Self-rated health and mortality in Chinese institutional elderly persons

Self-Rated Health as a Predictor of Mortality in Older Adults: A Systematic Review

The aim of this study was to investigate the link between self-reported health (SRH) and mortality in older adults. In total, 505 studies were found in PubMed and Scopus, of which 26 were included in this review. In total, 6 of the 26 studies included did not find any evidence of an association between SRH and mortality. Of the 21 studies that included community dwellers, 16 found a significant relationship between SRH and mortality. In total, 17 studies involved patients with no specific medical conditions; among these, 12 found a significant link between SRH and mortality. Among the studies in adults with specific medical conditions, eight showed a significant association between SRH and mortality. Among the 20 studies that definitely included people younger than 80 years, 14 found a significant association between SRH and mortality. Of the twenty-six studies, four examined short-term mortality; seven, medium-term mortality; and eighteen, long-term mortality. Among these, a significant association between SRH and mortality was found in 3, 7, and 12 studies, respectively. This study supports the existence of a significant relation between SRH and mortality. A better understanding of the components of SRH might help guide preventive health policies aimed at delaying mortality in the long term.

The distribution and correlates of self-rated health in elderly Chinese: the China Kadoorie Biobank study

BACKGROUND

Self-rated health (SRH) have been widely used as a valid indicator of health status at the population and individual level. We aimed to investigate the distribution and correlates of global SRH and age-comparative SRH in elderly Chinese.

METHODS

Survey of 57,693 men and 67,089 women aged 60 years and above was conducted in five rural (Gansu, Sichuan, Hunan, Henan, Zhejiang) and five urban areas (Heilongjiang, Shandong, Jiangsu, Guangxi, Hainan) in China between 2004 and 2008. Logistic regression models were used to calculate the relations of different factors with global SRH and age-comparative SRH.

RESULTS

Among the participants, 38.33% reported their global SRH as good or excellent while 61.67% as fair or poor, and 17.70% reported better age-comparative SRH while 17.99% as worse. In the multivariate model, compared to women, men tended to report a good global SRH and better age-comparative SRH, urban residents tend to report good global SRH and better age-comparative SRH. The socioeconomic and health behavior factors that were associated with good global SRH and better age-comparative SRH (with varying strengths of association) included: high educational level, high household income, house ownership, quitting smoking by own choices, occasional and current alcohol drinking, overweight, and high physical activity level. The factors that were associated with poor global SRH and worse age-comparative SRH included: quitting smoking by illness, former drinking, underweight, and weight lost ≥2.5 kg in the previous year.

CONCLUSIONS

We found a moderate level of good global SRH and a low level of better age-comparative SRH among elderly Chinese. We identified a number of demographic, socioeconomic and health behavior factors that were related to SRH measures. Our study emphasizes the importance of incorporating both global and age-comparative SRH measures in future studies, and considering gender inequalities and urban/rural disparity, as well as socioeconomic status and health behaviors as important modifiers of health.

Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50-75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81 % females, mean age = 62) included 67 % who spoke English poorly or not at all, 34 % who reported needing a medical interpreter, and 37 % who reported "often" or "always" needing assistance to read health information. Two-thirds reported poor self-rated health; many reported having access to racial-concordant (74 %) and language-concordant (86 %) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that are directly associated with health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants.

Self-Rated Health Status and Risk of Ischemic Heart Disease in the China Kadoorie Biobank Study: A Population-Based Cohort Study

BACKGROUND

Self-rated health (SRH) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease (IHD) have not been extensively explored, especially in a Chinese population.

METHODS AND RESULTS

More than 500 000 adults from 10 cities in China were followed from baseline (2004-2008) through December 31, 2013. Global and age-comparative SRH were reported from baseline questionnaires. Incident IHD cases were identified through links to well-established disease registry systems and the national health insurance system. During 3 423 542 person-years of follow-up, we identified 24 705 incident cases of IHD. In multivariable-adjusted models, both global and age-comparative SRH was significantly associated with incident IHD. Compared with excellent SRH, the hazard ratios for good, fair, and poor SRH were 1.02 (95% confidence interval [CI], 0.98-1.07), 1.32 (95% CI, 1.27-1.37), and 1.76 (95% CI, 1.68-1.85), respectively. Compared with better age-comparative SRH, the hazard ratios for same and worse age-comparative SRH were 1.23 (95% CI, 1.19-1.27) and 1.78 (95% CI, 1.70-1.86), respectively. The associations persisted in all subgroup analyses, although they were slightly modified by study location, education, and income levels.

CONCLUSIONS

A simple questionnaire for self-assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient tool for assessing future IHD risk.

Improving but unequal: Temporal trends in Chinese self-rated health, 1990-2012

This study examines temporal trends in the self-rated health of Chinese adults from 1990 to 2012. Concentration on this particular period in Chinese history provides insights into the health implications of China's massive societal transformation induced by economic reform. A series of cross-classified random effects models were estimated predicting favorable health status across time periods and adjusted for age, cohort effect and individual-level covariates. Results show that more recent birth cohorts exhibit better health conditions than earlier birth cohorts. However, period effects had a more profound effect than that of birth cohort. Net of age, cohort and individual-level covariates, there is a significant and increasing trend in self-rated health since the early 1990s. The period pattern was non-monotonic, with health improvement in the early 1990s, a dip later in that decade, but more evidence of improvement by 2012. We also found that health disparities have widened over the past 20 years, particularly on the basis of income and educational attainment.

Economic Segmentation and Health Inequalities in Urban Post-Reform China

During economic reform, Chinese economic labor markets became segmented by state sector associated with a planned redistributive economy and private sector associated with the market economy. By considering an economic sector as a concrete institutional setting in post-reform China, this paper compares the extent to which socioeconomic status, measured by education and income, is associated with self-rated health between state sector and private sector. The sample is limited to urban Chinese employees between the ages of 18 and 55 who were active in the labor force. By analyzing pooled data from the 1991-2006 Chinese Health and Nutrition Survey, I find that there is a stronger association between income and self-rated health in the private sector than in the state sector. This study suggests that sectoral differences between market and redistributive economies are an important key to understanding health inequalities in post-reform urban China.

Self-rated Health by Educational Level in Persons with and without Health Problems

The objective of this study was to determine whether differences in self-rated health by educational level vary as a function of the presence or absence of health problems. For this purpose, 12,800 people were studied from the 1995 and 1997 Spanish national health surveys to estimate the percentage of less-than-good and less-than-fair health for each educational level. The association between self-rated health and educational level was stronger in persons without health problems than in those who had health problems. The probable explanation for these results is that persons with different educational levels have different conceptions about what constitutes health.

Self-rated health and mortality in a prospective Chinese elderly cohort study in Hong Kong

OBJECTIVES

In the West, self-rated health reliably predicts death, but conceptualizations of health and cause-composition of mortality may be contextually specific. Little is known as to how self-rated health predicts death in non-Western settings.

METHODS

Multivariable Cox regression analysis was used to assess the adjusted associations of age-comparative and self-comparative self-rated health with death from all- and specific-causes using a population-based cohort of 66,820 Chinese (65+years) enrolled from 1998 to 2001 at 18 Elderly Health Centers in Hong Kong, and followed until May 31, 2012.

RESULTS

During an average of 10.9 years follow-up, 19,845 deaths occurred with 6336 from cancer. Worse age-comparative self-rated health, compared with better, was positively associated with death from all-causes (hazard ratio 1.68, 95% confidence interval 1.59, 1.77), cardiovascular disease (hazard ratio 1.83, 95% confidence interval 1.66, 2.02), stroke (hazard ratio 1.93, 95% confidence interval 1.63, 2.29), ischemic heart disease (hazard ratio 1.77, 95% confidence interval 1.51, 2.08), cancer (hazard ratio 1.17, 95% confidence interval 1.06, 1.30) and respiratory disease (hazard ratio 2.25, 95% confidence interval 2.01, 2.52), adjusted for age and sex. Self-comparative self-rated health was not associated with higher mortality.

CONCLUSION

Age-comparative self-rated health predicted death in older people from a non-Western setting although the association was less marked than in Western settings.

Difference of the associations between self-rated health and demographic characteristics, lifestyle, and psychosocial work environment between two types of Chinese worksite

BACKGROUND

Although studies of self-rated health (SRH) are conducted widely in developed countries, comprehensive assessments of the determinants of SRH in Chinese are scarce, particularly for working Chinese individuals. Determinants of SRH might differ among worksites based on differences in the nature and stress associated with different jobs, work intensity, and the lifestyles of employees.

METHODS

Two thousand and forty questionnaires that addressed SRH, demographic characteristics, lifestyle, and the psychosocial work environment were administered to employees at two worksites. A total of 1644 subjects provided complete data for analysis (80.6% response rate).

RESULTS

Participants from government departments had significantly better SRH than did those from high-tech enterprises (61.1% vs. 67.5%, respectively). Lifestyles were significantly less healthy at government departments compared with high-tech enterprises, whereas the psychosocial work environment was better. The results of unadjusted and adjusted models revealed differences between the potential health-influencing factors of participants based on their type of worksite. In logistic regression models, gender was strongly associated with SRH in all participants, whereas length of service was correlated with SRH only in participants from high-tech enterprises. In high-tech enterprises, good SRH was less common in physically inactive subjects vs. physically active participants (OR = 0.561). In government departments, passive smoking was negatively associated with SRH significantly. Social capital (OR = 1.073) and job control (OR = 1.550) were positively correlated with SRH in high-tech enterprises. Job control was the only psychosocial factor significantly associated with SRH in government departments.

CONCLUSIONS

Participants from different types of worksite reported different SRH, healthy lifestyles, and psychosocial work environments. Moreover, the association between SRH and demographic characteristics, lifestyle, and the psychosocial work environment significantly differed by type of worksite.

Outcomes of polypharmacy in nursing home residents

This article provides a comprehensive review of the outcomes of polypharmacy in nursing homes. Our review had some limitations. First, we only included studies beginning in 1990, and significant earlier studies are not included. Only English language articles were included. We only researched studies from MEDLINE, and may have missed studies based on our search terms and search tools. There are many definitions of polypharmacy in the literature, including number of medications or inappropriate medications. In this review, we defined polypharmacy as a high number of medications, but not inappropriate medications. It was not surprising that polypharmacy was consistently associated with an increased number of potentially inappropriate drugs. The majority of studies were viewed showed that polypharmacy was associated with increased ADEs, increased DDIs, and increased hospitalizations. We were surprised that polypharmacy was not consistently linked with falls, fractures, and mortality. For the mortality studies, it has been postulated that perhaps some patients receiving 10 or more medications may have been moribund or receiving end-of-life or hospice care. It is possible that the number of medications is not as important as the number of potentially in appropriate drugs. There need to be more studies on these outcomes, using different definitions of polypharmacy. Polypharmacy was associated with increased costs. The drug-related morbidity and mortality, including those resulting from inappropriate medications and increased staff time, led to increased costs. Use of consultant pharmacists has been shown to decrease polypharmacy costs.

Self-rated health status transition and long-term care need, of the oldest Chinese

OBJECTIVES

The objectives of this paper are: (1) to estimate the transition probabilities among self-rated health status for the oldest Chinese aged 80 and above; (2) to project the future need of long-term care due to changes in demography and health status among the oldest Chinese.

METHODS

Self-rated health data collected in Chinese Longitudinal Healthy Longevity Survey conducted in 1998, 2000 and 2002 were used to estimate the self-rated health status transition probabilities, and to project future long-term care need by calculating the number of unhealthy person-years.

RESULTS

The majority of the oldest Chinese's health status remains unchanged or worsens within 2 years. The number of unhealthy person-years rises regardless of gender, and the absolute number and increase rate of females are higher than those of males. Under the assumption that average care expenditure is 15 US dollars per hour in 2010, the long-term care expenditure will increase from 8352 million dollars in 2010 to 42,530 million dollars in 2050, a growth of more than 400% over the next 40 years.

CONCLUSIONS

Long-term care need for the oldest Chinese will rise rapidly in the next decades, which should stimulate increased governmental and public awareness of their need.

Self-Rated Health in middle-aged and elderly Chinese: distribution, determinants and associations with cardio-metabolic risk factors

Background

Self-rated health (SRH) has been demonstrated to be an accurate reflection of a person's health and a valid predictor of incident mortality and chronic morbidity. We aimed to evaluate the distribution and factors associated with SRH and its association with biomarkers of cardio-metabolic diseases among middle-aged and elderly Chinese.

Methods

Survey of 1,458 men and 1,831 women aged 50 to 70 years, conducted in one urban and two rural areas of Beijing and Shanghai in 2005. SRH status was measured and categorized as good (very good and good) vs. not good (fair, poor and very poor). Determinants of SRH and associations with biomarkers of cardio-metabolic diseases were evaluated using logistic regression.

Results

Thirty two percent of participants reported good SRH. Males and rural residents tended to report good SRH. After adjusting for potential confounders, residence, physical activity, employment status, sleep quality and presence of diabetes, cardiovascular disease, and depression were the main determinants of SRH. Those free from cardiovascular disease (OR 3.68; 95%CI 2.39; 5.66), rural residents (OR 1.89; 95% CI 1.47; 2.43), non-depressed participants (OR 2.50; 95% CI 1.67; 3.73) and those with good sleep quality (OR 2.95; 95% CI 2.22; 3.91) had almost twice or over the chance of reporting good SRH compared to their counterparts. There were significant associations -and trend- between SRH and levels of inflammatory markers, insulin levels and insulin resistance.

Conclusion

Only one third of middle-aged and elderly Chinese assessed their health status as good or very good. Although further longitudinal studies are required to confirm our findings, interventions targeting social inequalities, lifestyle patterns might not only contribute to prevent chronic morbidity but as well to improve populations' perceived health.

Widowhood and self-rated health among Chinese elders: the effect of economic condition

OBJECTIVE

To examine the mediating effect of economic condition (income, work status, self-rated financial situation and financial support) on widowhood and self-rated health in elderly Chinese.

METHODS

The study sample consists of 17,556 married and widowed elders age 60 and older selected from the nationwide 2000 Sample Survey on Aged Population in Urban/Rural China. Path analysis is used to identify the direct and indirect relationships of economic condition between widowhood and self-rated health.

RESULTS

Widowhood has a direct effect on self-rated health for those widowed for more than 4 years. Work status and perceived financial situation mediate that relationship regardless of length of time widowed. Being older, male, less educated, and functionally healthy are associated with better self-rated health among those widowed.

CONCLUSIONS

Work status and perceived financial situation have a more significant effect on widowhood and self-rated health than income and financial support. The findings have cross-cultural implications for developing elder care programs.

Determinants of Self-Rated Health Items With Different Points of Reference

Objective: This study assessed whether three commonly used self-rated health (SRH) items (global, age-comparative, and self-comparative) are equivalent measures of health perception for older adults. Method: Regression analyses were used to simultaneously contrast the associations between physical, psychological, and social factors relating to health for three SRH items, in a large ( N = 2,034) population-based sample of older adults (65 years and older) from the Australian Longitudinal Study of Aging. Results: Health perceptions were more positive for the age-comparative SRH measure, compared to the pessimistic ratings of the self-comparative measure, particularly for the oldest-old adults. Different patterns of associations between the health factors and SRH measures were found. Discussion: These results show the three SRH items are not equivalent measures of health and cannot be used interchangeably. The reference point of the SRH item has a considerable influence on health perceptions of older adults as it encapsulates unique health information.

Factors associated with self-rated health in older people living in institutions

BACKGROUND

Although self-rated health has been extensively studied in community older people, its determinants have seldom been investigated in institutional settings. We carried out a cross-sectional study to describe the physical, mental, and social factors associated with self-rated health in nursing homes and other geriatric facilities.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Does social participation by the elderly reduce mortality and cognitive impairment?

PURPOSE

This longitudinal study examines the effect of social participation on mortality and cognitive impairment for the elderly in Taiwan.

METHODS

Data were from an elderly population panel in Taiwan 'The Survey of Health and Living Status of the Elderly' 1993-1999. Social participation was defined as paid/unpaid job and participating in volunteer and social groups. Logistic regression analysis was used for predicting the influence of social participation to 6-year mortality and cognitive function impairment, by controlling of socioeconomic status and health-related variables.

RESULTS

The elderly with continuous paid work were more likely to participate in social groups. Having paid or unpaid work at the baseline year could lower the risk of mortality six years later, especially for men. Having unpaid work was associated with a higher risk of impaired cognitive function compared to that of non-workers. Participating in a religious group reduced the risk of mortality for women and participating in political groups reduced the risk of impaired cognitive function for men.

DISCUSSION

Participating in some types of social activities may reduce mortality or cognitive function impairment in the elderly. However, different activities, gender roles and uneven opportunities for work and social group participation may affect the risk of these endpoints.

Health and life satisfaction of ethnic minority older adults in mainland China: effects of financial strain

China has achieved indisputable economic growth in the past decades but, with it, unbalanced development across region and socio-economic groups. Little is known about how this impacts the lives of minority older adults who tend to live in remote inland areas. This study is the first attempt to examine and compare the relationships between financial strain, health conditions, and life satisfaction among ethnic minority and non-minority older adults in mainland China. Research data was obtained from respondents aged 60 and over who participated in the National Survey of the Aged Population in China (N = 995) in 2000. Hierarchical linear regression revealed financial strain to be significantly associated with life satisfaction and health, however functional health measurements of ADL were only associated for ethnic minority groups after controlling for socio-demographic variables. The impact of underdeveloped socio-economic levels and unfavorable living environments on health and life satisfaction is stronger among minority groups and warrants further attention.

Gender, ethnicity, health behaviour & self-rated health in Singapore

Background

Self-rated health and the factors that influence it have never been described in Singapore before. This paper presents a descriptive study of self-rated health in a nationally representative cross-sectional survey of 6236 persons.

Methods

As part of the National Health Surveillance Survey 2001, 6236 subjects aged 18 years and above were interviewed in the homes of participants by trained interviewers. The subjects were asked "In general, how would you rate your health today?", and given 5 possible responses. These were then categorized as "Good" (very good and good) and "Poor" (moderate, bad and very bad) self-rated health. The association of socio-economic and health behaviour risk factors with good self-rated health was studied using univariate and multivariate logistic regression analysis.

Results

Univariate analyses suggest that gender, ethnicity, marital status, education, household income, age, self-reported doctor-diagnosed illnesses, alcohol intake, exercise and BMI are all associated with poor self-rated health. In multivariate regression analyses, gender, ethnicity, household income, age, self-reported illness and current smoking and BMI were associated with poor self-rated health. There are gender differences in the association of various factors such as household income, smoking and BMI to self-rated health.

Conclusion

Socioeconomic factors and health behaviours are significantly associated with self-rated health, and gender differences are striking. We discuss why these factors may impact self-rated health and why gender differences may have been observed, propose directions for further research and comment on the public policy implications of our findings.

Patient perceptions of osteomyelitis, septic arthritis and prosthetic joint infection: the psychological influence of methicillin-resistant Staphylococcus aureus

INTRODUCTION

Patients form their own representations of their illness, which can be important determinants of their coping and influence outcome. Our aims were to (i) assess patient perceptions of osteomyelitis, septic arthritis and prosthetic joint infection, (ii) compare perceptions of methicillin-resistant Staphylococcus aureus (MRSA) with non-MRSA infection and (iii) investigate the emotional aspects of these infections.

METHODS

A questionnaire was developed from the 'Illness Perception Questionnaire' of Weinman et al.with additional questions assessing emotional response. This was offered to all patients with osteomyelitis, septic arthritis and prosthetic joint infection attending the Liverpool Hospital Infectious Diseases Outpatient Clinic during a 3-month period.

RESULTS

There were 91 respondents--25 with MRSA infection, 14 with MRSA colonization and 52 without MRSA. Seventy-nine per cent of all respondents felt that their infection was very serious and 76% felt their infection had had major consequences on their life. On multivariate analysis MRSA was associated with a greater emotional effect; the consequences and emotional effects of infection were greater in younger people and prosthetic joint infection was associated with less sense of control or cure.

CONCLUSION

Osteomyelitis, septic arthritis and prosthetic joint infection have a significant effect on an individual. Ongoing support and education are important, particularly for the young, those with prosthetic joint infection and patients with MRSA.

Age- versus time-comparative self-rated health in Hong Kong Chinese older adults

OBJECTIVES

The main objectives were to examine the relation between age-comparative (self vs others of same age) self-rated health (SRH) and time-comparative (self this year vs last year) SRH, and to evaluate which was more strongly associated with specific physical health problems.

METHODS

Cross-sectional data on two SRH measures and various physical health problems from 18749 male and 37413 female clients aged 65 or over from 18 Elderly Health Centres in Hong Kong were analysed using logistic regression with adjustment for potential confounders.

RESULTS

Men were more likely to report 'better' and less likely to report 'worse' SRH than women. 'Normal' was the most common option but the proportions choosing this decreased with age on both SRH measures. There was a fairly weak but statistically significant correlation between these two measures, with Kappa coefficients of 0.125 and 0.167 for men and women, respectively. For both men and women, there were significantly positive linear trends between age-comparative SRH options from 'better' to 'worse' and physical health problems, such as respiratory diseases, musculoskeletal diseases, any active chronic diseases, functional disability, depressive symptoms, taking medication regularly, and admission to hospital last year. However, for time-comparative SRH, those who rated 'normal' had the smallest odds ratios in all of the physical health problems above than those who rated 'better' or 'worse'.

CONCLUSIONS

The two SRH measures correlated with each other weakly but significantly. Age-comparative SRH was linearly, and time-comparative SRH was curvilinearly associated with physical health problems.

Comparative vs global self-rated health: associations with age and functional ability

BACKGROUND AND AIMS

This study examined the relationship of age and functional ability with comparative (age-referential) and global self-rated health (SRH), and the possible effect of selection bias. The focus is on differences between these questions and on the consequences which these differences have in research.

METHODS

The data came from the second wave of the Tampere Longitudinal Study on Ageing (TamELSA), consisting of 830 persons aged 60-99 years. The associations of both self-rated health measures with age and functional ability were examined using multinomial regression analyses.

RESULTS

People with increasing age, particularly over 80-year-old, are inclined to rate their health better than that of their age peers. The association of older age with better comparative SRH became even stronger after adjustment for functional ability, chronic diseases and sociodemographic factors. The relation of older age with global SRH was weaker than that with age-referential SRH. By contrast, functional ability was more strongly associated with global than with comparative SRH.

CONCLUSIONS

Our results suggest that comparative and global self-rated health cannot be used interchangeably. The comparative measure is more strongly "calibrated" by age. Therefore, when SRH is used as a measure in survey studies or in clinical settings, the global question should be preferred.

Knowledge and attitudes toward end-of-life care in veterans with symptomatic metastatic cancer

OBJECTIVES

The purposes of this study were to study symptomatic metastatic cancer patients' knowledge and attitudes toward end-of-life (EOL) care and to examine how patient-perceived health status affects attitudes toward EOL care and survival.

METHODS

From 1999 to 2002, 254 symptomatic metastatic cancer patients at the VA New Jersey Health Care System completed the Vermont Voices on Care of the Dying Questionnaire. Survival status and location of death were obtained. Descriptive statistics and the chi square method were used to assess the differences between African Americans (N=109) and Caucasians (N=135), and between different patient-perceived health status groups. A log-rank test was performed to assess for differences in median survival length between different patient-perceived health-status groups.

RESULTS

Veterans' responses to the Vermont questionnaire showed knowledge deficits regarding EOL care. There was wide variation in self-rankings of health status: 45.6% of patients rated their illness as serious and life threatening, 18.9% considered their health problem significant but not life threatening, 2.8% thought they were in good health, and one-third of patients were unsure about their health status. Most patients (86.2%) preferred physician frankness when communicating bad news and 61.8% preferred family involvement in EOL discussions. African American patients were less likely to have completed advance directives (p < 0.0001), to have knowledge about hospice programs (p < 0.00001), and to feel capable of assessing their health situation (p = 0.04). Patient-rated health status affected completion rates of advance directives and survival.

SIGNIFICANCE OF THE RESEARCH

These findings demonstrate knowledge deficits and racial differences in attitudes and values toward EOL care in veterans with cancer. The Vermont questionnaire enables patients to state their EOL preferences but may not be detailed enough for clinical applications. Patient-rated health status may be an important explanatory variable for EOL preferences and length of survival.

Global self-rated health data from a longitudinal study predicted mortality better than comparative self-rated health in old age

BACKGROUND AND OBJECTIVE

Self-rated health (SRH) has proved to be a predictor of subsequent mortality in old age. This study examines if the different question wording in SRH questions influences the association of SRH with mortality. Two SRH measures are examined, an age group comparative question and a global question with no explicit point of reference.

METHODS

The data are from the Tampere Longitudinal Study on Ageing, consisting 944 respondents aged 60-89 years. The association between mortality and self-rated health was studied at 5, 10, and 20 years follow-up using Cox proportional hazard models.

RESULTS

As crude measures, global SRH was significantly associated with mortality after 5, 10, and 20 years follow-up, but the comparative SRH was not. After adjustment for age and several social and health indicators both SRH measures were associated with increased mortality risk even after 20 years of follow-up.

CONCLUSIONS

Because the age-sensitivity of the comparative SRH the global SRH may be a more appropriate measure in studies where the study population has a large age range and also as a health measure in clinical settings.

Socio-demographic determinants of self-rated health in Brazil

Self-rated health has been used extensively in epidemiologic studies, not only due to its importance per se but also due to the validity established by its association with clinical conditions and with greater risk of subsequent morbidity and mortality. In this study, the socio-demographic determinants of good self-rated health are analyzed using data from the World Health Survey, adapted and carried out in Brazil in 2003. Logistic regression models were used, with age and sex as covariables, and educational level, a household assets index, and work-related indicators as measures of socioeconomic status. Besides the effects of sex and age, with consistently worst health perception among females and among the eldest, the results showed pronounced socioeconomic inequalities. After adjusting for age, among females the factors that contributed most to deterioration of health perception were incomplete education and material hardship; among males, besides material hardship, work related indicators (manual work, unemployment, work retirement or incapable to work) were also important determining factors. Among individuals with long-term illness or disability, the socioeconomic gradient persisted, although of smaller magnitude.

Self-rated health and life prognosis

BACKGROUND

Effects of self-rated health on survival using prospective surveys were evaluated during the past 20 years mainly in Europe and the US. An overview on this field of research was necessary to know the range of risk ratio (RR) of poor self-rated health.

METHODS

The MEDLINE database from 1982 until the end of 2001 was assessed. Self-rated health, mortality, and associated terms were used as key words and information retrieval was executed. After reference papers were broadly collected, 30 papers that included relative risk or odds ratio (OR) to express risk of poor self-rated health on survival were precisely reviewed. RR or OR of poor self-rated health against excellent self-rated health-controlling factors also recognized as relating to survival was calculated in these papers using multiple logistic regression or Cox regression analysis.

RESULTS

Multiple logistic regression analysis was frequently used in the first 10 years and Cox regression analysis was subsequently adopted in the following 10 years. Nearly one half of the study subjects were followed up for 5 years or less, and two thirds of the studies had a target population <5,000 persons. Mortality was largely dependent on age and ranged from 4.6 to 33%. When 54 data with 95% confidence interval (95% CI) were checked, statistical significance was observed in 41 data (75.9%).

CONCLUSIONS

Self-rated health is an independent predictor of survival that controls for other related health indicators or covariates. These types of research should be conducted not only in Western countries, but also in other areas including Japan.

Risk factors of mortality among the home-based disabled patients in central Taiwan

The objective of this study was to investigate the factors that affected mortality 1 year after an intensive service program among the disabled. Three hundred and twenty-two disabled subjects were selected from communities in central Taiwan. Sixty-six percent of the participants had cerebral vascular accident (CVA) followed by hypertension (28%) and diabetes mellitus (20%). After 1 year, 117 (36.3%) had died. The activities of daily living (ADL) scores of the participants who had died were significantly lower than those in the survival group. Of those who had pressure sores, 60% were in the 'death group' compared with about 40% in the survival group. Overall, mortality rate was 36.3% after the intensive service program. Based on multiple logistic regression, the factors that affected mortality were as follows: age over 65 years compared with less than 64 years (adjust odds ratio (AOR)=1.897), severe ADL dependence (AOR=0.502), incidence of CVA (AOR=0.448), and pressure sores (AOR=1.978). The authors recommend that the factors affecting mortality be evaluated urgently and that medical services and community support systems cooperate to provide disabled patients with adequate health care. In addition, the implementation of the intensive service program provides an opportunity and challenge for nurses to examine their working practices.

Social environment, life challenge, and health among the elderly in Taiwan

We use an ongoing longitudinal survey of elderly Taiwanese to examine the linkages among health, the social environment, and exposure to life challenge. Data from three waves of the survey provide measures of social hierarchy, social connection, life challenge, and health outcomes. On the basis of multinomial and binomial logistic models, we explore the effects of social factors and challenge on being unhealthy or deceased at follow-up. The estimates indicate that poor health status at follow-up is associated with (1) low socioeconomic status, not having any living children, limited networks of friends, and low participation in social activities; and (2) three life challenges-chronic financial problems, excessive demands placed by close relatives and friends, and having a spouse in poor health. Respondents facing several challenges or having multiple negative attributes in their social environment are especially likely to be unhealthy at follow-up, although negative attributes appear to be counteracted by positive ones. Many findings from Western societies extend to this Taiwanese population. However, some aspects of social connection and challenge hypothesized to affect health fail to reveal a significant association. The analysis identifies differences between men and women in the effects of specific challenges on health, but sex differences in the effects of socioeconomic status and social connection on health are not significant.

Determinantes das desigualdades na auto-avaliação do estado de saúde no Brasil: análise dos dados da PNAD/1998

O trabalho apresenta um panorama geral das desigualdades nos determinantes considerados na explicação das desigualdades na auto-avaliação do estado de saúde a partir dos dados da PNAD/1998. Mostra-se como existem gradientes na classificação do estado de saúde autopercebido de acordo com os níveis de educação, de renda per capita, de acordo com a raça ou cor de pele das pessoas, por grandes regiões do país e especialmente com o aumento da idade. Usando modelos de regressão logística, tenta-se explicar quais as determinações importantes dessa autoclassificação. Os resultados mais importantes indicam que educação e rendimento têm efeitos que se somam e que há diferenças entre homens e mulheres e de acordo com populações urbanas e rurais. As desigualdades na classificação do estado de saúde de acordo com a raça ou cor de pele das pessoas deixam de ser estatisticamente significativas depois de se controlar por nível de educação e de renda. Discute-se a utilidade desse tipo de informação sobre classificação autopercebida de saúde e a importância de melhorar, em futuros inquéritos, a qualidade dos dados por meio de sugestões sobre alterações nos procedimentos de entrevista.

Psychosocial work characteristics and self rated health in four post-communist countries

STUDY OBJECTIVES

To examine whether psychosocial factors at work are related to self rated health in post-communist countries.

DESIGN AND SETTINGS

Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors.

MAIN RESULTS

The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education.

CONCLUSIONS

The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.