Self- and physician-rated general health in relation to symptoms and diseases among women

Diverging ideas of health? Comparing the basis of health ratings across gender, age, and country

BACKGROUND

Self-rated health (SRH) is arguably the most widely used generic health measurement in survey research. However, SRH remains a black box for researchers. In our paper, we want to gain a better understanding of SRH by identifying its determinants, quantifying the contribution of different health domains to explain SRH, and by exploring the moderating role of gender, age groups, and the country of residence.

METHOD

Using data from 61,365 participants of the fifth wave (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE) living in fifteen European countries, we explain SRH via linear regression models. The independent variables are grouped into five health domains: functioning, diseases, pain, mental health, and behavior. Via dominance analysis, we focus on their individual contribution to explaining SRH and compare these contributions across gender, three age groups, and fifteen European countries.

RESULTS

Our model explains SRH rather well (R² = .51 for females/.48 for males) with functioning contributing most to the appraisal (.20/.18). Diseases were the second most relevant health dimension (.14/.16) followed by pain (.08/.07) and mental health (.07/.06). Health behavior (.02/.01) was less relevant for health ratings. This ranking held true for almost all countries with only little variance overall. A comparison of age groups indicated that the contribution of diseases and behavior to SRH decreased over the life-course while the contribution of functioning to R² increased.

CONCLUSION

Our paper demonstrates that SRH is largely based on diverse health information with functioning and diseases being most important. However, there is still room for idiosyncrasies or even bias.

How and to what extent can pensions facilitate increased use of health services by older people: evidence from social pension expansion in rural China

BACKGROUND

The proportion of people aged 60 years or over is growing faster than other age groups. Traditionally, retirement has been considered as both a loss to the labour market and an additional economic burden on the nation. More recently, it is widely accepted that retired people can still contribute to society in many ways, though the extent of their contributions will depend heavily on their state of health. In this context, a significant practical issue is how to encourage older people to use the health services they need. This study aims to evaluate the effects of pensions on older adults' health service utilization, and estimate the level of pension required to influence such utilization.

METHODS

Using data from a nationally representative sample survey, the China Health and Retirement Longitudinal Study, we adopted a fuzzy regression discontinuity design and undertook segmented regression analysis.

RESULTS

It was found that a pension did encourage low-income people to use both outpatient (OR = 1.219, 95% 1.018-1.460) and inpatient services (OR = 1.269, 95% 1.020-1.579); but also encouraged both low- and high-income people to choose self-treatment, specifically over-the-counter (OR = 1.208, 95% 1.037-1.407; OR = 1.206, 95% 1.024-1.419; respectively) and traditional Chinese medicines (OR = 1.452, 95% 1.094-1.932; OR = 1.456, 95% 1.079-1.955; respectively). However, receiving a pension had no effect on the frequency of outpatient and inpatient service use. Breakpoints for a pension to promote health service utilization were mainly located in the range 55-95 CNY (7.1-12.3 EUR or 8.0-13.8 USD).

CONCLUSIONS

A pension was found to have mixed effects on health service utilization for different income groups. Our study enriches existing evidence on the impact of pensions on healthcare-seeking behaviour and can be helpful in policy design and the formulation of improved models relating to pensions and healthcare utilisation.

Associations of Various Health-Ratings with Geriatric Giants, Mortality and Life Satisfaction in Older People

Self-rated health is routinely used in research and practise among general populations. Older people, however, seem to change their health perceptions. To accurately understand these changed perceptions we therefore need to study the correlates of older people’s self-ratings. We examined self-rated, nurse-rated and physician-rated health’s association with common disabilities in older people (the geriatric giants), mortality hazard and life satisfaction. For this, we used an age-representative population of 501 participant aged 85 from a middle-sized city in the Netherlands: the Leiden 85-plus Study. Participants with severe cognitive dysfunction were excluded. Participants themselves provided health ratings, as well as a visiting physician and a research nurse. Visual acuity, hearing loss, mobility, stability, urinal and faecal incontinence, cognitive function and mood (depressive symptoms) were included as geriatric giants. Participants provided a score for life satisfaction and were followed up for vital status. Concordance of self-rated health with physician-rated (k = .3 [.0]) and nurse-rated health (k = .2 [.0]) was low. All three ratings were associated with the geriatric giants except for hearing loss (all p < 0.001). Associations were equal in strength, except for depressive symptoms, which showed a stronger association with self-rated health (.8 [.1] versus .4 [.1]). Self-rated health predicted mortality less well than the other ratings. Self-rated health related stronger to life satisfaction than physician’s and nurse’s ratings. We conclude that professionals’ health ratings are more reflective of physical health whereas self-rated health reflects more the older person’s mental health, but all three health ratings are useful in research.

Using open-ended data to enrich survey results on the meanings of self-rated health: a study among women in underprivileged communities in Beirut, Lebanon

This study extends the debate on self-rated health by using different sources of data in the same study to explore the meanings of self-rated health among women who live in socio-economically disadvantaged communities in Beirut, Lebanon. Using data from the Urban Health Study, a cross-sectional household survey of 1,869 women between 15 and 59 years of age, multiple logistic regression models were developed to assess factors associated with self-rated health. Also, open-ended data was used to analyze women's explanations of their self-rated health ratings. Self-rated health was found to be a complex concept, associated not only with physical health but also with a combination of social, psychological, and behavioral factors. This open-ended analysis revealed new meanings of self-rated health that are often not included in self-rated health epidemiologic research, such as women's experiences with pain and fatigue, as well as exposure to financial stressors and the legacy of wars. We argue that triangulating survey and open-ended data provides a better understanding of the context-specific social and cultural meanings of self-rated health.

Causal thinking after a tsunami wave: karma beliefs, pessimistic explanatory style and health among Sri Lankan survivors

In 2004, one of the largest earthquakes ever recorded led to a tsunami devastating two-thirds of the Sri Lankan coastline. We examined whether certain causal beliefs (attributional style and karma, a Buddhist concept used to explain bad events) are associated with tsunami survivors experiencing PTSD and poor health about six months later. Previous studies of causal beliefs associated with illness following the same traumatic event have focused on Western countries and none have considered the role of karma. We interviewed 264 Sri Lankan tsunami survivors. As predicted, we found that belief in karma and a pessimistic explanatory style are independently associated with poor health and a pessimistic explanatory style is associated with PTSD, after adjusting for relevant factors. Thus, both universal and more culturally specific beliefs may contribute to coping following a natural disaster.

Symptom reporting and self-rated health among women in mid-life: the role of work characteristics and family responsibilities

This study investigated how socioeconomic factors and psychosocial conditions are related to self-reported health among 43-year-old women representing the general Swedish population (N = 569). Odds ratios and multiple logistic regression analyses were used for associations and effect modification, adjusted for symptom reporting in adolescence. Poor self-reported health was predicted by low income, financial worries, and job strain, as well as combined exposure to a high level of unpaid household work and job strain (double burden). In conclusion, poor psychosocial conditions related to working life, as well as to the combined impact of paid and unpaid work were revealed to be risk factors for poor self-reported health among middle-aged women. These results highlight the need for improving women's work conditions, as well as designing family policies that promote a better sharing of unpaid household tasks and responsibilities between spouses.

Physical symptoms after childbirth: prevalence and associations with self-rated health

OBJECTIVE

The aims of the present study were to describe the prevalence of a number of physical symptoms, as described by women themselves, two months and one year after childbirth in a national Swedish sample and to investigate the association between specific symptoms and women's self-rated health.

DESIGN

Cohort study.

SETTING

Swedish antenatal clinics.

POPULATION

A total of 2413 women recruited from 593 antenatal clinics in Sweden during three one-week periods evenly spread over one year (1999-2000), representing 54% of women eligible for the study and 76% of those who consented to participate. The representativity of the sample was assessed by comparison with the total Swedish birth cohort of 1999.

METHODS

Data were collected by means of questionnaires in early pregnancy, two months and one year after the birth and from the Swedish Medical Birth Register.

MAIN OUTCOME MEASURES

Self-reported symptoms and self-rated health.

RESULTS

Tiredness, headache, neck, shoulder and low back pain were common problems at two months as well as one year after childbirth. At two months, pain from caesarean section, dyspareunia and haemorrhoids were frequent problems, whereas stress incontinence was often reported at one year. Ninety-one percent of the women said self-rated health was 'very good' or 'good' at two months after birth, and 86% at one year. Low self-rated health was associated with symptoms that affected general physical functioning and wellbeing, such as tiredness, headache, musculoskeletal problems, mastitis, perineal pain, dysuria, stomachache and nausea. Complaints related to more specific situations, such as dyspareunia, constipation and stress incontinence were not associated with self-rated health.

CONCLUSION

Despite the fact that physical symptoms were common two months and one year after the birth, the vast majority of women rated their health as 'very good' or 'good'.

Symptom development and timing of menarche: a longitudinal study

Self-reported somatic complaints among females were studied cross sectionally at age 15 and 43, an longitudinally between these two ages. Specifically, the relationship between symptom development and timing of menarche was considered. The sample consisted of 477 females representing the general Swedish population. All the included symptoms were significantly related to each other at both ages. There was also longitudinal correlational stability for all the studied symptoms. Moreover, symptoms at age 15 were associated with early menarcheal timing. Pattern analyses of the studied symptoms were conducted with roots in person-oriented methodology. These results revealed structural as well as individual stability in patterns of symptom reporting for nearly 30 years. That is, similar configurations of symptoms were found at both ages, and it was the same females who reported being either symptom free or reporting a high symptom load at both ages. At age 15 fewer early maturing females than expected by chance reported being symptom free, whereas more of the late maturing females than expected reported being symptom free. However, there were no effects of menarcheal timing on symptom reporting at age 43.