Self-reported health and survival in the Longitudinal Study of Aging, 1984-1986

Self-Rated Health and Pain Problems in Mothers of Healthy Children or Children Requiring Outpatient Observation or Hospitalisation: A Pilot Cross-Sectional Study

A child's illness or disability is a considerable stressor for the mother and a risk factor for many psychological problems and somatic diseases. The purpose of the study was to (1) assess the prevalence of poor SRH and pain, (2) compare self-rated health and pain, (3) and identify the determinants of SRH and pain in mothers of healthy children and children requiring ambulatory observation or hospitalization. The study covered 234 mothers of both healthy and unhealthy children who required outpatient observation or treatment at an intensive care unit, neonatal intensive care unit, or oncology department. To analyse the variables obtained, the following tools were used: Self-Rated Health, Numerical Rating, Interpersonal Support Evaluation List, Peritraumatic Distress Inventory, Modified Hospital Anxiety and Depression Scale, and Impact of Effects Scale-Revised. The self-assessment of health in mothers of healthy children and those in need of outpatient observation or hospitalization at units with various specialities differed in a statistically significant way. The severity of the average and maximum pain among mothers of healthy children and those with a history of disease differed statistically significantly. Poor SRH co-occurred with severe maximum pain in all of the examined groups. Both in the control group and the group of mothers of children requiring outpatient observation, poor SRH co-occurred with a high level of anxiety. Only in the control group was a correlation found between the severity of the average and maximum pain and the severity of anxiety and depression symptoms.

Investigation of the Predictors of Self-rated Health of Economically Disadvantaged African American Men and Women: Evidence for Sponge Hypothesis

Background and aims

According to the sponge hypothesis, compared to men's self-rated health (SRH), women's SRH is more likely to reflect conditions other than chronic medical conditions (CMCs) such as psychiatric disorders (PDs). As a result, poor SRH is a weaker predictive factor for mortality risk for women than men. Most of this literature, however, is done in samples that are predominantly middleclass White. To test the sponge hypothesis among economically disadvantaged African Americans (AAs), this study compared low-income AA men and women for the effects of the number of PDs and CMCs on SRH.

Materials and Methods

This cross-sectional study recruited a non-random sample (n = 150) of economically disadvantaged AA adults with PD(s). Structured face-to-face interviews were used to collect data. SRH was measured using a single-item measure. PDs and CMCs were also self-reported. We applied linear regression models to test the interactions between SRH and the number of PDs and CMC as well as gender.

Results

The number of PDs and CMCs were associated with SRH in the pooled sample of low-income AA adults with PD(s). However, we found a significant interaction between the number of PDs and gender. This interaction suggested a stronger association between PDs and SRH for AA women than AA men. Gender did not alter the association between the number of CMCs and SRH.

Conclusion

The number of PDs is a determinant of SRH for low-income AA women but not AA men, supporting the sponge hypothesis.

Self-Perceived Health among Migrants Seen in Médecins du Monde Free Clinics in Europe: Impact of Length of Stay and Wealth of Country of Origin on Migrants' Health

Health of migrants is a widely studied topic. It has been argued that migrant health may deteriorate over time. Though migrants are a “hard to reach” population in survey data, this paper builds on a unique dataset provided by Médecins du Monde from five countries. We study self-perceived health (SPH) in connection with socio-economic and demographic factors and length of stay. Results differ for men and women. Compared to other documented migrants, asylum seekers have a 50–70% greater chance of having worse health. Migrants with better living conditions have a 57–78% chance of being in better health. Male migrants with a job have between a 82–116% chance of being in good health. The probability for women from poorer countries to have a better physical SPH after three months of residing in the host country is six-fold that of women from richer countries. This paper contributes widely to the knowledge of health of migrants. Contrary to other evidence, health of women migrants from poorer countries tends to improve with length of stay.

Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly

Background

Inequalities in the distribution of self-reported health (SRH) have been widely reported. Its higher expressivity among women, elderly and least educated groups has been partly attributed to differences in their health perceptions. However, this subjectivity may be masking the burden of mental illness in these groups. Thus, we sought to understand if depression symptoms mediate inequalities in SRH.

Methods

SHARE waves 4 and 6, pertaining to Spain, Italy and Portugal, were used (n2011 = 8517, n2015 = 11 046). Inequalities in SRH were calculated, comparing the risk amongst education level, gender and age groups, adjusting for chronic diseases, functional limitations and country fixed effects. We then tested depression symptoms as mediators.

Results

Depression symptoms were associated with poor SRH (odds ratio (OR)2011 = 1.379, OR2015 = 1.384, P < 0.001). Their inclusion reduced the magnitude of the association between SRH and education, annulled the statistical significance for age, and reversed the gender effect. As expected, chronic diseases and functional limitations remained significant predictors of poor SRH.

Conclusions

Depression symptoms, together with chronic diseases and functional limitations, explain the poorer SRH of the least educated, female and older groups in the Southern European population. Therefore, tackling inequalities in SRH must require focusing on mental health issues, which disproportionately affect the most vulnerable groups.

Self-rated health in mothers of children hospitalised for severe illnesses and mothers of healthy children: cross-sectional study

INTRODUCTION

Self-rated health (SRH) is a recognised tool for predicting morbidity and mortality.

AIM

The aim of the study was to investigate and compare SRH in a group of mothers of hospitalised children and mothers of healthy children and to indicate the variables associated with poor SRH in both groups.

METHODS

We conducted questionnaire-based cross-sectional research in a group of 184 women. Half of the respondents (n = 92) were the mothers of children hospitalised for a severe illnesses (Group H). The control group (n = 92) comprised mothers of healthy children (Group C). Self-Rated Health (SRH), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R) and Interpersonal Support Evaluation List (ISEL-40 v. GP) were used. In order to facilitate critical appraisal and interpretation of results, STROBE recommendations were used.

RESULTS

The prevalence of poor SRH was greater in mothers of children hospitalised for a severe illness than in those of healthy children (35 and 19%, respectively). In both groups, the risk of poor SRH was statistically significantly higher in those mothers who for the past 7 days reported at least moderate pain and in mothers who manifested anxiety symptoms. In both groups, the prevalence of poor SRH was statistically significantly lower if the respondents' children were in good health. The risk of poor SRH was associated with poor financial status in group H and with depression and at least moderate pain for the past 7 days in group C.

RELEVANCE TO CLINICAL PRACTICE

In order to provide mothers of severely ill children with high-quality health care including preventive measures, it is recommended that their health is assessed by healthcare professionals.

Self-rated health and its association with all-cause mortality of older adults in Poland: The PolSenior project

OBJECTIVES

Predictive effect of self-rated health (SRH) on mortality in older adults has been observed. The purpose of the study was to analyze this association in Poles aged 65+.

METHODS

Data were obtained from the nationwide, multidisciplinary PolSenior project, conducted in a representative sample of older population. The study group comprised 4049 respondents (48.0% women) without significant cognitive deficit. SRH was measured using Visual Analog Scale. The analysis included selected socio-economic, health status and life-style factors. Mortality data were retrieved from the state registry.

RESULTS

During 5-year period, 414 women (21.4%) and 672 men (31.8%) have died, including 17.5% of women and 26.6% of men with good, 21.6% and 32.9% with fair, 36.2% and 55.3% with poor SRH, respectively. Kaplan-Meier survival curves for SRH revealed significant differences for both genders. Univariate Cox regression analysis revealed significant hazard ratios (HRs) for mortality among women and men with poor compared to good SRH [2.48 (1.83-3.37); 2.62 (2.04-3.36), respectively] and those with fair compared to good SRH [1.29 (1.03-1.60); 1.29 (1.10-1.52), respectively]. Age-adjusted HRs for mortality were significant between groups with poor and good SRH [women: 1.98 (1.46-2.68), men: 2.06 (1.60-2.64)]. Multivariate Cox proportional hazard regression model including revealed significant HRs for mortality between women with poor and good SRH [1.67 (1.06-2.64)].

CONCLUSIONS

SRH was associated with mortality in both genders. After adjustment for age, this relationship was maintained in respondents with poor compared to good SRH. Inclusion of potential confounders demonstrated that SRH was an independent predictor of mortality only in women.

Comparison of general health status, myocardial infarction, obesity, diabetes, and fruit and vegetable intake between immigrant Pakistani population in the Netherlands and the local Amsterdam population

OBJECTIVE

South Asians living in Western countries have shown higher prevalence of cardiovascular disease and related non-communicable diseases as compared to the local populations. The aim of this study was to compare the general health status and prevalence of myocardial infarction (MI), diabetes, high blood pressure, overweight, obesity, and fruit and vegetable intake between Pakistani immigrants in the Netherlands and local Amsterdam population.

DESIGN

A health survey was conducted in 2012-2013 among Pakistanis in the Netherlands. Results were compared with a health survey conducted among inhabitants of Amsterdam in 2012. One hundred and fifty-four Pakistanis from four big cities of the Netherlands and 7218 inhabitants of Amsterdam participated. The data for Amsterdam population were weighed on the basis of age, gender, city district, marital status, ethnicity and income level while the data for Pakistanis were weighed on the basis of age and gender to make both data-sets representative of their general population.

RESULTS

Pakistanis reported a high prevalence of MI (3.3%), diabetes (11.4%), high blood pressure (14.4%), overweight (35.5%) and obesity (18.5%) while Amsterdam population reported the prevalence as 2.5% for MI, 6.8% for diabetes, 15.3% for high blood pressure, 28.1% for overweight and 11.1% for obesity. Pakistanis had a significantly higher level of MI (OR = 2.71; 95% CI: 1.19-6.14), diabetes (OR = 4.41; 95% CI: 2.66-7.33) and obesity (OR = 2.51; 95% CI: 1.53-4.12) after controlling for age, sex and educational level with Amsterdam population as the reference group. Pakistanis showed a higher intake of fruit and fruit juice as compared to Amsterdam population though the latter showed a higher intake of cooked vegetables.

CONCLUSION

Higher prevalence of MI, diabetes and obesity among Pakistanis than Amsterdam population indicates the need for health scientists and policy-makers to develop interventions for tackling non-communicable diseases and its determinants among Pakistanis living in the Netherlands.

Self-rated health is associated with subsequent functional decline among older adults in Japan

BACKGROUND

Previous studies have reported that self-rated health (SRH) predicts subsequent mortality. However, less is known about the association between SRH and functional ability. The aim of this study was to examine whether SRH predicts decline in basic activities of daily living (ADL), even after adjustment for depression, among community-dwelling older adults in Japan.

METHODS

A three-year prospective cohort study was conducted among 654 residents aged 65 years and older without disability in performing basic ADL at baseline. SRH was assessed using a visual analogue scale (range; 0-100), and dichotomized into low and high groups. Information on functional ability, sociodemographic factors, depressive symptoms, and medical conditions were obtained using a self-administered questionnaire. Logistic regression analysis was used to examine the association between baseline SRH and functional decline three years later.

RESULTS

One hundred and eight (16.5%) participants reported a decline in basic ADL at the three-year follow-up. Multiple logistic regression analysis showed that the low SRH group had a higher risk for functional decline compared to the high SRH group, even after controlling for potential confounding factors (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.3-4.4). Furthermore, a 10-point difference in SRH score was associated with subsequent functional decline (OR = 1.37; 95% CI = 1.16-1.61).

CONCLUSIONS

SRH was an independent predictor of functional decline. SRH could be a simple assessment tool for predicting the loss or maintenance of functional ability in community-dwelling older adults. Positive self-evaluation might be useful to maintain an active lifestyle and stay healthy.

Social Support and Mortality Among Older Persons With Diabetes

PURPOSE

The purpose of this study was to examine the relationship between social support and mortality among older persons with diabetes and the pathways by which social support affects diabetes survival.

METHODS

Using data from the Longitudinal Study of Aging cohort 2 baseline (1994) and follow-up (1997-1998 and 1999-2000 surveys), the authors identified 1431 persons aged >or=70 years with diabetes, among whom 387 deaths occurred. Social support was measured by an index with regard to participants' connection with relatives, friends, neighbors, social events, church, and senior centers. Regression analysis was used to find the pathway, and survival analysis was used to find the relationship between social support and mortality.

RESULTS

Compared to people with a low level of social support, the risk of death is 41% lower among people with medium levels of support (hazards ratio = 0.59, 0.39-0.91) and 55% lower among those with the highest levels of support (hazards ratio = 0.45, 0.21-0.98). Eight of the 11 regression models demonstrated that the effect of social support on mortality was mediated by both physical and mental health status.

CONCLUSIONS

Social support is strongly associated with mortality. Based on findings from this study, social support should be considered an important target for intervention to reduce mortality risk among older adults with diabetes.

Gender differences in the predictive role of self-rated health on short-term risk of mortality among older adults

OBJECTIVES

Despite the well-established association between self-rated health and mortality, research findings have been inconsistent regarding how men and women differ on this link. Using a national sample in the United States, this study compared American male and female older adults for the predictive role of baseline self-rated health on the short-term risk of mortality.

METHODS

This longitudinal study followed 1500 older adults (573 men (38.2%) and 927 women (61.8%)) aged 66 years or older for 3 years from 2001 to 2004. The main predictor of interest was self-rated health, which was measured using a single item in 2001. The outcome was the risk of all-cause mortality during the 3-year follow-up period. Demographic factors (race and age), socio-economic factors (education and marital status), and health behaviors (smoking and drinking) were covariates. Gender was the focal moderator. We ran logistic regression models in the pooled sample and also stratified by gender, with self-rated health treated as either nominal variables, poor compared to other levels (i.e. fair, good, or excellent) or excellent compared to other levels (i.e. good, fair, or poor), or an ordinal variable.

RESULTS

In the pooled sample, baseline self-rated health predicted mortality risk, regardless of how the variable was treated. We found a significant interaction between gender and poor self-rated health, indicating a stronger effect of poor self-rated health on mortality risk for men compared to women. Gender did not interact with excellent self-rated health on mortality.

CONCLUSION

Perceived poor self-rated health better reflects risk of mortality over a short period of time for older men compared to older women. Clinicians may need to take poor self-rated health of older men very seriously. Future research should test whether the differential predictive validity of self-rated health based on gender is due to a different meaning of poor self-rated health for older men and women and whether poor self-rated health reflects different health statuses based on gender.

Health Change in Retirement

This study examined health change in retirement. Using multiactor panel data on 778 Dutch older workers who experienced the transition into retirement, ordinary least squares regression models were estimated to explain changes in medical consumption, the severity of health problems, and perceived health. The results show that retirement does not categorically harm or benefit health. Instead, health consequences vary across individuals and according to the health measures adopted. The results suggest that employees' failure to control retirement according to their wishes adversely affects health. Older workers who perceived retirement as involuntary showed decreases in perceived health. The results do not provide empirical support for the hypothesis that the health consequences of retirement differ according to working conditions or job characteristics or older workers' access to resources in terms of income and social contacts. Psychological factors play a role: Fear of retirement and self-efficacy are associated with health change in retirement.

Associations Between Sociodemographic Characteristics, Pre Migratory and Migratory Factors and Psychological Distress Just After Migration and After Resettlement: The Indian Migration Study

BACKGROUND/OBJECTIVES

Migration is suspected to increase the risk for psychological distress for those who enter a new cultural environment. We investigated the association between sociodemographic characteristics, premigratory and migratory factors and psychological distress in rural-to-urban migrants just after migration and after resettlement.

METHODS

Data from the cross-sectional sib-pair designed Indian Migration Study (IMS, 2005-2007) were used. The analysis focused on 2112 participants aged ≥18 years from the total IMS sample (n = 7067) who reported being migrant. Psychological distress was assessed based on the responses of the 7-questions in a five-point scale, where the respondents were asked to report about their feelings now and also asked to recall these feelings when they first migrated. The associations were analyzed using multiple logistic regression models.

RESULTS

High prevalence of psychological distress was found just after migration (7.3%; 95% confidence interval [CI]: 6.2-8.4) than after settlement (4.7%; 95% CI: 3.8-5.6). Push factors as a reason behind migration and not being able to adjust in the new environment were the main correlates of psychological distress among both the male and female migrants, just after migration.

CONCLUSIONS

Rural-urban migration is a major phenomenon in India and given the impact of premigratory and migratory related stressors on mental health, early intervention could prevent the development of psychological distress among the migrants.

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

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

Direct and indirect effects of childhood conditions on survival and health among male and female elderly in China

This paper investigates whether childhood conditions affect survival and health, both directly and indirectly through the mediating variable of adulthood socioeconomic status, among Chinese elderly. Using data from the 2008-2009 and 2011-2012 waves of the Chinese Longitudinal Healthy Longevity Survey, we apply structural equation models to estimate these effects. We find that favorable childhood conditions exert a negative direct impact on survival probability at senior ages, possibly resulting from mortality selection. Our results also support the pathways model, which indicates that advantageous childhood conditions improve socioeconomic status in adulthood and thus indirectly promote longevity and health at advanced ages. Combining the direct and indirect effects, the total effects of childhood advantages on survival and health are positive. We further demonstrate that direct and indirect effects of childhood conditions are stronger for women than they are for men. Our findings suggest that public policies that target childhood wellbeing may have far-reaching protective impacts on health among seniors.

Rethinking the frequency of between-visit monitoring for patients with diabetes

BACKGROUND

Health systems increasingly look to mobile health tools to monitor patients cost-effectively between visits. The frequency of assessment services such as interactive voice response (IVR) calls is typically arbitrary, and no approaches have been proposed to tailor assessment schedules based on evidence regarding which measures actually provide new information about patients' status.

METHODS

We analyzed longitudinal data from over 5000 weekly IVR monitoring calls to 298 diabetes patients using logistic models to determine the predictability of IVR-reported physiological results, perceived health indicators, and self-care behaviors. We also determined the implications for assessment burden and problem detection of omitting assessment items that had no more than a 5% predicted probability of a problem report.

RESULTS

Assuming weekly IVR assessments, episodes of hyperglycemia were difficult to predict [area under the curve (AUC)=69.7; 95% confidence interval (CI), 50.2-89.2] based on patients' prior assessment responses. Hypoglycemic symptoms and fair/poor perceived health were more predictable, and self-care behaviors such as problems with medication adherence (AUC=92.1; 95% CI, 89.6-94.6) and foot care (AUC=98.4; 95% CI, 97.0-99.8) were highly predictable. Even if patients were only asked about foot inspection behavior when they had >5% chance of a problem report, 94% of foot inspection assessments could be omitted while still identifying 91% of reported problems.

CONCLUSIONS

Mobile health monitoring systems could be made more efficient by taking patients' reporting history into account. Avoiding redundant information requests could make services more patient centered and might increase engagement. Time saved by decreasing redundancy could be better spent educating patients or assessing other clinical problems.

A single-item self-rated health measure correlates with objective health status in the elderly: a survey in suburban beijing

INTRODUCTION

The measurement of health status of the elderly remains one important topic. Self-rated health status (SRH) is considered to be a simple indicator to measure the health status of the old population. But some researchers still take a skeptical view about its reliability. This study aims to investigate the association between SRH indicator and health status of the elderly and discuss its subsequent public health implications.

METHODS

In a total 1096 people who were 60 years of age or older from 1784 households from a suburban area of Beijing were interviewed using multistage stratified cluster sampling. SRH was measured by a single question "please choose one point in this 0-100 scale, which can best represent your health today." The disease status and physical functional status were also obtained. A multiple linear regression was conducted to test the associate between SRH and individual's disease/functional status.

RESULTS

The average of SRH scores of the elderly was 72.49 ± 15.64 (on a 1-100 scale). The SRH scores declined not only with the severity of self-reported mental/disease status, but also with the decrease of physical functional status. Multiple linear regression showed that after adjustment for other variables, 2-week sickness, chronic diseases, hospitalization, and ability of self-care (washing and dressing) were able to explain 35% of the variation in SRH among the elderly. Among them, disease status and self-care ability were the most powerful predictor of SRH. After adjusting other variables, physical functional status could explain only 5% of the variation in SRH.

CONCLUSION

Self-rated health reflects the disease/functional health status of the elderly. It is an easy-to-implement variable and it can reduce both recall bias and investigator bias, thus being widely used in health surveys. It is a cost-effective means of measuring the health status. However, the comparability of SRH in different populations should be studied in future.

The national elder mistreatment study: race and ethnicity findings

The prevalence of elder mistreatment with respect to race and ethnicity was examined in an unweighted sample of 5,777 participants (5,776 participants in weighted sample). Random Digit Dialing methodology was used to select a representative sample of community-dwelling older adults, and the survey was available in English and Spanish. Mistreatment types included emotional, physical, and sexual abuse. Race- and ethnicity-based differences were largely absent, and the only observed increase was for physical mistreatment among non-White older adults; however, this association was not sustained in multivariate analyses controlling for income, health status, and social support. Findings are in contrast to prior reports of increased risk of mistreatment in minority populations and point to correlated and modifiable factors of social support and poor health as targets for preventive intervention.

The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older, 1994-2006

PURPOSE

To assess associations among chronic obstructive pulmonary disease (COPD), disability as measured by activities of daily living (ADL) and instrumental ADL (IADL), engagement in social activities, and death among elderly noninstitutionalized US residents.

MATERIALS AND METHODS

A nationally representative sample of 9,415 adults who were aged ≥70 years and responded to the Second Supplement on Aging survey in 1994-1996 and mortality follow-up study through 2006 were assessed. Multiple logistic regression analyses were performed to assess the risk of all-cause mortality in participants with COPD after accounting for age, sex, race/ethnicity, and smoking status.

RESULTS

At baseline, approximately 9.6% of study participants reported having COPD. Compared with participants without COPD, those with COPD were significantly more likely (P<0.05) to have difficulty with at least one ADL (44.3% versus [vs] 27.5%) and with at least one IADL (59.9% vs 40.2%), significantly less likely to be engaged in social activities (32.6% vs 26.3%), and significantly more likely to die by 2006 (70.7% vs 60.4%; adjusted risk ratio 1.15, P<0.05). The association between COPD and risk for death was moderately attenuated by disability status.

CONCLUSION

COPD is positively associated with disability and mortality risk among US adults aged ≥70 years. The significant relationship between COPD and mortality risk was moderately attenuated, but was not completely explained by stages of ADL and IADL limitations and social activities.

Quality of life in female cancer survivors: is it related to ovarian reserve?

PURPOSE

The purpose of the study is to assess the quality-of-life scores and possible association with measures of ovarian reserve in female cancer survivors compared to healthy controls of similar age.

METHODS

In this prospective cohort study, fifty-nine cancer survivors aged 16-39 years and 66 healthy, similarly aged unexposed women were recruited at the University of Pennsylvania. The primary outcome measures are the generic and cancer-specific domain scores on the Quality of Life in Adult Cancer Survivors (QLACS) instrument, early follicular phase serum hormones, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), inhibin B (INH), anti-Mullerian hormone (AMH), and ovarian ultrasound measurements [ovarian volume and antral follicle count (AFC)].

RESULTS

Cancer survivors had significantly higher total and cancer-specific domain scores compared to unexposed participants. Serum AMH, INH, ovarian volume, and AFC were lower while serum FSH was higher in cancer survivors. Although survivors exhibited diminished ovarian reserve, these markers were not independently associated with total QLACS score. Cancer survivors with irregular menstrual function were found to have lower quality-of-life (QOL) scores than those with regular cycles.

CONCLUSIONS

We found that QOL appears to be significantly impaired in cancer survivors compared to controls, even when remote from initial cancer diagnosis. In addition, our study suggests that reproductive aging contributes to QOL in the setting of irregular menses and likely profound impairment of ovarian function.

Maximizing the value of mobile health monitoring by avoiding redundant patient reports: prediction of depression-related symptoms and adherence problems in automated health assessment services

Background

Interactive voice response (IVR) calls enhance health systems’ ability to identify health risk factors, thereby enabling targeted clinical follow-up. However, redundant assessments may increase patient dropout and represent a lost opportunity to collect more clinically useful data.

Objective

We determined the extent to which previous IVR assessments predicted subsequent responses among patients with depression diagnoses, potentially obviating the need to repeatedly collect the same information. We also evaluated whether frequent (ie, weekly) IVR assessment attempts were significantly more predictive of patients’ subsequent reports than information collected biweekly or monthly.

Methods

Using data from 1050 IVR assessments for 208 patients with depression diagnoses, we examined the predictability of four IVR-reported outcomes: moderate/severe depressive symptoms (score ≥10 on the PHQ-9), fair/poor general health, poor antidepressant adherence, and days in bed due to poor mental health. We used logistic models with training and test samples to predict patients’ IVR responses based on their five most recent weekly, biweekly, and monthly assessment attempts. The marginal benefit of more frequent assessments was evaluated based on Receiver Operator Characteristic (ROC) curves and statistical comparisons of the area under the curves (AUC).

Results

Patients’ reports about their depressive symptoms and perceived health status were highly predictable based on prior assessment responses. For models predicting moderate/severe depression, the AUC was 0.91 (95% CI 0.89-0.93) when assuming weekly assessment attempts and only slightly less when assuming biweekly assessments (AUC: 0.89; CI 0.87-0.91) or monthly attempts (AUC: 0.89; CI 0.86-0.91). The AUC for models predicting reports of fair/poor health status was similar when weekly assessments were compared with those occurring biweekly (P value for the difference=.11) or monthly (P=.81). Reports of medication adherence problems and days in bed were somewhat less predictable but also showed small differences between assessments attempted weekly, biweekly, and monthly.

Conclusions

The technical feasibility of gathering high frequency health data via IVR may in some instances exceed the clinical benefit of doing so. Predictive analytics could make data gathering more efficient with negligible loss in effectiveness. In particular, weekly or biweekly depressive symptom reports may provide little marginal information regarding how the person is doing relative to collecting that information monthly. The next generation of automated health assessment services should use data mining techniques to avoid redundant assessments and should gather data at the frequency that maximizes the value of the information collected.

Association between self-rated health and mortality: 10 years follow-up to the Pró-Saúde cohort study

BACKGROUND

The association between self-rated health (SRH) and mortality is well documented in the literature, but studies on the subject among young adults in Latin America are rare, as are those evaluating this association using repeated SRH measures, beyond the baseline measurement. This study aims to evaluate the association between SRH evaluated at three data collection stages and mortality.

METHODS

Cox regression models were used to examine the association between SRH (Very good, Good, Fair/Poor) varying over time and mortality, over a 10 year period, in a cohort of non-faculty civil servants at a public university in Rio de Janeiro, Brazil (Pró-Saúde Study, n = 4009, men = 44.4%).

RESULTS

About 40% of the population changed their self-rating over the course of follow-up. After adjustment for self-reported physician-diagnosed chronic diseases and other covariates, men who reported "Fair/Poor" SRH showed relative hazard of death of 2.13 (CI95% 1.03-4.40) and women, 3.43 (CI95% 1.23-9.59), as compared with those who reported "Very good" SRH.

CONCLUSIONS

In a population of young adults, our findings reinforce the role of SRH as a predictor of mortality, even controlling for objective measures of health.

Gender differences in the association between self-rated health and hypertension in a Korean adult population

Background

Self-rated health (SRH) has been reported as a predictor of mortality in previous studies. This study aimed to examine whether SRH is independently associated with hypertension and if there is a gender difference in this association.

Methods

16,956 community dwelling adults aged 20 and over within a defined geographic area participated in this study. Data on SRH, socio-demographic factors (age, gender, marital status, education) and health behaviors (smoking status, alcohol consumption, physical activity) were collected. Body mass index and blood pressure were measured. Logistic regression models were used to determine a relationship between SRH and hypertension.

Results

32.5% of the participants were found to have hypertension. Women were more likely than men to rate their SRH as poor (p < 0.001), and the older age groups rated their SRH more negatively in both men and women (p < 0.001). While the multivariate-adjusted odds ratio (OR, 95% CI) of participants rating their SRH as very poor for hypertension in men was OR 1.70 (1.13-2.58), that in women was OR 2.83 (1.80-4.44). Interaction between SRH and gender was significant (p < 0.001).

Conclusions

SRH was independently associated with hypertension in a Korean adult population. This association was modified by gender.

Head-to-head comparisons of quality of life instruments for young adult survivors of childhood cancer

PURPOSE

Few studies examine the relevance of health-related quality of life (HRQOL) instruments for young adult survivors of childhood cancer (YASCC). This study compared the psychometric properties of two survivor-specific instruments, the Quality of Life-Cancer Survivor (QOL-CS) and Quality of Life in Adult Cancer Survivor (QLACS).

METHODS

Data from 151 YASCC who enrolled in cancer/tumor registries of two medical centers were used. We examined construct validity by conducting confirmatory factor analysis using indices of chi-square statistic, comparative fit index, and root mean square error of approximation. We examined convergent/discriminant validity by comparing Pearson's correlation coefficients of homogeneous (e.g., physical functioning and pain) of both instruments versus heterogeneous domains (e.g., physical and psychological functioning). We assessed known-groups validity by examining the extent to which HRQOL differed by late effects and comorbid conditions and calculated relative validity (RV) defined as contrasting F-statistics of individual domains to the domain with the lowest F-statistic. Superior known-groups validity is observed if a domain of one instrument demonstrates a higher RV than other domains of the instruments.

RESULTS

YASCC data cannot replicate the constructs both instruments intend to measure, suggesting poor construct validity. Correlations of between-homogeneous and between-heterogeneous domains of both instruments were not discernible, suggesting poor convergent/discriminant validity. Both instruments were equally able to differentiate HRQOL between YASCC with and without late effects and comorbid conditions, suggesting similar known-groups validity.

CONCLUSIONS

Neither instrument is superior. Item response theory is suggested to select high-quality items from different instruments to improve HRQOL measure for YASCC.

Perception of Health, Suicidal Ideation, and Suicide Attempt Among Adults in the Community

Background: There is a well-known association between perception of poor physical health and higher rates of physical and psychological morbidity. However, little is known about the possible link between perception of health and suicidality. Aims: The study examines the relationship between perception of poor health and suicidal ideation and suicide attempt among adults in the community. Methods: Data were drawn from the National Comorbidity Survey (n = 5,877), a representative sample of individuals 15–54 years of age in the United States. Multiple logistic regression analyses were used to determine the relationship between perception of poor health and the likelihood of suicidal ideation and suicide attempt. Sociodemographic characteristics, comorbid mental disorders, and physical illnesses were adjusted for in the final model. Results: Perception of poor health was associated with a significantly increased likelihood of suicidal ideation (OR = 2.14 (1.36, 3.35) and suicide attempt (OR = 2.03 (1.06, 3.91)), which persisted after adjusting for differences in sociodemographic characteristics, mental disorders, and self-reported physical illnesses. Conclusions: Our findings provide initial evidence that perception of poor health is associated with a significantly increased likelihood of suicidal ideation and suicide attempt among adults in the community.

Prevalence and correlates of elder mistreatment in South Carolina: the South Carolina elder mistreatment study

The purposes of this study were to (a) derive prevalence estimates for elder mistreatment (emotional, physical, sexual, neglectful, and financial mistreatment of older adults [age 60 +]) in a randomly selected sample of South Carolinians; (b) examine correlates (i.e., potential risk factors) of mistreatment; and (c) examine incident characteristics of mistreatment events. Random Digit Dialing (RDD) was used to derive a representative sample in terms of age and gender; computer-assisted telephone interviewing was used to standardize collection of demographic, correlate, and mistreatment data. Prevalence estimates and mistreatment correlates were obtained and subjected to logistic regression. A total of 902 participants provided data. Prevalence for mistreatment types (since age 60) were 12.9% emotional, 2.1% physical, 0.3% sexual, 5.4% potential neglect, and 6.6% financial exploitation by family member. The most consistent correlates of mistreatment across abuse types were low social support and needing assistance with daily living activities. One in 10 participants reported either emotional, physical, sexual, or neglectful mistreatment within the past year, and 2 in 10 reported mistreatment since age 60. Across categories, the most consistent correlate of mistreatment was low social support, representing an area toward which preventive intervention may be directed with significant public health implications.

Short-term functional health and well-being after marital separation: does initiator status make a difference?

The authors investigated the health consequences of marital separation and whether the partners who initiated the separation had better health than those who did not. The data came from the Households, Income and Labour Dynamics in Australia (HILDA) panel study (2001-2007), comprising an analytic sample of 1,786 men and 2,068 women who were in their first marriages in 2001. For participants who separated, the authors distinguished between self-initiated, partner-initiated, and jointly initiated separations. Using linear random-intercept models, they examined scores on the 8 physical and mental health dimensions of Short Form 36, with scale scores ranging from 0 to 100. The results indicated that in general, men who separated had a decline in health, although this was more pronounced for mental dimensions than for physical dimensions. Among separated men, those whose partner initiated the separation had poorer mental health than those for whom the separation was self-initiated or jointly initiated (-4.61). Women's physical health improved with separation, but their mental health declined. For separated women, those whose partner initiated the separation had lower scores on the general health (-5.39), role-emotional (-11.08), and mental health (-7.18) scales than women who self-initiated separation. The health consequences of separation were less severe for self- or jointly initiated separations, suggesting that not all marital dissolutions are equally bad for health.

Health Measurement in Population Surveys: Combining Information from Self-reported and Observer-Measured Health Indicators

Our primary aim is to develop and validate a population health metric for survey-based health assessment that combines information from both self-reported and observer-measured health indicators. A secondary objective is to use this index to examine gender and socioeconomic differentials in the health status of older people. We use data from the second wave of the English Longitudinal Study of Ageing (ELSA) conducted in 2004 (N = 8,870). Information from three observer-measured and three self-reported health indicators was combined, using a latent variable modeling approach. A model that decomposed the manifest health indicators to valid health, systematic error, and random error was found to fit the data best. The latent health dimension represented somatic health, and was tested against three external criteria: height, waist-hip ratio, and smoking status. We present the Latent Index of Somatic Health (LISH), as well as a procedure for deriving the LISH in surveys employing both self- and observer-measured health indicators. Observer-measured and self-reported indicators were found to be equally biased in indexing population somatic health, with the exception of self-reports of functional limitations, which was the most reliable somatic health indicator. As expected, results showed that women had worse health than men and that socioeconomic advantage is associated with better somatic health.

Self-rated health in relation to rape and mental health disorders in a national sample of women

Overall health status is associated with long-term physical morbidity and mortality. Existing research on the correlates of mental health effects of rape suggests that rape victims are at higher risk for poor overall health status. Little is known, however, about how different rape tactics may relate to health status in rape victims. Our aim was to examine prevalence and correlates of self-rated health in a community sample of women, with particular emphasis on lifetime rape history (distinguishing between rape tactics), psychopathology, and substance use outcomes. A nationally representative sample of 3,001 U.S. women (age range: 18-86 years) residing in households with a telephone participated in a structured telephone interview. Poor self-rated health was endorsed by 11.4% of the sample. Final multivariable models showed that poor self-rated health was associated with older age (p<.001), lower educational attainment (p=.01), African American ethnicity (p=.03), lifetime posttraumatic stress disorder (PTSD; p<.001), lifetime major depressive episode (MDE; p=.01), and history of forcible rape (p=.01). Self-rated health was associated with three potentially modifiable variables (forcible rape, PTSD, and MDE). Therefore, trauma-focused interventions for rape victims should include collaboration on treatment or prevention modules that specifically address both mental and physical health.

Disease-specific quality-of-life measures as predictors of mortality in individuals living with type 2 diabetes

OBJECTIVE

The aim of this study was to examine whether disease-specific quality-of-life measures are independent predictors of mortality in patients with type 2 diabetes.

METHODS

A cohort of 420 patients with type 2 diabetes was recruited from the outpatient clinic of a medical center. At baseline, the disease-specific measure of the Diabetes Impact Measurement Scales (DIMS) and clinical and biological marker variables were measured. The DIMS domains included symptoms, diabetes-related morale, social role fulfillment, and well-being. Complications consisted of stroke, heart disease, visual impairment, amputations, kidney disease, cognitive impairment, and incontinence. Mortality data were collected from the national mortality register using personal identification numbers. Multivariate Cox proportional hazards models were used.

RESULTS

The overall mortality rate was 10.9%. The DIMS scales of symptoms and well-being and the total score were significantly associated with mortality, independent of age, gender, glucose control, and complications. When the scales of the DIMS were simultaneously considered, only symptom and social role fulfillment of the DIMS exerted a significant effect on mortality. Patients in the categories of the second and third quartiles (worse status) had significantly increased risk compared with those in the category of the fourth quartile (best status) [for the symptom scale: RR = 13.10, 95% confidence interval (CI) = 2.75-62.50 and RR = 5.49, 95% CI = 1.50-20.09, respectively; for the social role fulfillment scale: RR = 6.18, 95% CI = 1.10-34.87 and RR = 6.53, 95% CI = 1.40-30.57, respectively].

CONCLUSION

Our data suggest that the unique contribution of health-related quality of life to mortality was independent of objective health measures, such as glucose control and complications.

Self-rated health in relation to rape and mental health disorders in a national sample of college women

OBJECTIVE

The purpose of this study was to employ a multivariate approach to examine the correlates of self-rated health in a college sample of women, with particular emphasis on sexual assault history and related mental health outcomes.

PARTICIPANTS

A national sample of 2,000 female college students participated in a structured phone interview between January and June 2006.

METHODS

Interview modules assessed demographics, posttraumatic stress disorder, major depressive episode, substance use, rape experiences, and physical health.

RESULTS

Logistic regression analyses showed that poor self-rated health was associated with low income (odds ratio [OR] = 2.70), lifetime posttraumatic stress disorder (OR = 2.47), lifetime major depressive episode (OR = 2.56), past year illicit drug use (OR = 2.48), and multiple rape history (OR = 2.25).

CONCLUSIONS

These findings highlight the need for university mental health and medical service providers to assess for rape history, and to diagnose and treat related psychiatric problems in order to reduce physical morbidity.

Impact of social connections on risk of heart disease, cancer, and all-cause mortality among elderly Americans: findings from the Second Longitudinal Study of Aging (LSOA II)

This study examined the associations between social connections and risk of mortality among older adults aged ≥ 70 using data (n = 9246) from the United States LSOA II. Social connections were measured at baseline (1994-96), and survival status and cause of mortality were identified in December 2002. A weighted sum score of lack of social connections (LSC) was estimated. Associations between LSC score by quartiles and risk of mortality were examined prospectively using Cox's proportional hazard regression models. The results show that within an eight-year follow-up, African Americans (AA) had the highest age-adjusted all-cause mortality (48.7%), followed by white Americans (WA) (44.7%), and Asian Americans (ASA) (38.4%). Participants within the highest quartile of LSC score had 2 times higher risk of death from heart disease, cancer, and all-causes among AA, and 1.40-1.80 times higher among WA than those within the lowest quartile (p < 0.01). No significant association was observed among ASA, which was likely due to the small sample size of the ASA participants. In conclusion, the association between lack of social connections and risk of mortality in older adults raises important clinical and public health concerns, and calls for a reframing of health problems to include social connections.

Elder mistreatment and physical health among older adults: the South Carolina Elder Mistreatment Study

Exposure to potentially traumatic events (PTEs), including interpersonal violence, is associated with poorer physical health in young adults. This relation has not been well-investigated among older adults in specific populations. The present study was designed to investigate whether exposure to PTEs and elder mistreatment are associated with physical health status among older adults residing in South Carolina. Older adults aged 60 and above (N = 902) participated in a structured interview assessing elder mistreatment history, PTEs, demographics, and social dependency variables. Results demonstrated that PTEs were associated with poor self-rated health independently and when controlling for other significant predictors. A recent history of emotional mistreatment was associated with poor self-rated health independently, but not when controlling for other significant predictors.

Prevalence and correlates of poor self-rated health in the United States: the national elder mistreatment study

OBJECTIVES

Despite its subjective nature, self-report of health status is strongly correlated with long-term physical morbidity and mortality. Among the most reliable predictors of self-reported poor health is older age. In younger adult populations, the second reliable predictor of reported poor health is the experience of domestic and other interpersonal violence. However, very little research exits on the connection between elder mistreatment and self-reports of poor health. The aim of this study was to examine the level of, and correlates for, poor self-rated health in a community sample of older adults with particular emphasis on elder mistreatment history, demographics, and social dependency variables.

DESIGN

Random digit dialing telephone survey methodology.

SETTING

A national representative phone survey of noninstitutionalized U.S. household population.

PARTICIPANTS

Five thousand seven hundred seventy-seven U.S. adults, aged 60 years and older.

MEASUREMENTS

Individuals participated in a structured interview assessing elder mistreatment history, demographics, and social dependency variables.

RESULTS

Poor self-rated health was endorsed by 22.3% of the sample. Final multivariable logistic regression models showed that poor self-rated health was associated with unemployment, marital status, low income, low social support, use of social services, needing help in activities of daily living, and being bothered by emotional problems. Secondary analyses revealed a mediational role of emotional symptoms in the association between physical maltreatment and poor health.

CONCLUSIONS

Results suggest that poor health is common among older adults. This study also identified correlates of poor health that may be useful in identification of those in need of intervention.

Diagnosing diabetes in disadvantaged populations: the role of social participation

OBJECTIVE

Extensive social networks improve health and reduce mortality. Our aim was to investigate the effect of social participation on the probability that people with diabetes are diagnosed by health care providers and whether these effects differ in disadvantaged populations.

METHODS

Using the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, we included 1642 adults with diabetes. Diagnosed people with diabetes reported a provider diagnosis of diabetes; undiagnosed people with diabetes had a fasting plasma glucose over 125 mg/dl. Multivariate logistic regression models were used to assess the effect of social participation on diabetes diagnosis.

RESULTS

Increased social participation led to a higher probability of being diagnosed among people with diabetes who were low-income (OR = 1.19, P < 0.10) and who did not graduate from high school (OR = 1.21, P < 0.05).

CONCLUSIONS

People with diabetes who had low incomes and who did not graduate from high school were more likely to know they had diabetes if they had more frequent social interaction. Clarifying the mechanisms through which social participation affects the diagnosis of diabetes may help in developing strategies to improve diabetes identification.

Self-rated health (SRH) as a predictor of mortality in elderly men living in a medium-size city in Brazil

The objective was to examine the role of SRH as a predictor of mortality in elderly men in a medium-size Brazilian city. In 2 years of follow-up, 120 deaths occurred in the study population, with the following main causes: cardiovascular diseases (40%), neoplasms (22.5%), and respiratory diseases (10%). In practically all of the target variable strata, elderly men with fair or poor SRH showed a higher risk of dying as compared to those with excellent or good SRH. In the final model, the variables fair/poor SRH (hazard risk=HR=1.88, 95% confidence interval=95%CI=1.29-2.72), age (HR=1.05, 95%CI=1.03-1.08), public health system as the regular source of care (HR=1.69, 95%CI=1.10-2.60), current smoking (HR=1.94, 95%CI=1.24-3.04), and acute cardiovascular disease (HR=1.62, 95%CI=1.06-2.47) were associated with mortality. We concluded that SRH proved to be a predictive variable for mortality in elderly men after 2 years of follow-up, with nearly a twofold risk of death among men that reported fair or poor health, after adjusting for age, regular use of the public health system, current smoking, and acute cardiovascular disease. Given the importance of poor SRH for predicting mortality in elderly men, health services should incorporate this indicator into health assessments in this population.

Social and Psychological Resources Associated with Health Status in a Representative Sample of Adults Affected by the 2004 Florida Hurricanes

Overall health status after a disaster may be associated with long-term physical morbidity and mortality. Little is known about factors associated with overall health status in the aftermath of disasters. We examined self-rated health in relation to disaster characteristics, social resources, and post-disaster outcomes in a sample of adults who experienced the 2004 Florida hurricanes. We interviewed a representative sample of 1,452 adults aged 18 years and older residing in the 33 Florida counties that were in the direct path of at least one of the 2004 hurricanes (Charley, Frances, Ivan, Jeanne). Overall health status was assessed using a self-rating format known to be predictive of mortality. Poor self-rated health was endorsed by 14.6% of the sample. Final multivariable models showed that poor self-rated health was associated with older age (p < 0.001), extreme fear during the hurricane (p = 0.03), low social support (p = 0.03), and depression (p = 0.003) since the hurricane. Self-rated health following the Florida hurricanes was strongly associated with two variables (social support and depression) that potentially can be mitigated through targeted interventions after disasters. Future work should evaluate secondary prevention strategies that can address general health-related concerns in the wake of a disaster.

Gender differences in self-rated health, quality of life, quality of care, and metabolic control in patients with diabetes

BACKGROUND

Because the projected increase in the number of diabetic patients is expected to strain the capabilities of health care providers worldwide, we are challenged to find ways of reducing the burden of diabetes. Maintaining and improving health-related quality of life (QoL) for diabetic patients may be viewed as public health goals.

OBJECTIVE

The aim of this cross-sectional study was to compare different aspects of health, QoL, and quality of care (QoC) between men and women with diabetes as a basis for planning and managing diabees care.

METHODS

All patients in 2 age groups (aged 20-30 years [younger age group] and aged 50-60 years [middle-aged group]) who were registered with the Department of Endocrinology, Metabolism, and Diabetes at Karolinska University Hospital, Stockholm, Sweden, in October 2004, were recruited for a survey. Questions were included about self-rated health (SRH), QoL, QoC, diabetes-related worries, occupational status, physical activity level, living arrangements, and educational background. Glycosylated hemoglobin (HbA1c) values were obtained from medical records.

RESULTS

Of the 223 eligible patients (109 men, 114 women) in the younger age group, 49 men and 74 women responded to the questionnaire; of the 300 eligible patients (170 men, 130 women) in the middle-aged group, 120 men and 93 women responded. Middle-aged women rated their mental well-being and QoL as worse compared with men (P < 0.001 and P < 0.05, respectively). In both age groups, women reported more diabetes-related worries and less ability to cope (P < 0.05 for the younger age group and P < 0.001 for the middle-aged group for both variables), thus the differences were more marked for middleaged women. Although there were no gender differences in metabolic control, middle-aged women reported less satisfaction with diabetes care (P < 0.001). Higher HbA1c was related to worse SRH in both men and women when analyzing the age groups together (P < 0.05). This association was most prominent in young women, in whom having more diabetes-related worries was also related to higher HbA1c (P < 0.01).

CONCLUSION

In this study, women with diabetes appeared to have worse QoL and mental well-being compared with men with diabetes. Therefore, identifying strategies to improve SRH and QoL among diabetic patients, especially among women, is of great importance.

Chronic conditions and mortality among the oldest old

OBJECTIVES

We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.

METHODS

Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.

RESULTS

As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).

CONCLUSIONS

The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.

[Risk factors for 4-year mortality in older adults. Toledo Study]

INTRODUCTION

multiple factors contribute to mortality in older adults. Measures of physical and cognitive function are strong predictors of mortality, but the extent to which function, health-related quality of life and other factors contribute independently to mortality risk is not known.

MATERIAL AND METHODS

we performed a prospective study of a representative sample of people aged 65 years and older (n=3,214) followed-up for 4 years. Individuals from the sample were interviewed to obtain information about sociodemographic characteristics, comorbidity, functional status, health-related quality of life, and healthcare utilization. The main outcome measure was 4-year mortality. To assess the independent impact of each risk factor on mortality, several multivariate survival models were built using the Cox proportional hazard model.

RESULTS

in the 4 years of monitoring, 478 people died (14.9%). The variables independently associated with mortality risk were age 75 years or older (HR = 1.93), male gender (HR = 1.73), heart disease (HR = 1.32), chronic respiratory disease (HR = 1.78), activities of daily living disability (HR = 1.55), instrumental activities of daily living disability (HR = 2.19), cognitive impairment (HR = 1.39), poor health-related quality of life (HR = 1.85) and hospital admission in the year prior to the interview (HR = 1.51).

CONCLUSIONS

objective measures of physical and cognitive function are independent predictors of 4-year mortality in the elderly. Poor health-related quality of life is associated with mortality. The magnitude of this association is comparable to that of other well-know predictors of mortality. Instruments to measure health-related quality of life can be useful to evaluate health requirements in the elderly.

The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study

OBJECTIVES

Self-rated health (SRH) is considered a valid measure of health status as it has been shown to predict mortality in several studies. We examine whether SRH predicts mortality equally well in different socioeconomic groups.

METHODS

Data (14 879 men and 5525 women) are drawn from GAZEL, a prospective cohort study of French public utility workers. Data on SRH and the socioeconomic measures (education, occupational position and income) were taken from the baseline questionnaire (1989), when the average age of individuals was 44.2 years (SD = 3.5). Mortality follow-up was available for a mean of 17.2 years and analysed over the first 10 years and over the entire follow-up period. Associations between SRH and mortality were assessed using Cox regression models using the relative index of inequality (RII) to summarize associations.

RESULTS

The RII for the association between SRH and mortality over the first 10 years was 6.78 [95% confidence interval (CI) = 3.33-13.81] in the lowest occupational group and 2.10 (95% CI = 0.97-4.54) in the highest. For income, the RIIs were 8.82 (95% CI = 4.70-16.54) for the lowest and 1.80 (95% CI = 0.86-3.80) for the highest groups respectively. Findings over the full follow-up period were similar. The association between SRH and mortality was weaker in the high occupation and income groups, both in the short and the long term. The results for education were similar but generally weaker than for the other socioeconomic measures.

CONCLUSIONS

The predictive ability of SRH for mortality weakens with increasing socioeconomic advantage among middle-aged individuals. Thus SRH appears not to measure 'true' health status in a similar way across socioeconomic categories.

The relationship between self-rated health and mortality in older black and white Americans

OBJECTIVES

To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship.

DESIGN

Prospective cohort.

SETTING

Communities in the United States.

PARTICIPANTS

Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older.

MEASUREMENTS

Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index.

RESULTS

SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH.

CONCLUSION

This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.