.82–3.07] and 4.11 [CI 2.80–6.04]), respectively. Covariates significantly associated with both adverse health outcomes were older age, poor income, no health insurance, and increasing number of chronic diseases.ConclusionOur study reveals substantial disparities between urban and rural areas observed in both the well-developed areas (eg Shandong) and also the lower end of the economic spectrum (eg Hubei and Jilin). Targeted economic development policy and systematic health prevention and healthcare policies could be beneficial in improving health in later life whilst minimising geographical inequalities.

Single-Item, Self-Rated Health is a Useful Indicator of Health in Myofascial Temporomandibular Disorders.

Aims:To (1) examine differences in self-rated health (SRH) between a group of women with myofascial temporomandibular disorders (mTMD) and controls; (2) determine the extent to which pain, mental health, and physical function mediate these differences; and (3) explore specific mTMD symptoms and impairments explaining SRH among mTMD cases.Methods:An existing dataset of a sample of women with mTMD (n = 125) and a group of demographically similar controls (n = 49) was used. SRH was measured via a single item with 5 answer options ranging from poor (SRH = 1) to excellent (SRH = 5). Bodily pain, mental health, and physical function were measured with the Short-Form Health Survey. Regression analyses with SRH as the outcome were conducted.Results:mTMD cases reported poorer SRH compared to controls, and bodily pain score fully mediated these lower scores. Physical function partially mediated the association between mTMD and SRH, while mental health did not explain much of the variance in SRH. This pattern held in case-only analyses. The association was not explained by mTMD-specific symptoms or by localized mTMD pain severity, although mTMD disability was independently associated with lower SRH.Conclusion:SRH is a simple and useful tool to consider in mTMD research, as it discriminates between cases and controls based on pain and physical function and is associated with mTMD disability.

Pain and self-rated health among middle-aged and older Canadians: an analysis of the Canadian community health survey\u2015healthy aging

BackgroundPain is an important health problem adversely affecting functionality and quality of life. Though self- rated health (SRH) is a major predictor of mortality, its relationship with pain is not well understood. We explore 1) how pain and age interact to influence SRH, and 2) provincial variations in SRH across Canada.MethodsWe analyzed cross-sectional data from Statistics Canada’s Canadian Community Health Survey-Healthy Aging (n = 30,685), which targeted those 45 years and older and was conducted from 2008 to 12-01 to 2009–11-30. The response rate was 74.4%.The topics covered included socio-demographics, well-being and chronic diseases. We performed both bivariate and multivariate analyses between each predictor and SRH; unadjusted and adjusted odds ratios and 95% confidence intervals are reported. Two-level logistic regression mixed model was used to account for provincial differences. An intraclass correlation coefficient was also computed.ResultsSlightly more than half of respondents (56.40%) were female. In bivariate analyses, those experiencing pain had an odds ratio of 0.20. Which means that the odds of reporting good self-rated health are 4 to 5 times lower for those with pain, compare to the odds of reporting good self-rated health among those without pain (p < 0.001). In multivariate analyses the highly educated, female gender, the never married or single and households with high yearly income were predictors of good health (p < 0.001). Those who reported depressive symptoms, the lonely, the obese, daily smokers and/or the stressed were less likely to rate their health as good (p < 0.001). The influence of pain on SRH was stronger among younger age groups (45–54 years) compared to older age groups (75-84 years, with an odds ratio of 3.53 [p < 0.001] versus 3.14 [p < 0.001]).ConclusionsPain, among other determinants, is associated with SRH. Individuals in rating their health may consider a variety of factors, some of which may not be apparent to health providers. We found that those who reported depressive symptoms, were daily smokers, the obese, the lonely, and/or having a stressful life were less likely to rate their health as good. No significant provincial variations in SRH in Canada was observed in this study.

The effect of community organisations’ participation and existence on self-rated health in China: evidence from China Health and Retirement Longitudinal Study

Using the China Health and Retirement Longitudinal Study cross-sectional survey in 2011 with an 80.51% response rate, an endogenous logit model is adopted to account for the relationship between social capital and self-rated health and the heterogeneity from gender, age and marital status on individual self-rated health status. Consequently, social capital at both individual and community levels is found to be positively correlated with better subjective self-rated health status. Furthermore, the social capital’s marginal effect of the male, high-income groups, the married are larger than that of the female, rural residents, low-income groups and the divorced. In addition, interclass correlation value from the partition of the fixed and random effect of social capital is significantly, ranging from 3.0 to 5.49%, indicating a significant proportion of the total variance in self-rated health that can be explained by community-level differences.

Which symptoms contribute the most to patients' perception of health in multiple sclerosis?

BackgroundMultiple sclerosis is a polysymptomatic disease. Little is known about relative contributions of the different multiple sclerosis symptoms to self-perception of health.ObjectivesTo investigate the relationship between symptom severity in 11 domains affected by multiple sclerosis and self-rated health.MethodsMultiple sclerosis patients in two multiple sclerosis centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by multiple sclerosis. Pearson correlations and multivariate linear regressions were used to investigate the relationship between symptoMScreen scores and self-rated health.ResultsAmong 1865 multiple sclerosis outpatients (68% women, 78% with relapsing–remitting multiple sclerosis, mean age 46.38 ± 12.47 years, disease duration 13.43 ± 10.04 years), average self-rated health score was 2.30 (‘moderate to good’). Symptom burden (composite symptoMScreen score) highly correlated with self-rated health (r = 0.68, P < 0.0001) as did each of the symptoMScreen domain subscores. In regression analysis, pain (t = 7.00), ambulation (t = 6.91), and fatigue (t = 5.85) contributed the highest amount of variance in self-rated health (P < 0.001).ConclusionsPain contributed the most to multiple sclerosis outpatients’ perception of health, followed by gait dysfunction and fatigue. These findings suggest that ‘invisible disability’ may be more important to patients’ sense of wellbeing than physical disability, and challenge the notion that physical disability should be the primary outcome measure in multiple sclerosis.

The relationship between pain with walking and self-rated health 12\xa0months following total knee arthroplasty: a longitudinal study

BackgroundA subgroup of patients continue to report pain with walking 12 months after total knee arthroplasty (TKA). The association between walking pain and self-rated health (SRH) after TKA is not known. This prospective longitudinal study aimed to investigate the association between a comprehensive list of preoperative factors, postoperative pain with walking, and SRH 12 months after TKA.MethodsPatients (N = 156) scheduled for TKA completed questionnaires that evaluated demographic and clinical characteristics, symptoms, psychological factors, and SRH. SRH was re-assessed 12 months after TKA. Clinical variables were retrieved from medical records. Pain with walking was assessed before surgery, at 6 weeks, 3, and 12 months after TKA. Subgroups with distinct trajectories of pain with walking over time were identified using growth mixture modeling. Multiple linear regression was used to investigate the relationships between pain with walking and other factors on SRH.ResultsHigher body mass index, a higher number of painful sites at 12 months, recurrent pain with walking group membership, ketamine use, higher depression scores, and poorer preoperative self-rated health were associated with poorer SRH 12 months after TKA. The final model was statistically significant (p = 0.005) and explained 56.1% of the variance in SRH 12 months after surgery. SRH improved significantly over time. Higher C-reactive protein levels, higher number of painful sites before surgery, higher fatigue severity, and more illness concern was associated with poorer preoperative SRH.ConclusionsIn patients whose walking ability decreases over time, clinicians need to assess for unreleaved pain and decreases in SRH. Additional research is needed on interventions to improve walking ability and SRH.

Determinants of and socio-economic disparities in self-rated health in China

BackgroundSelf-rated health (SRH) is not only used to measure health status and health inequalities, but also as a strong predictor of morbidity and mortality. The purpose of this study was to: 1) evaluate the factors that account for variations in self-rated health among Chinese citizens; and to 2) explore the process through which socio-economic status may impact self-rated health.MethodsData were derived from the Chinese General Social Survey (CGSS) (2013). Determinants of self-rated health were analyzed along four main dimensions: demographic characteristics, socio-economic status, lifestyle, and psychosocial factors. Multivariate odds ratios for good self-rated health were calculated for different variables in order to analyze the determinants. Binary logistic regression analysis was performed to assess the extent to which lifestyle and psychosocial factors explained the association between socio-economic status and self-rated health.ResultsAbout 65% of the survey respondents reported good self-rated health. Women, the elderly, married or single respondents and residents of Western China were less likely to report good self-rated health. Respondents who were engaged in work, had higher household income, reported high social class and higher socio-economic status compared with peers were more likely to report good self-rated health. Normal weight and physically active respondents along with those reporting a happy life, no depression, and good relationships with families and friends were related to good self-rated health. We also found the effect of socio-economic status on self-rated health was partly explained by lifestyle and psychosocial factors.ConclusionThe present findings support the notion that both socio-economic status and lifestyle as well as psychosocial factors were related with good self-rated health. The interventions targeting these factors could improve the health status of the population. The depression was the most influential predictor of self-rated health, especially for the women and the elderly. Although lifestyle and psychosocial factors explained partly the the association between socio-economic status and health, the reason why socio-economic difference exists in health must be further explored. What’s more, it needs to be further studied why the same determinant has different influence strengths on the health of different groups of people.

Ethnic variation in self-rated health–mortality association: Results from a 17-year follow-up study in Estonia

Background and aimPrevious research has highlighted the role of self-rated health (SRH) as an important predictor of mortality. With substantial ethnic differences in SRH and mortality reported in Estonia, this study aims to examine the ethnic variation in SRH–mortality association in this setting. Materials and methodsThe baseline data come from the nationally representative 1996 Estonian Health Interview Survey. Individual records of 3983 respondents in the 25–79 age group were linked with mortality data with 17 years follow-up time. The association between SRH and all-cause mortality was analyzed using the Cox regression for two ethnic groups and separately for men and women. ResultsAmong ethnic Estonians, both men and women with bad or very bad SRH had about 60% higher mortality compared to those with good or very good SRH even after adjustment for age, socioeconomic and health-related variables. In contrast, SRH did not predict mortality among non-Estonian men and women. A strong and universal inverse association with mortality was found for personal income. Education (among men) and occupation (among women) predicted mortality only among non-Estonians, whereas ever smoking was associated with mortality in Estonian men and women. Overweight women had lower mortality risk compared to women in normal weight category. ConclusionsWe found considerable ethnic variation in SRH–mortality association and in socioeconomic predictors of mortality. Further research, preferably focusing on cause-specific mortality and reporting heterogeneity of SRH could potentially shed further light on ethnic differences in SRH–mortality association in Estonia and more generally on socioeconomic inequalities in mortality in Eastern Europe.