Re-evaluating gender differences in self-rated health: The importance of cohort

Do Home and Community Environments Explain Self-Rated Health Among Older Canadians? Evidence From the 2018 Canadian Housing Survey

OBJECTIVES

This study examined the associations between home and community environmental factors and self-rated health (SRH) among older Canadians and how these associations vary by gender and living arrangements. Background: In social gerontology research, the psychosocial determinants of SRH have been widely investigated. Based on the environmental gerontology framework, this study examined the home and community environmental correlates of SRH.

METHOD

The sample (aged 60 or older) was drawn from the 2018 Canadian Housing Survey (4,086 men living alone; 6,471 men living with others; 9,170 women living alone; 4,876 women living with others). Multiple regression analyses were used to examine the relationships between SRH and potential environmental correlates in a hierarchical model.

RESULTS

Findings show that older men and women living alone reported lower levels of SRH than those living with others. Regression findings show common and unique home and community environmental predictors of SRH by group. Common predictors of higher SRH were private housing residence, larger living space, satisfaction with dwelling, volunteering, no perceived need for community services, and community safety. Home maintenance needs predicted lower SRH among older men and women living with others; uninhabitable conditions predicted poor SRH among older men living with others and older women living alone.

CONCLUSION

Results support the important effects of place in terms of home and community environments for older adults' SRH, and associations differed by gender and living arrangements.

Gender Gap in Self-Rated Health: A Cohort Perspective in Eastern European Countries

Background: The relationship between self-rated health and gender differs across countries and generations. The aim of this study is to analyze the effect of socioeconomic conditions on self-rated health from a generational perspective, its differential effect on gender, and its influence on the gender gap in order to explore health diversity using a multidisciplinary approach and considering policy implications in Eastern European countries. Methods: We used data drawn from the European Health Interview Survey for eight Eastern European countries and EUROSTAT from 2006 through to 2009. We conducted multilevel analyses to understand the individual and national health determinants of self-rated health by gender and to determine whether national differences remain after controlling for micro variables. In order to analyze the role of equity (Gini quartile) in gender differences, Oaxaca analyses were used. Results: The self-rated health gender gap increases with age. Individual characteristics, such as educational level or smoking, influence citizens’ perceived health, and have a stronger effect on women than on men. Knowing both the characteristics (endowment effects) and the effects of individual characteristics (coefficient effects) on health is important in order to understand gender gaps among people from the silent generation. Conclusions: Our research indicates that random effects are greater for men than for women. Moreover, random effects might be explained to a certain extent by economic equity (Gini index). The combined effects of gender, cohort, and geographical differences on self-rated health have to be taken into account to develop public health policies.

Built Environment and Self-Rated Health: Comparing Young, Middle-Aged, and Older People in Chengdu, China

OBJECTIVES

This article explores how the building-scale built environment is associated with self-rated health, examining differences in this association among younger, middle-aged, and older age groups. Features examined included building type, building condition, and sidewalk presence in front of dwellings.

BACKGROUND

Understanding how the relationships between built environments and health vary across age groups helps to build a healthy environment for all. However, most studies have concentrated on the neighborhood or indoor environment, rather than whole buildings, and few have compared age groups.

METHODS

This study analyzed survey data from 1,019 adults living in 40 neighborhoods in Chengdu, China, recruited through a clustered random sampling approach. It used a Bayesian logistic mixed-effects model with interaction terms between age-group indicators and other variables.

RESULTS

Significant differences exist in the relationships of self-rated health with some environmental and other indicators among age groups. For older people, living in multi-floor buildings, having a household smoker, and undertaking fewer hours of weekly exercise were associated with lower odds of reporting good, very good, or excellent health. These relationships were not identified among middle-aged and younger people. More education was associated with higher odds of reporting better health among older and middle-aged groups.

CONCLUSIONS

Older people experience more health-related challenges compared to middle-aged and younger people. However, among the examined built environment factors, building type was the only significant factor related to self-rated health among older people. To promote health among older people, this study recommends adding elevators in the multi-floor buildings.

Are Israelis becoming healthier? Trends in self-rated health, 2002-2018

Background

Life expectancy at birth in Israel is steadily increasing. This raises the question whether Israelis are becoming healthier. The purpose of this study is to estimate trends in morbidity and to try to explain what causes morbidity levels to change.

Methods

We used 17 years of repeated cross-sectional data from the Social Survey to estimate trends in self-rated health. We used regression models to explain the trends in self-rated health that were observed from 2002 to 2018.

Results

Four major findings emerged. First, morbidity as measured by self-rated health has declined. Second, gains in educational attainment do not explain the decline in morbidity. Third, the rise in national expenditure on health per capita is strongly correlated with the decline in morbidity. And fourth, the effect of the national expenditure on health per capita appears to be stronger among women and among those without an academic degree.

Conclusions

Self-rated health has improved. However, it has not improved to the same extent for all Israelis. The results of this study show that the health of women has improved more than that of men and that the health of non-academics has improved more than that of academics. The latter suggests that the progressive effect of public financing has offset the regressive effect of out-of-pocket payments on self-rated health.

Depression in women and men, cumulative disadvantage and gender inequality in 29 European countries

Macro-sociological theories stress the contribution of gender inequality to this gender gap in depression, while cumulative advantage/disadvantage theory (CAD) reminds us that mental health inequalities accumulate over the life course. We explore the complementarity of both perspectives in a variety of European countries using data of the European Social Survey (2006 2012, 2014, N of countries = 29; N of men = 53,680 and N of women = 63,103) and using an 8-item version of the CES-D. Results confirm that the relevance of gender stratification for the mental health of women and men in Europe depends on age. The gender gap is nearly absent amongst adults in their twenties in the most gender equal countries, while an impressive gender gap is present amongst older adults in gender unequal countries, in accordance with CAD theory. These effects occur on top of the mental health consequences of taking up work and family roles at various life stages. The convergence of the results predicted by gender stratification and cumulative disadvantage theories strengthen the case for the link between gender, disadvantage and depression.

Sex-Differences in Health-Related Characteristics of Senior Center Users: The VERISAÚDE Study

Background

We explored sex-related differences in sociodemographic, medical, psychological, and functional conditions in older adults attending to senior citizens’ centers.

Materials and Methods

An exploratory study was conducted as part of the VERISAÚDE project, a cross-sectional population-based study of individuals aged ≥65 years enrolled in senior community centers located in Galicia, Northwest of Spain (n = 749). A comprehensive gerontological evaluation was used to assess the social, medical, psychological, and functional characteristics of the sample.

Results

Women presented a higher prevalence of frailty (p = 0.017), a higher risk of malnutrition (p = 0.029), more medication consumption (p = 0.002), and polypharmacy (p = 0.008), higher depressive scores (p = 0.007), and lower cognitive scores (p = 0.045) than men, who showed a higher prevalence of hearing impairment (p = 0.034), toxic habits (all ps = 0.0001), and comorbidity (p = 0.002), and better quality of life (p = 0.030), and social resources (p = 0.002). Participants considered that attending and being involved in senior centers has a positive influence on their health and promotes successful aging.

Discussion

Important differences were found between women and men in health variables, suggesting that sex exerts a powerful influence on health status in older age. These differences should be identified and taking into account when designing interventions to promote active aging and to improve the quality of life of older adults. Taking a sex perspective during the evaluation process could lead to a higher number of older people being effectively treated in clinical practice.

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-Rated Health Predicts Mortality in Very Old Men-the Manitoba Follow-Up Study

Background

Self-rated health (SRH) predicts death, but there are few studies over long-time horizons that are able to explore the effect age may have on the relationship between SRH and mortality.

Objectives

1. To determine how SRH evolves over 20 years; and 2. To determine if SRH predicts death in very old men.

Methods

We analyzed a prospective cohort study of men who were fit for air crew training in the Second World War. In 1996, a regular questionnaire was administered to the 1,779 surviving participants. SRH was elicited with a 5-point Likert Scale with the categories: excellent, very good, good, fair and poor/bad. We examined the age-specific distribution of SRH in these categories from the age of 75 to 95 years, to the end of the follow-up period in 2018. We constructed age-specific Cox proportional hazard models with an outcome of time to death.

Results

SRH declined with age. The gradient in risk of death persisted across all ages; those with poor/fair/bad SRH had consistently higher mortality rates. However, the discrimination between good and excellent was less in those aged 85+.

Conclusions

SRH declines with advancing age, but continues to predict death in older men.

Decomposing gender inequalities in self-assessed health status in Liberia

Background: Understanding the magnitude of inequalities and drivers for reducing gender-related health inequalities is crucial in developing countries. This is particularly the case for Liberia with its very high level of gender-related inequalities in health and health outcomes.

Objective: This paper assesses the magnitude of gender health inequalities and the relative contribution of different factors to health inequality in Liberia.

Methods: Data came from the Liberian Household Income Expenditure Survey 2014. A two stage sampling methodology was used and 4,104 households were randomly selected and interviewed. The main variable of interest is dichotomised, good versus poor self-assessed health. Gender-related health inequality is assessed using the Oaxaca–Blinder decomposition for non-linear models. The decomposition reveals the magnitude of inequality and contributions of different factors.

Results: We found large gender disparities (0.054, p < 0.01) characterised by women disadvantages in health status. In addition, the gender health disparities are mostly pronounced in rural areas. About 54% of the gender inequalities in health status were explained by the differences in endowments. Equalizing access to information, wealth and utilization of mosquito nets would reduce the gender gaps by 44, 5 and 4%, respectively.

Conclusions: Addressing gender health inequalities inter alia requires access to health information (i.e. electronic and print media), gender responsive interventions that improve wealth in key sectors (i.e. education, employment, social protection, housing, and other appropriate infrastructure). In addition, the government, private sector and civil society should ensure that the health sector provides access to quality mosquito nets and improved health services including preventive care in order to reduce disease burden.

Depression Fully Mediates the Effect of Multimorbidity on Self-Rated Health for Economically Disadvantaged African American Men but Not Women

Background. Although chronic medical conditions (CMCs), depression, and self-rated health (SRH) are associated, their associations may depend on race, ethnicity, gender, and their intersections. In predominantly White samples, SRH is shown to better reflect the risk of mortality and multimorbidity for men than it is for women, which suggests that poor SRH among women may be caused not only by CMCs, but also by conditions like depression and social relations-a phenomenon known as "the sponge hypothesis." However, little is known about gender differences in the links between multimorbidity, depression, and SRH among African Americans (AAs). Objective. To study whether depression differently mediates the association between multimorbidity and SRH for economically disadvantaged AA men and women. Methods. This survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 AA older adults (age ≥ 55 years) were enrolled in this study, of which 266 were AA men and 474 were AA women. The independent variable was the number of CMCs. The dependent variable was SRH. Age and socioeconomic status (educational attainment and marital status) were covariates. Depression was the mediator. Gender was the moderator. Structural Equation Modeling (SEM) was used to analyze the data. Results. In the pooled sample that included both genders, depression partially mediated the effect of multimorbidity on SRH. In gender specific models, depression fully mediated the effects of multimorbidity on SRH for AA men but not AA women. For AA women but not AA men, social isolation was associated with depression. Conclusion. Gender differences exist in the role of depression as an underlying mechanism behind the effect of multimorbidity on the SRH of economically disadvantaged AA older adults. For AA men, depression may be the reason people with multimorbidity report worse SRH. For AA women, depression is only one of the many reasons individuals with multiple CMCs report poor SRH. Prevention of depression may differently influence the SRH of low-income AA men and women with multimorbidity.

Confounding and Statistical Significance of Indirect Effects: Childhood Adversity, Education, Smoking, and Anxious and Depressive Symptomatology

The life course perspective, the risky families model, and stress-and-coping models provide the rationale for assessing the role of smoking as a mediator in the association between childhood adversity and anxious and depressive symptomatology (ADS) in adulthood. However, no previous study has assessed the independent mediating role of smoking in the association between childhood adversity and ADS in adulthood. Moreover, the importance of mediator-response confounding variables has rarely been demonstrated empirically in social and psychiatric epidemiology. The aim of this paper was to (i) assess the mediating role of smoking in adulthood in the association between childhood adversity and ADS in adulthood, and (ii) assess the change in estimates due to different mediator-response confounding factors (education, alcohol intake, and social support). The present analysis used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 4,530), a representative prospective cohort study of men and women. Seven childhood adversities (low mother's education, low father's education, low financial conditions, exposure to passive smoke, psychological abuse, physical abuse, and substance abuse distress) were used to create a childhood adversity score. Smoking status was measured at a mean age of 54.7 years (Tromsø IV), and ADS in adulthood was measured at a mean age of 61.7 years (Tromsø V). Mediation analysis was used to assess the indirect effect and the proportion of mediated effect (%) of childhood adversity on ADS in adulthood via smoking in adulthood. The test-retest reliability of smoking was good (Kappa: 0.67, 95% CI: 0.63; 0.71) in this sample. Childhood adversity was associated with a 10% increased risk of smoking in adulthood (Relative risk: 1.10, 95% CI: 1.03; 1.18), and both childhood adversity and smoking in adulthood were associated with greater levels of ADS in adulthood (p < 0.001). Smoking in adulthood did not significantly mediate the association between childhood adversity and ADS in adulthood. However, when education was excluded as a mediator-response confounding variable, the indirect effect of childhood adversity on ADS in adulthood was statistically significant (p < 0.05). This study shows that a careful inclusion of potential confounding variables is important when assessing mediation.