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Sex/Gender and Socioeconomic Differences in the Predictive Ability of Self-Rated Health for Mortality  [PDF]
Akihiro Nishi,Ichiro Kawachi,Kokoro Shirai,Hiroshi Hirai,Seungwon Jeong,Katsunori Kondo
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0030179
Abstract: Studies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups.
Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
Célia L Szwarcwald, Paulo RB Souza-Júnior, Giseli N Damacena
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-217
Abstract: A three-stage cluster sampling was used to select 5000 adults (18 years and over). The non-response rate was 24.7% and calibration of the natural expansion factors was necessary to obtain the demographic structure of the Brazilian population. Utilization was established by use of outpatient services in the 12 months prior to the interview. Socioeconomic inequalities were analyzed by logistic regression models using years of schooling and private health insurance as independent variables, and controlling by age and sex. Effects of the socioeconomic variables on health services utilization were further analyzed according to self-rated health (good, fair and poor), considered as an indicator of intensity of health care need.Among the 5000 respondents, 63.4% used an outpatient service in the year preceding the survey. The association of health services utilization and self-rated health was significant (p < 0.001). Regarding socioeconomic inequalities, the less educated used health services less frequently, despite presenting worse health conditions. Highly significant effects were found for both socioeconomic variables, years of schooling (p < 0.001) and private health insurance (p < 0.00), after controlling for age and sex. Stratifying by self-rated health, the effects of both socioeconomic variables were significant among those with good health status, but not statistically significant among those with poor self-rated health.The analysis showed that the social gradient in outpatient services utilization decreases as the need is more intense. Among individuals with good self-rated health, possible explanations for the inequality are the lower use of preventive services and unequal supply of health services among the socially disadvantaged groups, or excessive use of health services by the wealthy. On the other hand, our results indicate an adequate performance of the Brazilian health system in narrowing socioeconomic inequalities in health in the most serious situation
Health Information Seeking Partially Mediated the Association between Socioeconomic Status and Self-Rated Health among Hong Kong Chinese  [PDF]
Man Ping Wang, Xin Wang, Tai Hing Lam, Kasisomayajula Viswanath, Sophia S. Chan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082720
Abstract: Background Poor self-rated health (SRH) is socially patterned with health communication inequalities, arguably, serving as one mechanisms. This study investigated the effects of health information seeking on SRH, and its mediation effects on disparities in SRH. Methods We conducted probability-based telephone surveys administered over telephone in 2009, 2010/11 and 2012 to monitor health information use among 4553 Chinese adults in Hong Kong. Frequency of information seeking from television, radio, newspapers/magazines and Internet was dichotomised as <1 time/month and ≥1 time/month. Adjusted odds ratios (aOR) for poor SRH were calculated for health information seeking from different sources and socioeconomic status (education and income). Mediation effects of health information seeking on the association between SES and poor SRH was estimated. Results Poor SRH was associated with lower socioeconomic status (P for trend <0.001), and less than monthly health information seeking from newspapers/magazines (aOR = 1.23, 95% CI 1.07–1.42) and Internet (aOR = 1.13, 95% CI 0.98–1.31). Increasing combined frequency of health information seeking from newspapers/magazines and Internet was linearly associated with better SRH (P for trend <0.01). Health information seeking from these two sources contributed 9.2% and 7.9% of the total mediation effects of education and household income on poor SRH, respectively. Conclusions Poor SRH was associated with lower socioeconomic status, and infrequent health information seeking from newspapers/magazines and Internet among Hong Kong Chinese. Disparities in SRH may be partially mediated by health information seeking from newspapers/magazines and Internet.
The contribution of childhood circumstances, current circumstances and health behaviour to educational health differences in early adulthood
Laura Kestil?, Tuija Martelin, Ossi Rahkonen, Tommi H?rk?nen, Seppo Koskinen
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-164
Abstract: The data derived from the Health 2000 Survey represent the Finnish young adults aged 18–29 in 2000. The analyses were carried out on 68% (n = 1282) of the sample (N = 1894). The cross-sectional data based on interviews and questionnaires include retrospective information on childhood circumstances. The outcome measure was poor self-rated health.Poor self-rated health was much more common among subjects with primary education only than among those in the highest educational category (OR 4.69, 95% CI 2.63 to 8.62). Childhood circumstances contributed substantially (24%) to the health differences between these educational groups. Nearly two thirds (63%) of this contribution was shared with behavioural factors adopted by early adulthood, and 17% with current circumstances. Health behaviours, smoking especially, were strongly contributed to educational health differences.To develop means for avoiding undesirable trajectories along which poor health and health differences develop, it is necessary to understand the pathways to health inequalities and know how to improve the living conditions of families with children.Socio-economic health inequalities [1,2] seem to emerge rapidly when heading into adulthood: they are small or non-existent in childhood and adolescence [3-6], but marked already at early middle age [7-9]. Health differences related to socioeconomic position (SEP) are generated by various factors and mechanisms [10]. Higher SEP may promote better living and healthier working conditions [11-13], as well as healthier lifestyle, attitudes and choices [14] and is usually associated with physically less strenuous and psychosocially more rewarding work and better housing conditions than lower SEP. Moreover, compared with persons with a low SEP, those with a high SEP tend to smoke less [15-17], drink less alcohol [18,19], be physically more active [20,21], have healthier nutrition habits [22] and less likely be obese [23,24]. However, health itself can have an influe
Household item ownership and self-rated health: material and psychosocial explanations
Hynek Pikhart, Martin Bobak, Richard Rose, Michael Marmot
BMC Public Health , 2003, DOI: 10.1186/1471-2458-3-38
Abstract: Random national samples of men and women in Hungary (n = 973) and Poland (n = 1141) were interviewed (response rates 58% and 59%, respectively). The subjects reported their self-rated health, socioeconomic circumstances, including ownership of different household items, and perceived control over life. Household items were categorised as "basic needs", "socially oriented", and "luxury". We examined the association between the ownership of different groups of items and self-rated health. Since the lists of household items were different in Hungary and Poland, we conducted parallel identical analyses of the Hungarian and Polish data.The overall prevalence of poor or very poor health was 13% in Poland and 25% in Hungary. Education, material deprivation and the number of household items were all associated with poor health in bivariate analyses. All three groups of household items were positively related to self-rated health in age-adjusted analyses. The relation of basic needs items to poor health disappeared after controlling for other socioeconomic variables (mainly material deprivation). The relation of socially oriented and luxury items to poor health, however, persisted in multivariate models. The results were similar in both datasets.These data suggest that health is influenced by both material and psychosocial aspects of socioeconomic factors.Socioeconomic differences in mortality and morbidity are well documented [1-3]. An unresolved issue in understanding the socioeconomic gradient in health is what are the causes of the gradient. A key question is whether the gradient is driven by relative or absolute deprivation [4-8]. One interpretation of the association is that health inequalities result from the direct effects of material conditions [5]. The psychosocial interpretation proposes that relative deprivation (relative to persons higher in the social hierarchy) generates psychosocial processes independent from direct effects of material conditions, and that ps
Impact of socioeconomic status on Brazilian elderly health
Revista de Saúde Pública , 2007, DOI: 10.1590/S0034-89102006005000042
Abstract: objective: to investigate the impact of socioeconomic status on elderly health. methods: the study was based on cross-sectional data from survey on health, well-being, and aging in latin america and the caribbean. the sample comprised 2,143 non-institutionalized elderly aged 60 years and older living in the urban area of s?o paulo, southeastern brazil. linear regression models estimated the effect of socioeconomic status indicators (years of schooling completed, occupation and purchasing power) on each one of the following health indicators: depression, self-rated health, morbidity and memory capacity. a 5% significance level was set. results: there was a significant effect of years of education and purchasing power on self-rated health and memory capacity when controlled for the variables number of diseases during childhood, bed rest for at least a month due to health problems during childhood, self-rated health during childhood, living arrangements, sex, age, marital status, category of health insurance, intake of medicines. only purchasing power had an effect on depression. despite the bivariate association between socioeconomic status indicators and number of diseases (morbidity), this effect was no longer seen after including the controls in the model. conclusions: the study results confirm the association between socioeconomic status indicators and health among brazilian elderly, but only for some dimensions of socioeconomic status and certain health outcomes.
Factors associated with self-rated health in older people living in institutions
Javier Damián, Roberto Pastor-Barriuso, Emiliana Valderrama-Gama
BMC Geriatrics , 2008, DOI: 10.1186/1471-2318-8-5
Abstract: A representative sample of 800 subjects 65 years of age and older living in 19 public and 30 private institutions of Madrid was randomly selected through stratified cluster sampling. Residents, caregivers, physicians, and nurses were interviewed by trained geriatricians using standardized instruments to assess self-rated health, chronic illnesses, functional capacity, cognitive status, depressive symptoms, vision and hearing problems, and social support.Of the 669 interviewed residents (response rate 84%), 55% rated their health as good or very good. There was no association with sex or age. Residents in private facilities and those who completed primary education had significantly better health perception. The adjusted odds ratio (95% confidence interval) for worse health perception was 1.18 (1.07–1.28) for each additional chronic condition, 2.37 (1.38–4.06) when comparing residents with moderate dependency to those functionally independent, and 10.45 (5.84–18.68) when comparing residents with moderate/severe depressive symptoms to those without symptoms. Visual problems were also associated with worse health perception. Similar results were obtained in subgroup analyses, except for inconsistencies in cognitively impaired individuals.Chronic conditions, functional status, depressive symptoms and socioeconomic factors were the main determinants of perceived health among Spanish institutionalized elderly persons. Doubts remain about the proper assessment of subjective health in residents with altered cognition.Self-rated health is a complex variable that captures multiple dimensions of the relation between physical health and other personal and social characteristics. It is very consistent its capacity to predict mortality [1] and functional loss [2,3], independently of objective health, psychosocial, and demographic variables. It has also been strongly associated with successful aging [4] and evidence of biologic roots has been recently shown [5,6]. Self-rated healt
Family social environment in childhood and self-rated health in young adulthood
Christelle Roustit, Eric Campoy, Emilie Renahy, Gary King, Isabelle Parizot, Pierre Chauvin
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-949
Abstract: We analyzed data from the first wave of the Health, Inequalities and Social Ruptures Survey (SIRS), a longitudinal health and socio-epidemiological survey of a random sample of 3000 households initiated in the Paris metropolitan area in 2005. Sample-weighted logistic regression analyses were performed to determine the association between the quality of family social environment in childhood and self-rated health (overall health, physical health and psychological well-being) in young adults (n = 1006). We used structural equation model to explore the mediating role of the quality of family functioning in childhood in the association between family breakup in childhood and self-rated health in young adulthood.The multivariate results support an association between a negative family social environment in childhood and poor self-perceived health in adulthood. The association found between parental separation or divorce in childhood and poor self-perceived health in adulthood was mediated by parent-child relationships and by having witnessed interparental violence during childhood.These results argue for interventions that enhance family cohesion, particularly after family disruptions during childhood, to promote health in young adulthood.Research studies using measures of social stratification based on the three core dimensions of socioeconomic status, namely, level of education, occupational status and income, social health inequalities are being increasingly explored through the life-course epidemiological approach [1-5]. Adverse life events or circumstances can constitute pathways between social conditions and disparities in health outcomes (pathway model) or lead to social inequalities in economic resources, which in turn, are associated with poor health outcomes (i.e., accumulation model) [6]. Research studies in this field are contributing to the health inequality debate, thus providing data for policy makers to allocate human resources to disadvantaged families w
Risk of Inflammatory Bowel Disease According to Self-Rated Health, Pregnancy Course, and Pregnancy Complications: A Study within the Danish National Birth Cohort  [PDF]
Maria C. Harps?e, Kristian Tore J?rgensen, Morten Frisch, Tine Jess
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0059698
Abstract: Background Poor self-rated health (SRH) has been connected to immunological changes, and pregnancy complications have been suggested in the etiology of autoimmune diseases including inflammatory bowel disease (IBD). We evaluated the impact of self-rated pre-pregnancy health and pregnancy course, hyperemesis, gestational hypertension, and preeclampsia on risk of IBD. Methods Information was collected by questionnaires from The Danish National Birth Cohort (enrolment 1996–2002) at 16th and 30th week of pregnancy and 6 months postpartum. A total of 55,699 women were followed from childbirth until development of IBD (using validated National Hospital Discharge Register diagnoses), emigration, death, or end of follow-up, 31st of October, 2011. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards models adjusting for age and evaluating pre-pregnancy BMI, parity, alcohol and tobacco consumption, and socio-occupational status as potential confounders. Results Risk of IBD increased with decreasing level of self-rated pre-pregnancy health (p = 0.002) and was elevated in women with poor self-rated pregnancy course (HR, 1.61, 95% CI 1.22–2.12). Associations persisted for more than 5 years postpartum. Hyperemesis and preeclampsia were not significantly associated with risk of IBD. Conclusions This is the first prospective observational study to suggest that poor self-rated health – in general and in relation to pregnancy – is associated with increased risk of IBD even in the long term though results needs further confirmation. Symptoms of specific pregnancy complications were, on the other hand, not significantly associated with risk of IBD.
The influence of social capital and socio-economic conditions on self-rated health among residents of an economically and health-deprived South African township
Jane M Cramm, Anna P Nieboer
International Journal for Equity in Health , 2011, DOI: 10.1186/1475-9276-10-51
Abstract: Data were gathered through a survey administered to respondents from 1,020 households in Grahamstown a suburb in the Eastern Cape, South Africa (response rate 97.9%). We investigated the influence of social and economic conditions (education, employment, income, social capital, housing quality and neighborhood quality) on self-rated health. We used ordinal logistic regression analyses to identify the relationship of these conditions and self-rated health.Our study found that education and social capital positively correlated with health; unemployment, poor educational level and advanced age negatively correlated. We found no significant correlations between self-rated health and housing quality, neighbourhood quality, income, gender, or marital status.We highlight the possible impacts of social capital, employment, and education on health, and suggest that health outcomes may be improved through interventions beyond the health system: creating job opportunities, strengthening social capital, bettering educational systems, and promoting educational access. Policymakers should consider the benefits of such programmes when addressing health outcomes in financially distressed districts.People at the bottom of society are faced with the worst living conditions and report the worst health outcomes. Regardless the country these poor people live in, what type of health insurance they have or do not have, and the level of health care they receive, they still have the worst health of all [1]. These disparities cannot be explained by biological differences. The World Health Organization [2] holistically viewed the social determinants of health, concluding that global health and illness follow a social gradient; lower socioeconomic positions are consistently correlated with poorer health. These avoidable health inequalities arise because of the circumstances in which people are born, live, work, and age, including the adequacy of health care systems. The conditions in which peo
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