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Davis J, Taira DA, Lim E, Chen J. Modeling Poverty and Health for Native Hawaiian and Pacific Islander and Asian Ethnic Populations. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:77-83. [PMID: 37901660 PMCID: PMC10612419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
This study examined differences in poverty and health among Native Hawaiians and Pacific Islanders (NHPI) and 6 disaggregated Asian ethnic subgroups and an aggregated Other Asian category. Participants were followed longitudinally for 2 years using data from 2009 to 2019 from the Current Population Survey, a monthly survey conducted by the Census Bureau. Having 2 years of data enabled the study to assess both prevalence of poverty and fair/poor health in only 1 of the 2 years and in both years. For NHPI, 13.5% were in poverty 1of the 2 years and 7.1% in both years. Asian ethnicities showed high variability ranging from a low of 6.4% for 1 year and 1.9% for 2 years among Asian Indians to 16.0% for 1 year and 6.3% for 2 years among Vietnamese. Fair/poor health also showed ethnic variability, made most apparent after age-sex adjustment in regression models. For poverty, after adjustment, Asian Indians, Filipinos and Japanese had significantly lower odds of being in poverty at least 1 year than NHPI. For having fair/poor health, Asian Indians and Japanese experienced lower odds than NHPI for both 1 and 2 years and Filipinos for 1 year, after age/sex adjustment. The results emphasize the diversity of Asian and Pacific Islander populations, the variability of poverty over time, and the importance of using disaggregated data to understand ethnic differences in poverty and health. These findings can be used to inform future modeling of social determinants on poverty and health among NHPI and Asian subgroups.
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Affiliation(s)
- James Davis
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (JD, EL, JC)
| | - Deborah A. Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, Hilo, HI (DAT)
| | - Eunjung Lim
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (JD, EL, JC)
| | - John Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (JD, EL, JC)
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Kang W, Malvaso A. Personality Traits Predict Self-Rated Health (SRH) in Coronary Heart Disease (CHD) Patients and Healthy Controls. Healthcare (Basel) 2023; 11:healthcare11111645. [PMID: 37297784 DOI: 10.3390/healthcare11111645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The objective of the present study is to examine the association between Big Five personality traits and self-rated health (SRH) among individuals with coronary heart disease (CHD), and to compare this relationship with that of healthy control participants, which is of importance as SRH can be a determinant of outcomes. METHODS The current study used data from 566 participants with CHD with a mean age of 63.00 (S.D. = 15.23) years old (61.13% males) and 8608 age- and sex-matched healthy controls with a mean age of 63.87 (S.D.= 9.60) years old (61.93% males) from the UKHLS. The current study used predictive normative modelling approaches, one-sample t tests, a hierarchical regression, and two multiple regressions. RESULTS The current study found that CHD patients have significantly lower Conscientiousness (t(565) = -3.84, p < 0.001, 95% C.I. [-0.28, -0.09], Cohen's d = -0.16) and SRH (t(565) = -13.83, p < 0.001, 95% C.I. [-0.68, -0.51], and Cohen's d = -0.58) scores compared to age and sex-matched healthy controls. Moreover, health status (controls vs. CHD patients) moderated the links between Neuroticism, Extraversion and SRH. Specifically, Neuroticism (b = -0.03, p < 0.01, 95% C.I. [-0.04, -0.01]), Openness (b = 0.04, p < 0.001, 95% C.I. [0.02, 0.06]), and Conscientiousness (b = 0.08, p < 0.001, 95% C.I. [0.06, 0.10]) were significant predictors of SRH in healthy controls, whereas Conscientiousness (b = 0.08, p < 0.05, 95% C.I. [0.01, 0.16]) and Extraversion (b = -0.09, p < 0.01, 95% C.I. [-0.15, -0.02]) were significant predictors of SRH in CHD patients. CONCLUSION Based on the close associations between personality traits and SRH, and the subsequent impact on patient outcomes, the results of this study should be taken into consideration by clinicians and health professionals when developing tailored treatment and intervention programs for their patients.
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Affiliation(s)
- Weixi Kang
- UK DRI Care Research and Technology Centre, Department of Brain Sciences, Imperial College London, London W12 0BZ, UK
| | - Antonio Malvaso
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
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Mokhele T, Mutyambizi C, Manyaapelo T, Ngobeni A, Ndinda C, Hongoro C. Determinants of Deteriorated Self-Perceived Health Status among Informal Settlement Dwellers in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4174. [PMID: 36901185 PMCID: PMC10001468 DOI: 10.3390/ijerph20054174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Self-perceived health (SPH) is a widely used measure of health amongst individuals that indicates an individual's overall subjective perception of their physical or mental health status. As rural to urban migration increases, the health of individuals within informal settlements becomes an increasing concern as these people are at high health and safety risk due to poor housing structures, overcrowding, poor sanitation and lack of services. This paper aimed to explore factors related to deteriorated SPH status among informal settlement dwellers in South Africa. This study used data from the first national representative Informal Settlements Survey in South Africa conducted by the Human Sciences Research Council (HSRC) in 2015. Stratified random sampling was applied to select informal settlements and households to participate in the study. Multivariate logistic regression and multinomial logistic regression analyses were performed to assess factors affecting deteriorated SPH among the informal settlement dwellers in South Africa. Informal settlement dwellers aged 30 to 39 years old (OR = 0.332 95%CI [0.131-0.840], p < 0.05), those with ZAR 5501 and more household income per month (OR = 0.365 95%CI [0.144-0.922], p < 0.05) and those who reported using drugs (OR = 0.069 95%CI [0.020-0.240], p < 0.001) were significantly less likely to believe that their SPH status had deteriorated compared to the year preceding the survey than their counterparts. Those who reported always running out of food (OR = 3.120 95%CI [1.258-7.737], p < 0.05) and those who reported having suffered from illness or injury in the past month preceding the survey (OR = 3.645 95%CI [2.147-6.186], p < 0.001) were significantly more likely to believe that their SPH status had deteriorated compared to the year preceding the survey than their counterparts. In addition, those who were employed were significantly (OR = 1.830 95%CI [1.001-3.347], p = 0.05) more likely to believe that their SPH status had deteriorated compared to the year preceding the survey than those who were unemployed with neutral SPH as a base category. Overall, the results from this study point to the importance of age, employment, income, lack of food, drug use and injury or illness as key determinants of SPH amongst informal settlement dwellers in South Africa. Given the rapid increasing number of informal settlements in the country, our findings do have implications for better understanding the drivers of deteriorating health in informal settlements. It is therefore recommended that these key factors be incorporated into future planning and policy development aimed at improving the standard of living and health of these vulnerable residents.
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Affiliation(s)
- Tholang Mokhele
- Geospatial Analytics, eResearch Knowledge Centre, Human Sciences Research Council, Pretoria 0001, South Africa
| | | | - Thabang Manyaapelo
- Africa Health Research Institute, KwaZulu-Natal, Somkhele 3935, South Africa
| | | | - Catherine Ndinda
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town 8000, South Africa
| | - Charles Hongoro
- Developmental, Capable and Ethical State Division, Human Sciences Research Council, Pretoria 0001, South Africa
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Pan Y, Pikhartova J, Bobak M, Pikhart H. Reliability and predictive validity of two scales of self-rated health in China: results from China Health and Retirement Longitudinal Study (CHARLS). BMC Public Health 2022; 22:1863. [PMID: 36199057 PMCID: PMC9536015 DOI: 10.1186/s12889-022-14218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite the widespread use of the single item self-rated health (SRH) question, its reliability has never been evaluated in Chinese population. Methods We used data from the China Health and Retirement Longitudinal Study, waves 1–4 (2011–2019). In wave 1, the same SRH question was asked twice, separated by other questions, on a subset of 4533 subjects, allowing us to examine the test–retest reliability of SRH. In addition, two versions of SRH questions (the WHO and US versions) were asked (n = 11,429). Kappa (κ), weighted kappa (\documentclass[12pt]{minimal}
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\begin{document}$${\kappa}_{w}$$\end{document}κw), and polychoric correlation coefficient (ρ) were used for reliability assessment. Cox proportional-hazards models were estimated to assess the predictive validity of SRH measurement for mortality over 7 years of follow up. To do so, relative index of inequality (RII) and slope index of inequality (SII) were estimated for each SRH scale. Results There was moderate to substantial test–retest reliability (κ = 0.54, \documentclass[12pt]{minimal}
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\begin{document}$${\kappa}_{w}$$\end{document}κw=0.63) of SRH; 31% of respondents who used the same scale twice changed their ratings after answering other questions. There was strong positive association between the two SRH measured by the two scales (ρ > 0.8). Compared with excellent/very good SRH, adjusted hazard ratios (HR) of death are 2.30 (95% CI, 1.70–3.13) for the US version and 1.86 (95% CI, 1.33–2.60) for the WHO version. Using slope indices of inequality, the WHO version estimated slightly larger mortality differences (RII = 3.50, SII = 15.53) than the US version (RII = 3.25, SII = 14.80). Conclusions In Chinese middle-aged and older population, the reliability of SRH is generally good, although the two commonly used versions of SRH scales could not be compared directly. Both indices predict mortality, with similar predictive validity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14218-1.
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Affiliation(s)
- Yuwei Pan
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Jitka Pikhartova
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Hynek Pikhart
- Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, UK.
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Patte M, Chaix B, Gerber P, Klein O, Perchoux C, Vallée J. [Environnement résidentiel et vieillissement en santé : le rôle de l'activité physique et de la participation sociale]. Can J Aging 2022; 41:348-362. [PMID: 35512791 DOI: 10.1017/s0714980821000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Le vieillissement démographique est un des défis majeurs du 21e siècle. Il pose directement la question du « vieillissement en santé », un processus aidant les personnes âgées à rester en bonne santé et indépendantes le plus longtemps possible. L'influence des facteurs environnementaux sur ce processus peut varier selon les individus et leurs comportements. L'enchevêtrement de ces facteurs représente un défi autant théorique que méthodologique. Cet article a pour objectifs i) de quantifier les associations entre l'environnement physique et social du quartier des personnes âgées et leur vieillissement en santé et ii) d'examiner si leur activité physique et leur participation sociale jouent un rôle de médiation dans ces associations. Si certaines caractéristiques du quartier relatives à la réputation, l'accès aux services, et la cohésion sociale sont associées au vieillissement en santé, il existe un soutien limité à l'idée que les comportements tiennent un rôle d'intermédiaire dans cette relation.
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Affiliation(s)
- Marion Patte
- Géographie-Cités - UMR 8504, Campus Condorcet 5, Cours des Humanités 93322 Aubervilliers Cedex, 75006, France
| | - Basile Chaix
- Inserm, UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique - Faculté de Médecine Site Saint-Antoine - 27, rue Chaligny 75012 Paris, France
| | - Philippe Gerber
- Luxembourg Institute of Socio-Economic Research, Maison des Sciences Humaines, 11, Porte des Sciences L-4366Esch-sur-Alzette / Belval, Luxembourg
| | - Olivier Klein
- Luxembourg Institute of Socio-Economic Research, Maison des Sciences Humaines, 11, Porte des Sciences L-4366Esch-sur-Alzette / Belval, Luxembourg
| | - Camille Perchoux
- Luxembourg Institute of Socio-Economic Research, Maison des Sciences Humaines, 11, Porte des Sciences L-4366Esch-sur-Alzette / Belval, Luxembourg
| | - Julie Vallée
- Géographie-Cités - UMR 8504, Campus Condorcet 5, Cours des Humanités 93322 Aubervilliers Cedex, 75006, France
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Holm AE, Gomes LC, Wegener A, Lima KO, Matos LO, Vieira IVM, Kaagaard MD, Pareek M, de Souza RM, Marinho CRF, Biering-Sørensen T, Silvestre OM, Brainin P. Is self-rated health associated with cardiovascular risk factors and disease in a low-income setting? A cross-sectional study from the Amazon Basin of Brazil. BMJ Open 2022; 12:e058277. [PMID: 36041756 PMCID: PMC9438027 DOI: 10.1136/bmjopen-2021-058277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Prior studies have suggested that self-rated health may be a useful indicator of cardiovascular disease. Consequently, we aimed to assess the relationship between self-rated health, cardiovascular risk factors and subclinical cardiac disease in the Amazon Basin. DESIGN Cross-sectional study. SETTING, PARTICIPANTS AND INTERVENTIONS In participants from the Amazon Basin of Brazil we obtained self-rated health according to a Visual Analogue Scale, ranging from 0 (poor) to 100 (excellent). We performed questionnaires, physical examination and echocardiography. Logistic and linear regression models were applied to assess self-rated health, cardiac risk factors and cardiac disease by echocardiography. Multivariable models were mutually adjusted for other cardiovascular risk factors, clinical and socioeconomic data, and known cardiac disease. OUTCOME MEASURES Cardiovascular risk factors and subclincial cardiac disease by echocardiography. RESULTS A total of 574 participants (mean age 41 years, 61% female) provided information on self-rated health (mean 75±21 (IQR 60-90) points). Self-rated health (per 10-point increase) was negatively associated with hypertension (OR 0.87 (95% CI 0.78 to 0.97), p=0.01), hypercholesterolaemia (OR 0.89 (95%CI 0.80 to 0.99), p=0.04) and positively with healthy diet (OR 1.13 (95%CI 1.04 to 1.24), p=0.004). Sex modified these associations (p-interaction <0.05) such that higher self-rated health was associated with healthy diet and physical activity in men, and lower odds of hypertension and hypercholesterolaemia in women. No relationship was found with left ventricular ejection fraction <45% (OR 0.97 (95% CI 0.77 to 1.23), p=0.8), left ventricular hypertrophy (OR 0.97 (95% CI 0.76 to 1.24), p=0.81) or diastolic dysfunction (OR 1.09 (95% CI 0.85 to 1.40), p=0.51). CONCLUSION Self-rated health was positively associated with health parameters in the Amazon Basin, but not with subclinical cardiac disease by echocardiography. Our findings are of hypothesis generating nature and future studies should aim to determine whether assessment of self-rated health may be useful for screening related to policy-making or lifestyle interventions. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT04445103; Post-results.
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Affiliation(s)
- Anna Engell Holm
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Laura Cordeiro Gomes
- Department of Parasitology, University of São Paulo, Institute of Biomedical Sciences, São Paulo, Brazil
| | - Alma Wegener
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Molly D Kaagaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Manan Pareek
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
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Jordan AN, Anning C, Wilkes L, Ball C, Pamphilon N, Clark CE, Bellenger NG, Shore AC, Sharp ASP, Valderas JM. Cross-cultural adaptation of the Spanish MINICHAL instrument into English for use in the United Kingdom. Health Qual Life Outcomes 2022; 20:39. [PMID: 35246164 PMCID: PMC8895672 DOI: 10.1186/s12955-022-01943-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/20/2022] [Indexed: 12/12/2022] Open
Abstract
Background Hypertension is a highly prevalent condition, with optimal treatment to BP targets conferring significant gains in terms of cardiovascular outcomes. Understanding why some patients do not achieve BP targets would be enhanced through greater understanding of their health-related quality of life (HRQoL). However, the only English language disease-specific instruments for measurement of HRQoL in hypertension have not been validated in accordance with accepted standards. It is proposed that the Spanish MINICHAL instrument for the assessment of HRQoL in hypertension could be translated, adapted and validated for use in the United Kingdom. The aim of the study was therefore to complete this process. Methods The MINICHAL authors were contacted and the original instrument obtained. This was then translated into English by two independent English-speakers, with these versions then reconciled, before back-translation and subsequent production of a 2nd reconciled version. Thereafter, a final version was produced after cognitive debriefing, for administration and psychometric analysis in the target population of patients living in the Exeter area (Southwest UK) aged 18–80 years with treatment-naïve grade II-III hypertension, before, during and after 18 weeks’ intensive treatment. Results The English-language instrument was administered to 30 individuals (median age: 58.5 years, 53% male). Psychometric analysis demonstrated a floor effect, though no ceiling effect. Internal consistency for both state of mind (StM) and somatic manifestations (SM) dimensions of the instrument were acceptable (Cronbach’s alpha = 0.81 and 0.75), as was test–retest reliability (ICC = 0.717 and 0.961) and construct validity, which was measured through co-administration with the EQ-5D-5L and Bulpitt-Fletcher instruments. No significant associations were found between scores and patient characteristics known to affect HRQoL. The EQ-5D-5L instrument found an improvement in HRQoL following treatment, with the StM and SM dimensions of the English language MINICHAL trending to support this (d = 0.32 and 0.02 respectively). Conclusions The present study details the successful English translation and validation of the MINICHAL instrument for use in individuals with hypertension. The data reported also supports an improvement in HRQoL with rapid treatment of grade II-III hypertension, a strategy which has been recommended by contemporaneous European guidelines. Trial registration ISRCTN registry number: 57475376 (assigned 25/06/2015).
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Affiliation(s)
- Andrew N Jordan
- NIHR Exeter Clinical Research Facility, Vascular Medicine, University Hospitals Dorset, Exeter, UK. .,Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.
| | - Christine Anning
- NIHR Exeter Clinical Research Facility, Vascular Medicine, University Hospitals Dorset, Exeter, UK
| | - Lindsay Wilkes
- NIHR Exeter Clinical Research Facility, Vascular Medicine, University Hospitals Dorset, Exeter, UK
| | - Claire Ball
- NIHR Exeter Clinical Research Facility, Vascular Medicine, University Hospitals Dorset, Exeter, UK
| | - Nicola Pamphilon
- NIHR Exeter Clinical Research Facility, Vascular Medicine, University Hospitals Dorset, Exeter, UK
| | - Christopher E Clark
- Health Services and Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, University of Exeter, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Nicholas G Bellenger
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.,Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Angela C Shore
- NIHR Exeter Clinical Research Facility, Vascular Medicine, University Hospitals Dorset, Exeter, UK.,Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Andrew S P Sharp
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.,Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Jose M Valderas
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.,Health Services and Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, University of Exeter, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
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Sutton-Klein J, Moody A, Hamilton I, Mindell JS. Associations between indoor temperature, self-rated health and socioeconomic position in a cross-sectional study of adults in England. BMJ Open 2021; 11:e038500. [PMID: 33622938 PMCID: PMC7907859 DOI: 10.1136/bmjopen-2020-038500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Excess winter deaths are a major public health concern in England and Wales, with an average of 20 000 deaths per year since 2010. Feeling cold at home during winter is associated with reporting poor general health; cold and damp homes have greater prevalence in lower socioeconomic groups. Overheating in the summer also has adverse health consequences. This study evaluates the association between indoor temperature and general health and the extent to which this is affected by socioeconomic and household factors. DESIGN Cross-sectional study. SETTING England. PARTICIPANTS Secondary data of 74 736 individuals living in England that took part in the Health Survey for England (HSE) between 2003 and 2014. The HSE is an annual household survey which uses multilevel stratification to select a new, nationally representative sample each year. The study sample comprised adults who had a nurse visit; the analytical sample was adults who had observations for indoor temperature and self-rated health. RESULTS Using both logistic and linear regression models to examine indoor temperature and health status, adjusting for socioeconomic and housing factors, the study found an association between poor health and higher indoor temperatures. Each one degree increase in indoor temperature was associated with a 1.4% (95% CI 0.5% to 2.3%) increase in the odds of poor health. After adjusting for income, education, employment type, household size and home ownership, the OR of poor health for each degree temperature rise increased by 19%, to a 1.7% (95% CI 0.7% to 2.6%) increase in odds of poor health with each degree temperature rise. CONCLUSION People with worse self-reported health had higher indoor temperatures after adjusting for household factors. People with worse health may have chosen to maintain warmer environments or been advised to. However, other latent factors, such as housing type and energy performance could have an effect.
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Tsukerman D, Leger KA, Charles ST. Work-family spillover stress predicts health outcomes across two decades. Soc Sci Med 2020; 265:113516. [PMID: 33213944 DOI: 10.1016/j.socscimed.2020.113516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/25/2020] [Accepted: 11/07/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE Work is a common source of stress for many adults, arising from situations that occur at work (e.g., job demands) as well as the worries and responsibilities that people take home with them (negative work-family spillover). Over time, work-related stress may impact physical health. OBJECTIVE The current study prospectively examined the effects of job demands and negative work-family spillover (NWFS) on three self-reported physical health measures. METHOD Participants in the Midlife in the United States (MIDUS) survey (N = 4200) reported their job demands and negative work-family spillover at wave 1. They also reported on their health across three waves of data collection. RESULTS Higher levels of NWFS at baseline were related to a higher number of self-reported chronic illnesses, greater functional limitation, and poorer self-rated health approximately 10 and 20 years later. In contrast, job demands were unrelated to any health indices at baseline or at the approximately 10- and 20-year follow-ups. CONCLUSIONS Findings suggest that NWFS is a unique form of stress with long-lasting and detrimental effects on physical health.
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Takahashi S, Tanno K, Yonekura Y, Ohsawa M, Kuribayashi T, Ishibashi Y, Omama S, Tanaka F, Sasaki R, Tsubota-Utsugi M, Takusari E, Koshiyama M, Onoda T, Sakata K, Itai K, Okayama A. Poor self-rated health predicts the incidence of functional disability in elderly community dwellers in Japan: a prospective cohort study. BMC Geriatr 2020; 20:328. [PMID: 32894047 PMCID: PMC7487733 DOI: 10.1186/s12877-020-01743-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study. METHODS A total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex. RESULTS The number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes). CONCLUSION Self-rated health, therefore, might be a useful predictor of functional disability in elderly people.
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Affiliation(s)
- Shuko Takahashi
- Division of Medical Education, Iwate Medical University, Idaidori 1-1-1, Yahaba-Cho, Shiwa-gun, Iwate, 028-3694, Japan. .,Department of Health and Welfare, Iwate Prefecture, Morioka, Iwate, Japan. .,Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | | | - Masaki Ohsawa
- Morioka Tsunagi Onsen Hospital, Morioka, Iwate, Japan
| | - Toru Kuribayashi
- Faculty of Humanities and Social Sciences, Iwate University, Morioka, Iwate, Japan
| | - Yasuhiro Ishibashi
- Department of Neurology and Gerontology, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Shinichi Omama
- Department of Neurosurgery, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Fumitaka Tanaka
- Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Ryohei Sasaki
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Megumi Tsubota-Utsugi
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Eri Takusari
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | | | | | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Shiwa-gun, Iwate, Japan
| | - Kazuyoshi Itai
- Department of Nutritional Sciences, Morioka University, Takizawa, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
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11
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Doan T, Strazdins L, Leach L. Cost of poor health to the labour market returns to education in Australia: another pathway for socio-economic inequality. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:635-648. [PMID: 32048084 DOI: 10.1007/s10198-020-01163-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
While several studies have estimated returns to education in Australia, there is limited evidence regarding the influence of health on the returns. This paper identifies how health affects returns to education in the labour market using the Heckman selection bias-corrected model. We measured health status using a self-rated health item with five response categories 'poor, fair, good, very good, and excellent'. The findings show that poor health or being unhealthy (defined as 'poor' or 'fair') interacts with education, such that the benefits of education (i.e. higher hourly wage rate) are curtailed in those with health problems; the adverse effect is stronger for those in lower skilled jobs. The estimated returns to an additional year of schooling on average over 2001-2017 is 7.43% and 6.88% for the healthy and unhealthy groups, respectively. Thus, the return for workers with poor health is 7.4% lower than the return for healthier workers (for each additional year of schooling). This gap in the returns is equivalent to a productivity loss of about $19-25 billion per year. The lower returns to education for workers with poor health likely results from lower productivity while at work rather than loss of working days as the estimate is based on an hourly wage rate (rather than days or hours absent from work). These lower returns may also be explained by unhealthy workers accepting lower paid jobs given the same levels of experience, skills and education that healthier counterparts have. The cost of poor health to labour market returns is further amplified in low-skilled occupations, a process which is likely to exacerbate socio-economic inequalities and undercut social mobility.
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Affiliation(s)
- Tinh Doan
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia.
| | - Lyndall Strazdins
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Liana Leach
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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12
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Karvonen S, Kestilä L, Rimpelä A. Accumulated Disadvantage over the Lower Secondary School Years in Helsinki Metropolitan Area, Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072290. [PMID: 32235306 PMCID: PMC7177873 DOI: 10.3390/ijerph17072290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022]
Abstract
Accumulated disadvantage (AD) is conceptualised here as an agglomeration of unfavourable or prejudicial conditions which in adolescence may compromise the progress to further education or future life chances. There are several theories on AD, suggesting, e.g., (1) an increase of AD by age and (2) trajectories (previous disadvantage predicts later disadvantage). Social pathways theory suggests that (3) a third factor (e.g., socioeconomic position, SEP) mediates or moderates the association between early and later disadvantage, while other theories imply (4) polarisation (a strengthening association between AD and SEP by age) or (5) equalisation (a weakening of association between AD and SEP). We apply these theories to longitudinal data of 7th graders (13 years, N = 5742), followed until the end of the 9th grade. Five dimensions of disadvantage were health (poor self-rated health), social behaviour (poor prosocial behaviour), normative (conduct disorders), educational (poor academic achievement), and economic (parental unemployment). The results show that the prevalence of AD increased over the follow-up as most indicators of disadvantage elevated. AD at the 7th grade predicted later AD, as did the SEP of the students. Moderation of AD by SEP was also observed. The study corroborates with hypotheses on increase of AD, trajectory, and social pathways but no signs of polarisation or equalisation were observed.
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Affiliation(s)
- Sakari Karvonen
- Finnish Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland;
- Correspondence:
| | - Laura Kestilä
- Finnish Institute for Health and Welfare (THL), FI-00271 Helsinki, Finland;
| | - Arja Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, FI-33014 Tampere, Finland;
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13
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Bao X, Borné Y, Yin S, Niu K, Orho-Melander M, Nilsson J, Melander O, Engström G. The associations of self-rated health with cardiovascular risk proteins: a proteomics approach. Clin Proteomics 2019; 16:40. [PMID: 31832026 PMCID: PMC6859604 DOI: 10.1186/s12014-019-9258-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Though subjective, poor self-rated health (SRH) has consistently been shown to predict cardiovascular disease (CVD). The underlying mechanism is unclear. This study evaluates the associations of SRH with biomarkers for CVD, aiming to explore potential pathways between poor SRH and CVD. Methods Based on the Malmö Diet and Cancer Cardiovascular Cohort study, a targeted proteomics approach was used to assess the associations of SRH with 88 cardiovascular risk proteins, measured in plasma from 4521 participants without CVD. The false discovery rate (FDR) was controlled using the Benjamini and Hochberg method. Covariates taken into consideration were age, sex, traditional CVD risk factors (low-density lipoprotein cholesterol, systolic blood pressure, anti-hypertensive medication, diabetes, body mass index, smoking), comorbidity, life-style and psycho-social factors (education level, living alone, alcohol consumption, low physical activity, psychiatric medication, sleep duration, and unemployment). Results Age and sex-adjusted associations with SRH was found for 34 plasma proteins. Nine of them remained significant after adjustments for traditional CVD risk factors. After further adjustment for comorbidity, life-style and psycho-social factors, only leptin (β = − 0.035, corrected p = 0.016) and C–C motif chemokine 20 (CCL20; β = − 0.054, corrected p = 0.016) were significantly associated with SRH. Conclusions Poor SRH was associated with raised concentrations of many plasma proteins. However, the relationships were largely attenuated by adjustments for CVD risk factors, comorbidity and psycho-social factors. Leptin and CCL20 were associated with poor SRH in the present study and could potentially be involved in the SRH–CVD link.
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Affiliation(s)
- Xue Bao
- 1Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden.,3Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yan Borné
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Songjiang Yin
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden.,4Department of Orthopedics, Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kaijun Niu
- 3Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Marju Orho-Melander
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Jan Nilsson
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Olle Melander
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Gunnar Engström
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
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14
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Forke CM, Catallozzi M, Localio AR, Grisso JA, Wiebe DJ, Fein JA. Intergenerational effects of witnessing domestic violence: Health of the witnesses and their children. Prev Med Rep 2019; 15:100942. [PMID: 31321205 PMCID: PMC6614529 DOI: 10.1016/j.pmedr.2019.100942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/09/2019] [Accepted: 06/28/2019] [Indexed: 12/04/2022] Open
Abstract
Studies that explore intergenerational effects of witnessing domestic violence during childhood (“witnessing”) are lacking. We examined effects of witnessing on general health status for adults who witnessed domestic violence during childhood and their children. Cross-sectional data from population-based phone interviews conducted in Philadelphia during 2012–2013 provided health information for 329 parents and children, and parent's witnessing exposure. We used propensity scores to predict parent's witnessing status using childhood confounders; response models included inverse probability of treatment weighting and population weights for standardization. Separate standardized multivariate logistic regression models provided average treatment effects and 95% CIs for associations between childhood witnessing and below average health for: 1) adults who witnessed and 2) their children. Sensitivity analyses guided interpretation. Standardized models showed no differences in average treatment effects for below average adult health for witnesses vs. non-witnesses [0.04 (−0.12, 0.19)]. Conversely, children whose parents witnessed had considerably higher probability of having below average health than children whose parents did not witness [0.15 (0.02, 0.28)]. An unmeasured confounder would need 3.0-fold associations with both exposure and outcome to completely remove observed effects, indicating a moderate relationship. However, the lower confidence bound could cross 1.0 in the presence of a weaker unmeasured confounder having 1.2-fold associations with both exposure and outcome, while controlling for our same measured confounders. Witnessing during childhood did not affect adult health in our population, but we found moderate evidence supporting harmful intergenerational effects of witnessing on health, with parent's witnessing exposure affecting their child's health.
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Affiliation(s)
- Christine M Forke
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America.,Violence Prevention Initiative, Children's Hospital of Philadelphia, United States of America.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States of America
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center-College of Physicians & Surgeons, United States of America.,Heilbrunn Department of Population & Family Health, Columbia University Medical Center, New York, NY, United States of America.,Mailman School of Public Health, New York, NY, United States of America
| | - A Russell Localio
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Jeane Ann Grisso
- Departments of Public Health, Nursing, and Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Joel A Fein
- Violence Prevention Initiative, Children's Hospital of Philadelphia, United States of America.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States of America.,Division of Emergency Medicine, Children's Hospital of Philadelphia, United States of America
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15
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Low-grade inflammation is negatively associated with physical Health-Related Quality of Life in healthy individuals: Results from The Danish Blood Donor Study (DBDS). PLoS One 2019; 14:e0214468. [PMID: 30921429 PMCID: PMC6438577 DOI: 10.1371/journal.pone.0214468] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background Health-Related Quality of Life (HRQL) represent individuals’ subjective assessment of their mental and physical well-being, and is highly predictive of future health. C-reactive protein (CRP) is a well-established marker of inflammation. Low-grade inflammation (LGI), defined as slightly increased CRP levels, is associated with increased risk of several diseases. LGI may reflect subclinical pathology, which could affect individual’s subjective health assessment. This study aimed to examine whether LGI has an independent impact on self-reported health or rather is a mediator of a confounder in a large population of healthy individuals. Methods Plasma CRP levels were measured in 17,024 participants from the Danish Blood Donor Study (DBDS). All participants completed a standard questionnaire including smoking status, and the 12-item short-form health survey (SF-12), which is a widely used scale for HRQL. SF-12 is reported as a mental (MCS) and physical (PCS) score. The relationship between LGI (defined as a plasma CRP level between 3 mg/L and 10 mg/L) and MCS or PCS was explored by mediation analysis and adjusted multivariable linear regression analysis. Multiple imputation modelling was used to remedy missing values. The analyses were stratified according to sex and use of combined oral contraception (OC). Results In the study, 1,542 (10.3%) participants had LGI. PCS was associated with LGI in all strata, i.e. women using OC: RC = -0.36 points lower PCS in participants with LGI vs no LGI, CI: -0.94 to -0.19, women not using OC: RC = -0.63, CI: -1.05 to -0.21 and men: RC = -0.76, CI: -1.10 to -0.42. But LGI had no impact on MCS. Predictors of lower PCS included obesity, current smoking, and waist circumference in all strata. Physical activity in leisure time was the only factor positively associated with PCS. Age and physical activity in leisure time was associated with increased MCS in all strata whereas current smoking was the only strong predictor of a reduction in MCS. Only a small effect of smoking on PCS was mediated through LGI. Conclusion In this population of healthy individuals, LGI had independent impact on lower self-rated physical health score in HRQL in both sexes, but was not associated with self-rated mental health score. A small and significant effect of smoking on physical health score was mediated through LGI.
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16
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Kose T. Gender differences in heart diseases: Evidence from Turkey. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Vie TL, Hufthammer KO, Meland E, Breidablik HJ. Self-rated health (SRH) in young people and causes of death and mortality in young adulthood. A prospective registry-based Norwegian HUNT-study. SSM Popul Health 2019; 7:100364. [PMID: 30723772 PMCID: PMC6351583 DOI: 10.1016/j.ssmph.2019.100364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/10/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022] Open
Abstract
Background Self-rated health (SRH), which is frequently used in epidemiological research, has consistently been shown to be a strong predictor of morbidity and mortality, even after controlling for demographic, social and medical risk factors. However, less is known about the relationship between SRH and all-cause and cause-specific mortality in young adulthood. Objective To investigate SRH in young people (13-35 years-old) as a predictor of all-cause mortality in young adulthood (deaths before age 54) and examine the associated causes of death. Methods We used data from two large population-based cohort studies (N = 23,679): Young-HUNT1 (1995-1997, persons 13 to 20 years old, participation rate = 90%) and HUNT2 (1995-1997, persons 20 to 35 years old, participation rate = 70%). These data were linked to the Norwegian Cause of Death Registry up to 2014, and 247 deaths were identified. Other predictors we examined included age, gender, baseline smoking, physical activity and physical and mental disability. Results Participants reporting 'not so good'/'poor' SRH had approximately twice the risk of death compared to those reporting 'good' or 'very good' SRH at baseline. The association between low SRH and risk of death was attenuated when the models were adjusted for other predictors, but remained statistically significant. The causes of death differed somewhat between SRH levels. Most of the deaths for people reporting 'very good' SRH at baseline were mostly due to neoplasms (34%) and other external causes (30%). The causes of death were more varied for people reporting 'not so good'/'poor' SRH, with suicide (23%), other external causes (21%) and other/unknown causes of death (17%) being the most frequent causes. Conclusion SRH predicts all-cause mortality in young adulthood, with poor SRH being associated with death in young adulthood. The findings also indicate different causes of death for different SRH. This knowledge is important for identifying groups at risk for later disease, which can potentially be used to prevent morbidity in the adult population.
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Affiliation(s)
- Tina Løkke Vie
- Helse Førde HF/Førde Health Trust, postboks 1000, 6807 Førde, Norway
| | | | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Norway
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18
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Harris SE, Hagenaars SP, Davies G, David Hill W, Liewald DCM, Ritchie SJ, Marioni RE, Sudlow CLM, Wardlaw JM, McIntosh AM, Gale CR, Deary IJ. Molecular genetic contributions to self-rated health. Int J Epidemiol 2018; 46:994-1009. [PMID: 27864402 PMCID: PMC5837683 DOI: 10.1093/ije/dyw219] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 01/11/2023] Open
Abstract
Background: Poorer self-rated health (SRH) predicts worse health outcomes, even when adjusted for objective measures of disease at time of rating. Twin studies indicate SRH has a heritability of up to 60% and that its genetic architecture may overlap with that of personality and cognition. Methods: We carried out a genome-wide association study (GWAS) of SRH on 111 749 members of the UK Biobank sample. Univariate genome-wide complex trait analysis (GCTA)-GREML analyses were used to estimate the proportion of variance explained by all common autosomal single nucleotide polymorphisms (SNPs) for SRH. Linkage disequilibrium (LD) score regression and polygenic risk scoring, two complementary methods, were used to investigate pleiotropy between SRH in the UK Biobank and up to 21 health-related and personality and cognitive traits from published GWAS consortia. Results: The GWAS identified 13 independent signals associated with SRH, including several in regions previously associated with diseases or disease-related traits. The strongest signal was on chromosome 2 (rs2360675, P = 1.77 x 10-10) close to KLF7. A second strong peak was identified on chromosome 6 in the major histocompatibility region (rs76380179, P = 6.15 x 10-10). The proportion of variance in SRH that was explained by all common genetic variants was 13%. Polygenic scores for the following traits and disorders were associated with SRH: cognitive ability, education, neuroticism, body mass index (BMI), longevity, attention-deficit hyperactivity disorder (ADHD), major depressive disorder, schizophrenia, lung function, blood pressure, coronary artery disease, large vessel disease stroke and type 2 diabetes. Conclusions: Individual differences in how people respond to a single item on SRH are partly explained by their genetic propensity to many common psychiatric and physical disorders and psychological traits.
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Affiliation(s)
- Sarah E Harris
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Medical Genetics Section, University of Edinburgh Centre for Genomic and Experimental Medicine and MRC Institute of Genetics and Molecular Medicine, Edinburgh, UK
| | - Saskia P Hagenaars
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Psychology.,Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Gail Davies
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Psychology
| | - W David Hill
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Psychology
| | - David C M Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Psychology
| | - Stuart J Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Psychology
| | - Riccardo E Marioni
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Medical Genetics Section, University of Edinburgh Centre for Genomic and Experimental Medicine and MRC Institute of Genetics and Molecular Medicine, Edinburgh, UK.,Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | | | | | | | | | - Cathie L M Sudlow
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Medical Genetics Section, University of Edinburgh Centre for Genomic and Experimental Medicine and MRC Institute of Genetics and Molecular Medicine, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Catharine R Gale
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Psychology.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Department of Psychology
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Vie TL, Hufthammer KO, Holmen TL, Meland E, Breidablik HJ. Is self-rated health in adolescence a predictor of prescribed medication in adulthood? Findings from the Nord Trøndelag Health Study and the Norwegian Prescription Database. SSM Popul Health 2017; 4:144-152. [PMID: 29349283 PMCID: PMC5769112 DOI: 10.1016/j.ssmph.2017.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 01/10/2023] Open
Abstract
Self-rated health (SRH) is a commonly used health indicator predicting morbidity and mortality in a range of populations. However, the relationship between SRH and medication is not well established. The aim of this study was to examine adolescent SRH as a predictor for prescribed medication later in young adulthood. Eighteen years' prospective data from the Nord-Trøndelag Health Study (HUNT) and the Norwegian Prescription Database (NorPD) were analyzed. Baseline data, gathered from 8982 adolescents (mean age 16.0 years) in the Young-HUNT I survey (1995-1997), were linked to individual data from NorPD, including information on all medications prescribed in 2013-2014. Gender-stratified negative binomial regression models were used to investigate the association between SRH and medication, also adjusted for age, baseline self-reported medicine use, physical and mental disability, smoking, and physical activity. Based on the Anatomical Therapeutic Chemical (ATC) Classification System, total consumption and consumption related to various ATC groups were examined. The adjusted analyses showed a dose-response relationship for females, with poorer SRH predicting higher average medication for both total consumption and for the ATC groups "Musculoskeletal system" (M), "Nervous system" (N; Analgesics (N02), Opioids (N02A)) and "Respiratiory system" (R). The predictive power of SRH, as well as the role of the adjustment factors, varies by gender and drug groups. This knowledge is important in order to identify risks for later disease and to capture pathological changes before and beyond the disease diagnosis, potentially preventing morbidity in the adult population.
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Affiliation(s)
- Tina Lokke Vie
- Helse Førde HF/Førde Health Trust, postboks 1000, 6807 Førde, Norway
| | | | - Turid Lingaas Holmen
- HUNT Research Centre, Department of Public health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Norway
| | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Norway
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20
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Beckie TM, Campbell SM, Schneider YT, Macario E. Self-care Activation, Social Support, and Self-care Behaviors among Women Living with Heart Failure. AMERICAN JOURNAL OF HEALTH EDUCATION 2017. [DOI: 10.1080/19325037.2017.1335626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Dong W, Pan X, Yu C, Lv J, Guo Y, Bian Z, Yang L, Chen Y, Wu T, Chen Z, Pan A, Li L. Self-Rated Health Status and Risk of Ischemic Heart Disease in the China Kadoorie Biobank Study: A Population-Based Cohort Study. J Am Heart Assoc 2017; 6:e006595. [PMID: 28939702 PMCID: PMC5634301 DOI: 10.1161/jaha.117.006595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/09/2017] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Wenhong Dong
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiong‐Fei Pan
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Canqing Yu
- Department of Epidemiology and BiostatisticsSchool of Public HealthBeijing UniversityBeijingChina
| | - Jun Lv
- Department of Epidemiology and BiostatisticsSchool of Public HealthBeijing UniversityBeijingChina
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingChina
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingChina
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Tangchun Wu
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - An Pan
- Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating)School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Liming Li
- Department of Epidemiology and BiostatisticsSchool of Public HealthBeijing UniversityBeijingChina
- Chinese Academy of Medical SciencesBeijingChina
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22
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Kucharska-Newton AM, Palta P, Burgard S, Griswold ME, Lund JL, Capistrant BD, Kritchevsky SB, Bandeen-Roche K, Windham BG. Operationalizing Frailty in the Atherosclerosis Risk in Communities Study Cohort. J Gerontol A Biol Sci Med Sci 2017; 72:382-388. [PMID: 27470301 DOI: 10.1093/gerona/glw144] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/08/2016] [Indexed: 11/13/2022] Open
Abstract
Background Factors that may contribute to the development of frailty in late life have not been widely investigated. The Atherosclerosis Risk in Communities (ARIC) Study cohort presents an opportunity to examine relationships of midlife risk factors with frailty in late life. However, we first present findings on the validation of an established frailty phenotype in this predominantly biracial population of older adults. Methods Among 6,080 participants, we defined frailty based upon the Cardiovascular Health Study (CHS) criteria incorporating measures of weight loss, exhaustion, slow walking speed, low physical activity, and low grip strength. Criterion and predictive validity of the frailty phenotype were estimated from associations between frailty status and participants' physical and mental health status, physiologic markers, and incident clinical outcomes. Results A total of 393 (6.5%) participants were classified as frail and 50.4% pre-frail, similar to CHS (6.9% frail, 46.6% pre-frail). In age-adjusted analyses, frailty was concurrently associated with depressive symptoms, low self-rated health, low medication adherence, and clinical biomarker levels (ie, cholesterol, hemoglobin A1c, white blood cell count, C-reactive protein, and hemoglobin). During 1-year follow-up, frailty was associated with falls, low physical ability, fatigue, and mortality. Conclusions These findings support the validity of the CHS frailty phenotype in the ARIC Study cohort. Future studies in ARIC may elucidate early-life exposures that contribute to late-life frailty.
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Affiliation(s)
- Anna M Kucharska-Newton
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill
| | - Priya Palta
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill
| | - Sheila Burgard
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill
| | - Michael E Griswold
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill
| | | | - Stephen B Kritchevsky
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - B Gwen Windham
- Department of Medicine, University of Mississippi Medical Center, Jackson
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23
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Pieters K, Utens EMWJ, Ter Hoeve N, van Geffen M, Dulfer K, Sunamura M, van Domburg RT. Age does matter: Younger pPCI patients profit more from cardiac rehabilitation than older patients. Int J Cardiol 2017; 230:659-662. [PMID: 28077225 DOI: 10.1016/j.ijcard.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended as secondary prevention in primary percutaneous coronary intervention (pPCI) patients. This study was conducted to expand the knowledge about age-effects of CR in pPCI patients. The aim of this study was to compare changes in subjective health status (SHS) during and after CR between patients <60years and patients ≥60years, who underwent pPCI after myocardial infarction. METHODS Between 2009 and 2011, in total 282 pPCI patients who participated in CR were included. Patients completed the Short Form 12 (SF-12) questionnaire at baseline (pre-CR), 3months (post-CR) and 12months follow-up. Patients were divided into two age-groups, <60years versus ≥60years. To compare improvements in SHS between groups, Generalized Estimating Equations (GEE) analyses were performed. RESULTS The mean physical component summary (PCS) score improved over time in both groups and even reached mean levels of the normative Dutch population. The improvement on the PCS score was equal in both age groups. The mental component summary (MCS) score also improved in both groups. Patients <60years reported on average more improvement on the MCS score than patients ≥60years (Exp(B) 1.019; 95%CI 1.009-1.030; P<0.001). However, mean levels of the normative Dutch population were not reached by patients <60years. CONCLUSION Even though pPCI patients <60years reported more improvement on the MCS score, mean levels of the normative Dutch population were not reached. Therefore, a tailored CR program with more focus on their mental status, may be beneficial in younger patients.
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Affiliation(s)
- Kimberley Pieters
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center Rotterdam, The Netherlands
| | - Myrna van Geffen
- Capri Cardiac Rehabilitation Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center Rotterdam, The Netherlands
| | - Karolijn Dulfer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, The Netherlands.
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24
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Nayak S, Hubbard A, Sidney S, Syme SL. Characteristics associated with self-rated health in the CARDIA study: Contextualising health determinants by income group. Prev Med Rep 2016; 4:199-208. [PMID: 27413683 PMCID: PMC4929073 DOI: 10.1016/j.pmedr.2016.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/05/2016] [Indexed: 11/24/2022] Open
Abstract
An understanding of factors influencing health in socioeconomic groups is required to reduce health inequalities. This study investigated combinations of health determinants associated with self-rated health (SRH), and their relative importance, in income-based groups. Cross-sectional data from year 15 (2000 - 2001) of the CARDIA study (Coronary Artery Risk Development in Young Adults, USA) - 3648 men and women (mean 40 years) - were split into 5 income-based groups. SRH responses were categorized as 'higher'/'lower'. Health determinants (medical, lifestyle, and social factors, living conditions) associated with SRH in each group were analyzed using classification tree analysis (CTA). Income and SRH were positively associated (p < 0.05). Data suggested an income-based gradient for lifestyle/medical/social factors/living conditions. Profiles, and relative importance ranking, of multi-domain health determinants, in relation to SRH, differed by income group. The highest ranking variable for each income group was chronic burden-personal health problem (<$25,000); physical activity ($25-50,000; $50-75,000; $100,000 +); and cigarettes/day ($75-100,000). In lower income groups, more risk factors and chronic burden indicators were associated with SRH. Social support, control over life, optimism, and resources for paying for basics/medical care/health insurance were greater (%) with higher income. SRH is a multidimensional measure; CTA is useful for contextualizing risk factors in relation to health status. Findings suggest that for lower income groups, addressing contributors to chronic burden is important alongside lifestyle/medical factors. In a proportionate universalism context, in addition to differences in intensity of public health action across the socioeconomic gradient, differences in the type of interventions to improve SRH may also be important.
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Affiliation(s)
- Shilpa Nayak
- Department of Public Health and Policy, The Whelan Building, Quadrangle, The University of Liverpool, Liverpool L69 3GB, UK
| | - Alan Hubbard
- School of Public Health, The University of California, Berkeley, Berkeley, USA
| | - Stephen Sidney
- Kaiser Permanente Northern California Division of Research, Oakland, USA
| | - S. Leonard Syme
- School of Public Health, The University of California, Berkeley, Berkeley, USA
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25
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Bardage C, Isacson D, Pedersen NL. Self-rated health as a predictor of mortality among persons with cardiovascular disease in Sweden. Scand J Public Health 2016. [DOI: 10.1177/14034948010290010601] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: This study analyses the association between cardiovascular diseases with and without drug treatment, self-rated health, and all-cause mortality during a 12-year period. Methods: Genetic and familial environmental effects were controlled for in subsets of the analyses. Data for these analyses were collected in 1984, 1987, 1990, and 1993 as part of the Swedish Adoption/Twin Study of Aging ( SATSA) , and through record linkage to mortality data from the National Cause of Death Register through 1996. Results: In multivariate analyses, both cardiovascular disease and low self-rated health were associated with higher mortality. Age, sex, lifestyle, diabetes, respiratory problems, cancer, depression, marital status, and social network were controlled for in the analyses. Furthermore, development of cardiovascular disease and/or drug use is associated with a decline in perceived health and higher mortality rates. The co-twin control analyses suggest that drug-treated cardiovascular disease has a marginal effect on survival beyond the effects of bad self-rated health and genetic liability to a certain survival time. Conclusions: This study shows that subjective health ratings are important predictors of mortality for persons with cardiovascular disease.
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Affiliation(s)
- Carola Bardage
- Department of Pharmacy, Pharmaceutical Services Research, Uppsala University, Sweden,
| | - Dag Isacson
- Division of Pharmacoepidemiology and Pharmacy Practice, University of Tromsø, Norway
| | - Nancy L. Pedersen
- Department of Medical Epidemiology, The Karolinska Institute, Stockholm, Sweden
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26
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MÅnsson NO, RÅstam L. Self-rated health as a predictor of disability pension and death — A prospective study of middle-aged men. Scand J Public Health 2016. [DOI: 10.1177/14034948010290020201] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Self-rated health (SRH) is increasingly attracting attention as a predictor of morbidity and mortality while its relation to impaired function has been given less momentum. The aim of this study was to assess the relation between SRH and the risk of being awarded a disability pension and premature death. Methods : Five birth-year cohorts of middle-aged men were invited to a screening programme and were followed for approximately 11 years. Of the 718 (12%) men with a disability pension granted during follow-up, 46% had perceived their health as perfect on inclusion. The corresponding figure for the remaining 5,082 men was 77%. Results: The crude relative risk (RR) of disability pension for men with SRH less than perfect was 3.7 (3.2-4.2). After adjustment for premorbidity/medication, the RR declined to 3.3 (2.8-3.8). The crude RR of death associated with SRH less than perfect was 1.6 (1.3-2.0), unchanged after adjustment. Conclusion: The results showed that SRH is a strong and independent predictor of disability and, to a lesser degree, of mortality.
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Affiliation(s)
- Nils-Ove MÅnsson
- Department of Community Medicine, Lund University, Malmö University Hospital, Malmö, Sweden,
| | - Lennart RÅstam
- Department of Community Medicine, Lund University, Malmö University Hospital, Malmö, Sweden
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27
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Sayed BA, French MT. To your health!: Re-examining the health benefits of moderate alcohol use. Soc Sci Med 2016; 167:20-8. [PMID: 27592004 DOI: 10.1016/j.socscimed.2016.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 08/07/2016] [Accepted: 08/20/2016] [Indexed: 11/15/2022]
Abstract
Although excessive alcohol use and alcohol misuse contribute to a broad range of health problems, recent research indicates that moderate alcohol consumption may in fact be beneficial. The present study builds on previous research to investigate the associations between alcohol use and self-rated health status among young adults. Using data collected in 2008 from the National Longitudinal Survey of Adolescent to Adult Health (Add Health), we use ordered probit models to determine whether the protective effects of moderate alcohol use are present after controlling for demographic, lifestyle, family background, and health-related characteristics. Our findings generally support earlier research with older samples, but some key gender differences are present. For women (n = 8275), moderate drinkers have better self-rated health status relative to former drinkers, infrequent drinkers, and light drinkers. Among men (n = 7207), the effects are mixed and less often significant. Differences in results between men and women point to the need for further gender-specific research and studies with other measures of health.
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Affiliation(s)
- Bisma Ali Sayed
- Department of Sociology and Health Economics Research Group, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, Room 122, P.O. Box 248251, Coral Gables, FL, 33124-0719, USA.
| | - Michael T French
- Department of Sociology and Health Economics Research Group, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, Room 122, P.O. Box 248251, Coral Gables, FL, 33124-0719, USA; Department of Health Sector Management and Policy, University of Miami, 5202 University Drive, Merrick Building, Room 121F, P.O. Box 248162, Coral Gables, FL, 33124-2030, USA; Department of Sociology, University of Miami, 5202 University Drive, Merrick Building, Room 121F, P.O. Box 248162, Coral Gables, FL, 33124-2030, USA; Department of Economics, University of Miami, 5202 University Drive, Merrick Building, Room 121F, P.O. Box 248162, Coral Gables, FL, 33124-2030, USA; Department of Public Health Sciences, University of Miami, 5202 University Drive, Merrick Building, Room 121F, P.O. Box 248162, Coral Gables, FL, 33124-2030, USA.
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28
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Shooshtari S, Menec V, Tate R. Comparing Predictors of Positive and Negative Self-Rated Health Between Younger (25-54) and Older (55+) Canadian Adults. Res Aging 2016. [DOI: 10.1177/0164027507305729] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to explore age variations in predictors of positive and negative self-rated health and examine whether the determinants of positive and negative self-rated health are mirror images. Longitudinal data were used from the National Population Health Survey for a nationally representative cohort of Canadians aged 25 years and older ( N = 9,371) to predict positive and negative self-rated health among younger and older Canadian adults separately. Self-rated health was confirmed as a multidimensional concept. There were variations in determinants of positive and negative self-rated health for the younger and the older Canadian adults. Determinants of self-rated health include but are not limited to physical health and functioning. Self-rated health is a dynamic evaluation influenced by changes over time in individuals' physical and psychosocial health, genetic endowment, socioeconomic status and health behaviors. Determinants of positive and negative self-rated health are not mirror images.
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29
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Darker CD, Donnelly-Swift E, Whiston L, Moore F, Barry JM. Determinants of self-rated health in an Irish deprived suburban population - a cross sectional face-to-face household survey. BMC Public Health 2016; 16:767. [PMID: 27515433 PMCID: PMC4982417 DOI: 10.1186/s12889-016-3442-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/04/2016] [Indexed: 02/03/2023] Open
Abstract
Background Self-rated health (SRH) is amongst the most frequently assessed health perceptions in epidemiological research. While there is a growing understanding of the role of SRH, a paradigm model has yet to be widely accepted with recent studies concluding that further work is required in determining whether there are important predictors of SRH yet to be highlighted. The aim of this paper is to determine what health and non-health related factors were associated with SRH in a suburban deprived population in Dublin, Ireland. Methods A cross sectional face-to-face household survey was conducted. Sampling consisted of random cluster sampling in 13 electoral divisions, with a sampling frame of 420 houses. Demographic information relating to the primary carer was collected. Health status of the primary carer was measured through SRH. Household level data included the presence or absence of persons with a chronic disease, persons who smoked, persons with a disability and healthcare utilisation of general practitioner and hospital level services. A logistic regression model was utilised in the analysis whereby the odds of primary carers with poor SRH were compared to the odds of carers with good SRH taking health and non-health related factors into account. Results Of the 420 households invited to participate a total of 343 were interviewed (81.6 % response rate). Nearly half of the primary carers indicated their health as being ‘good’ (n = 158/342; 46.2 %). Adjusting for the effects of other factors, the odds of primary carers with second level education were increased for having poor SRH in comparison to the odds of those with third level education (OR 3.96, 95 % CI (1.44, 11.63)). The odds of primary carers who were renting from the Council were increased for having poor SRH compared to the odds for those who owned their own property (OR 3.09, 95 % CI (1.31, 7.62)). The odds of primary carers that were unemployed (OR 3.91, 95 % CI 1.56, 10.25)) or retired, ill or unable to work (OR 4.06, 95 % CI (1.49, 11.61)) were higher for having poor SRH than the odds of those in employment. If any resident of the household had a chronic illness then the odds of the primary carer were increased for having poor SRH compared to the odds for a primary carer in a household where no resident had a chronic illness (OR 4.78, 95 % CI (2.09, 11.64)). If any resident of the household used the local hospital, the odds of the primary carer were increased for having poor SRH compared to the odds for the primary carer in a household where no resident used the local hospital (OR 2.01, 95 % CI (1.00, 4.14)). Conclusions SRH is affected by both health and non-health related factors. SRH is an easy to administer question that can identify vulnerable people who are at risk of poor health. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3442-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine D Darker
- Public Health & Primary Care, Institute of Population Health Trinity College Dublin, Tallaght Cross, Dublin 24, D24 DH74, Ireland.
| | - Erica Donnelly-Swift
- School of Dental Science, Dublin Dental University Hospital, Trinity College, Lincoln Place, Dublin 2, Ireland
| | - Lucy Whiston
- Public Health & Primary Care, Institute of Population Health Trinity College Dublin, Tallaght Cross, Dublin 24, D24 DH74, Ireland
| | - Fintan Moore
- Public Health & Primary Care, Institute of Population Health Trinity College Dublin, Tallaght Cross, Dublin 24, D24 DH74, Ireland
| | - Joe M Barry
- Public Health & Primary Care, Institute of Population Health Trinity College Dublin, Tallaght Cross, Dublin 24, D24 DH74, Ireland
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30
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Rodriguez A, Bohlin G, Lindmark G. A Longitudinal Study of Perceived Health during Pregnancy. J Health Psychol 2016; 4:129-47. [DOI: 10.1177/135910539900400209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Perceived health was studied longitudinally in a sample of 364 nulliparous women. Psychosocial, contextual, and biomedical factors were taken into account to predict medically relevant versus benign symptoms which were then used to predict perceived health over time. The results of structural equation modeling showed that pregnancy adjustment and medically relevant symptoms which were affected by social support, perceived stress, and negative affect predicted later perceived health. The outcomes of perceived health were examined during the third trimester in terms of medical care utilization and emergency room visits. Perceived health solely accounted for medical care utilization, while emergency room visits were accounted by medical care utilization and perceived stress.
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Affiliation(s)
| | | | - Gunilla Lindmark
- Department of Obstetrics and Gynaecology, Uppsala University, Sweden
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31
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Tingström PR, Kamwendo K, Bergdahl B. Effects of a Problem-Based Learning Rehabilitation Programme on Quality of Life in Patients with Coronary Artery Disease. Eur J Cardiovasc Nurs 2016; 4:324-30. [PMID: 15923147 DOI: 10.1016/j.ejcnurse.2005.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 03/18/2005] [Accepted: 04/18/2005] [Indexed: 12/11/2022]
Abstract
Background: The aim of cardiac rehabilitation (CR) is not only physical improvement but also increased quality of life (QoL). A CR programme based upon problem based learning (PBL) philosophy was developed, to achieve and apply new knowledge related to coronary artery disease (CAD). The aim of this paper was to evaluate the impact of the PBL programme on QoL. Methods: 207 consecutive patients < 70 years of age with a recent event of CAD were randomised to a PBL group ( n = 104) or a control group ( n = 103). In addition to standard treatment, the PBL patients participated in 13 group sessions during 1 year, where individual learning needs and behavioural changes were focused upon. QoL was measured by the Ladder of Life, Self-Rated Health (SRH), SF 36, and Cardiac Health Profile (CHP). Results: Significant differences between the groups, favouring the PBL patients, were found by global instruments: more optimistic expectations of the future QoL and a better general condition. No differences were found by SRH, SF 36 or subscales of CHP, but QoL increased in both groups during the year. Conclusions: The main outcome was that QoL improved in both groups with some effects favouring the PBL programme.
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Affiliation(s)
- Pia R Tingström
- Department of Medicine and Care, Division of Cardiology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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32
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Jørgensen P, Langhammer A, Krokstad S, Forsmo S. Diagnostic labelling influences self-rated health. A prospective cohort study: the HUNT Study, Norway. Fam Pract 2015; 32:492-9. [PMID: 26240089 PMCID: PMC4576760 DOI: 10.1093/fampra/cmv065] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Studies have shown an independent association between poor self-rated health (SRH) and increased mortality. Few studies, however, have investigated any possible impact on SRH of diagnostic labelling. OBJECTIVE To test whether SRH differed in persons with known and unknown hypothyroidism, diabetes mellitus (DM) or hypertension, opposed to persons without these conditions, after 11-year follow-up. METHODS Prospective population-based cohort study in North-Trøndelag County, Norway, HUNT2 (1995-97) to HUNT3 (2006-08). All inhabitants aged 20 years and older were invited. The response rate was 69.5% in HUNT2 and 54.1% in HUNT3. In total, 34144 persons aged 20-70 years were included in the study population. The outcome was poor SRH. RESULTS Persons with known disease had an increased odds ratio (OR) to report poor SRH at follow-up; figures ranging from 1.11 (0.68-1.79) to 2.52 (1.46-4.34) (men with hypothyroidism kept out owing to too few numbers). However, in persons not reporting, but having laboratory results indicating these diseases (unknown disease), no corresponding associations with SRH were found. Contrary, the OR for poor SRH in women with unknown hypothyroidism and unknown hypertension was 0.64 (0.38-1.06) and 0.89 (0.79-1.01), respectively. CONCLUSIONS Awareness opposed to ignorance of hypothyroidism, DM and hypertension seemed to be associated with poor perceived health, suggesting that diagnostic labelling could have a negative effect on SRH. This relationship needs to be tested more thoroughly in future research but should be kept in mind regarding the benefits of early diagnosing of diseases.
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Affiliation(s)
- Pål Jørgensen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7489 Trondheim and
| | - Arnulf Langhammer
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, 7600 Levanger, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, 7489 Trondheim and
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Demographic and socioeconomic inequalities for self-rated health and happiness in elderly: The situation for Turkey regarding World Values Survey between 1990 and 2013. Arch Gerontol Geriatr 2015; 61:224-30. [DOI: 10.1016/j.archger.2015.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
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Ko Y, Boo S. Self-perceived health versus actual cardiovascular disease risks. Jpn J Nurs Sci 2015; 13:65-74. [PMID: 26103790 DOI: 10.1111/jjns.12087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 04/30/2015] [Indexed: 01/22/2023]
Abstract
AIM Self-perceived poor health is related to cardiovascular disease (CVD) risk perception, cardiovascular event, hospital readmission, and death from CVD. This study evaluated the associations between self-perceived health and actual CVD risk in South Koreans as well as the influence of sociodemographic and cardiovascular risk factors on self-perceived poor health. METHODS This is a secondary data analysis of the 2010 Korea National Health and Nutrition Examination Survey. The sample was 4535 South Koreans aged 30-74 years without CVD. Self-perceived health status was compared with actual cardiovascular risk separately by sex using χ(2) -tests. Logistic regressions were used to identify potential sociodemographic and cardiovascular risk factors of self-perceived poor health. RESULTS Self-perceived poor health was related to higher CVD risk but there were substantial gaps between them. Among cardiovascular risk factors, dyslipidemia, obesity, smoking, and a family history of CVD did not affect self-perceived health. CONCLUSION Gaps between perceived health and actual CVD risk should be closed to optimize cardiovascular health of South Koreans. Koreans need to increase risk perception to a level commensurate with their actual risk. Healthcare providers should try to provide individuals at increased CVD risk with better information more frequently, especially those who have favorable perceptions of their health but smoke or have elevated cholesterol levels and bodyweight.
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Affiliation(s)
- Young Ko
- College of Nursing, Gachon University, Incheon, South Korea
| | - Sunjoo Boo
- College of Nursing, Ajou University, Suwon, South Korea
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Nielsen ABS, Jensen P, Gannik D, Reventlow S, Hollnagel H, Olivarius NDF. Change in self-rated general health is associated with perceived illness burden: a 1-year follow up of patients newly diagnosed with type 2 diabetes. BMC Public Health 2015; 15:439. [PMID: 25924731 PMCID: PMC4431173 DOI: 10.1186/s12889-015-1790-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/22/2015] [Indexed: 11/15/2022] Open
Abstract
Background Diabetic patients’ lifestyle adaptations to improve glycaemic control are not always followed by improvements in self-rated general health (SRH). The perceived impact of diabetes on patients’ daily lives may influence changes in their SRH. This paper examines the association of illness severity, treatment, behavioural, and coping-related factors with changes in SRH from diagnosis of type 2 diabetes until one year later, in a population-based sample of 599 patients aged 40 years or over who were treated in general practice. Methods Change in SRH was estimated by a cumulative probit model with the inclusion of covariates related to SRH (e.g. illness severity at diagnosis, behaviour, treatment, and the perceived impact of diabetes on patients’ daily lives one year later). Results At diagnosis, 11.6% of patients reported very good, 35.1% good, 44.6% fair and 8.5% poor SRH. Physical inactivity, many diabetes-related symptoms, and cardiovascular disease were related to lower SRH ratings. On average SRH improved by 0.46 (95% CI: 0.37; 0.55) during the first year after diagnosis without inclusion of covariates. Mental and practical illness burden was the only factor associated with change in SRH, independent of patients’ diabetes severity and medical treatment (p = 0.03, multivariate analysis). Compared to otherwise similar patients without illness burden, increase in SRH was marginally smaller among patients who expressed minor illness burden, but much smaller among patients with more pronounced illness burden. Conclusions Much as one would expect, many patients increased their SRH during the first year after diabetes diagnosis. This increase in SRH was not associated with indicators of illness severity or factors reflecting socio-demographic circumstances, but patients experiencing illness burden had a smaller increase than those who reported no illness burden. We suggest that during the diabetes consultation, general practitioners explore further how patients manage their illness burden. We further suggest that diabetes guidelines extend their current focus on clinical and social aspects of diabetes to include questions on patient’s perceived illness burden and SRH. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1790-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anni Brit Sternhagen Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Per Jensen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
| | - Dorte Gannik
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Hanne Hollnagel
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Waller G, Janlert U, Norberg M, Lundqvist R, Forssén A. Self-rated health and standard risk factors for myocardial infarction: a cohort study. BMJ Open 2015; 5:e006589. [PMID: 25681313 PMCID: PMC4330330 DOI: 10.1136/bmjopen-2014-006589] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the relationship between self-rated health, adjusted for standard risk factors, and myocardial infarction. DESIGN Population-based prospective cohort study. SETTING Enrolment took place between 1990 and 2004 in Västerbotten County, Sweden PARTICIPANTS Every year, persons in the total population, aged 40, 50 or 60 were invited. Participation rate was 60%. The cohort consisted of 75 386 men and women. After exclusion for stroke or myocardial infarction before, or within 12 months after enrolment or death within 12 months after enrolment, 72 530 persons remained for analysis. Mean follow-up time was 13.2 years. OUTCOME MEASURES Cox regression analysis was used to estimate HRs for the end point of first non-fatal or fatal myocardial infarction. HR were adjusted for age, sex, systolic blood pressure, total cholesterol, smoking, diabetes, body mass index, education, physical activity and self-rated health in the categories very good; pretty good; somewhat good; pretty poor or poor. RESULTS In the cohort, 2062 persons were diagnosed with fatal or non-fatal myocardial infarction. Poor self-rated health adjusted for sex and age was associated with the outcome with HR 2.03 (95% CI 1.45 to 2.84). All categories of self-rated health worse than very good were statistically significant and showed a dose-response relationship. In a multivariable analysis with standard risk factors (not including physical activity and education) HR was attenuated to 1.61 (95% CI 1.13 to 2.31) for poor self-rated health. All categories of self-rated health remained statistically significant. We found no interaction between self-rated health and standard risk factors except for poor self-rated health and diabetes. CONCLUSIONS This study supports the use of self-rated health as a standard risk factor among others for myocardial infarction. It remains to demonstrate whether self-rated health adds predictive value for myocardial infarction in combined algorithms with standard risk factors.
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Affiliation(s)
- Göran Waller
- Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden
| | - Urban Janlert
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Department of Public Health and Clinical Medicine, Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Annika Forssén
- Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden
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Shiloh S, Steinvil A, Drori E, Peleg S, Abramowitz Y, Banai S, Finkelstein A. Effect of guidance during cardiac catheterization on emotional, cognitive and behavioral outcomes. J Cardiovasc Med (Hagerstown) 2014; 15:336-42. [PMID: 23756409 DOI: 10.2459/jcm.0b013e3283613925] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Percutaneous coronary intervention (PCI) may be perceived as a frightening experience. Some psychological factors are known correlates of recovery and rehabilitation of cardiac patients. Our objective was to investigate the emotional, cognitive and behavioral effects of patient guidance during their cardiac catheterization. METHODS We performed a randomized trial comparing a patient group that was instructed while watching the monitor screen during their PCI (study group) and another group that was not (controls). Replies to questionnaires measuring emotional, cognitive and behavioral variables known to be associated with cardiac patients' health status, rehabilitation and quality of life were collected 1 day and 1 month after the procedure. RESULTS The study group included 57 patients and the control group included 51 patients. Most patients (∼87%) were men at the mean age of 60. They were well matched for reasons for referral to PCI. The study group reported less pain, a more positive affect, greater self-efficacy and stronger intentions to change health-related behaviors than the control group. At 1 month following the procedure, the study group evaluated their general health as significantly better, and reported a less negative affect, less cardiac anxiety, greater functional self-efficacy and more positive outcome expectancies regarding diet, and quitting smoking than the controls. CONCLUSION A simple adjustment in the standard PCI protocol can become a highly beneficial psychological intervention for enhancing patient outcomes.
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Affiliation(s)
- Shoshana Shiloh
- aThe Gordon Faculty of Social Sciences, School of Psychological Sciences bDepartment of Cardiology, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel *Shoshana Shiloh and Arie Steinvil contributed equally to this work
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Lindström M, Modén B, Rosvall M. Country of birth, parental background and self-rated health among adolescents: a population-based study. Scand J Public Health 2014; 42:743-50. [PMID: 25278274 DOI: 10.1177/1403494814545104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim of this study was to investigate differences according to country of birth and parental country of birth, in relation to poor self-rated health (SRH), in Swedish adolescents. METHODS The Scania public health survey among children and adolescents, conducted in 2012, is a cross-sectional study including most pupils in grade 9 (15 years old), including in 32 of 33 municipalities. The participation rate was 83% (9,791 of 11,735). We performed logistic regressions to investigate the association between the students' country of birth, parental country of birth and poor SRH. RESULTS Boys born outside Europe had an odds ratio (OR) 2.1 (1.6-2.8) of poor SRH in the unadjusted model, which was reduced to 0.7 (0.4-1.3) in the multiple model, as compared to boys born in Sweden with both or one parent born in Sweden. Boys born in Europe had an OR 0.4 (0.2-0.9) of poor SRH, after multiple adjustments. Girls born in Sweden with both parents born abroad, and girls born outside of Europe had significantly lower ORs of poor SRH in the multiple model. In particular, adjustment for socio-demographic and psychosocial factors reduced the ORs of poor SRH among boys, but did so to a lesser extent among girls. CONCLUSIONS Differences in socio-demographic and psychosocial factors explained the higher odds of poor SRH among boys born outside of Europe. Girls born in Sweden with both parents born abroad, and girls born outside Europe, had significantly lower ORs of poor SRH. Our results indicate that there are gender differences in the factors behind poor self-rated health, according to the country-related background of adolescents in Sweden.
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Affiliation(s)
- Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden Centre for Economic Demography, Lund University, Sweden
| | - Birgit Modén
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden Centre for Economic Demography, Lund University, Sweden
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Self-rated health and mortality in a prospective Chinese elderly cohort study in Hong Kong. Prev Med 2014; 67:112-8. [PMID: 25045836 DOI: 10.1016/j.ypmed.2014.07.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 11/21/2022]
Abstract
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.
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Jia Y, Gao J, Dai J, Zheng P, Wu X, Li G, Fu H. Difference of the associations between self-rated health and demographic characteristics, lifestyle, and psychosocial work environment between two types of Chinese worksite. BMC Public Health 2014; 14:851. [PMID: 25128033 PMCID: PMC4150959 DOI: 10.1186/1471-2458-14-851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | - Hua Fu
- School of Public Health, Health Communication Institute, Fudan University, Shanghai 200032, China.
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Jørgensen P, Langhammer A, Krokstad S, Forsmo S. Is there an association between disease ignorance and self-rated health? The HUNT Study, a cross-sectional survey. BMJ Open 2014; 4:e004962. [PMID: 24871539 PMCID: PMC4039843 DOI: 10.1136/bmjopen-2014-004962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore whether awareness versus unawareness of thyroid dysfunction, diabetes mellitus or hypertension is associated with self-rated health. DESIGN Large-scale, cross-sectional population-based study. The association between thyroid function, diabetes mellitus and blood pressure and self-rated health was explored by multiple logistic regression analysis. SETTING The second survey of the Nord-Trøndelag Health Study, HUNT2, 1995-1997. PARTICIPANTS 33 734 persons aged 40-70 years. PRIMARY OUTCOME MEASURES Logistic regression was used to estimate ORs for good self-rated health as a function of thyroid status, diabetes mellitus status and blood pressure status. RESULTS Persons aware of their hypothyroidism, diabetes mellitus or hypertension reported poorer self-rated health than individuals without such conditions. Women with unknown and subclinical hypothyroidism reported better self-rated health than women with normal thyroid status. In women and men, unknown and probable diabetes as well as unknown mild/moderate hypertension was not associated with poorer health. Furthermore, persons with unknown severe hypertension reported better health than normotensive persons. CONCLUSIONS People with undiagnosed but prevalent hypothyroidism, diabetes mellitus and hypertension often have good self-rated health, while when aware of their diagnoses, they report reduced self-rated health. Use of screening, more sensitive tests and widened diagnostic criteria might have a negative effect on perceived health in the population.
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Affiliation(s)
- Pål Jørgensen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Siri Forsmo
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Brackbill RM, Cone JE, Farfel MR, Stellman SD. Chronic physical health consequences of being injured during the terrorist attacks on World Trade Center on September 11, 2001. Am J Epidemiol 2014; 179:1076-85. [PMID: 24561992 DOI: 10.1093/aje/kwu022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003-2004 and 2006-2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5-6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002-2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons.
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Nenonen T, Kaikkonen R, Murto J, Luoma ML. Cultural services and activities: The association with self-rated health and quality of life. Arts Health 2014. [DOI: 10.1080/17533015.2014.897958] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ghorbani Saeedian R, Nagyova I, Klein D, Skorvanek M, Rosenberger J, Gdovinova Z, Groothoff JW, van Dijk JP. Self-rated health mediates the association between functional status and health-related quality of life in Parkinson's disease. J Clin Nurs 2013; 23:1970-7. [PMID: 24354845 DOI: 10.1111/jocn.12442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore whether self-rated health acts as a potential mediator in the association between functional status and health-related quality of life in Parkinson's disease. BACKGROUND Older persons (as most patients with Parkinson's disease are) who reported poor self-rated health compared with those with excellent self-rated health were two-and-a-half times more likely to have experienced a decline in functional ability. DESIGN Cross-sectional. METHODS Socio-demographic and clinical data of the patients (n = 176) were obtained during a structured interview and from medical records. Functional status was measured with the Unified Parkinson's Disease Rating Scale (total score), self-rated health with the first item of the Short-Form 36-item Health Survey Questionnaire and health-related quality of life with the disease-specific questionnaire called the Parkinson's Disease Quality of Life Questionnaire-39. Multiple linear regression analyses and the Sobel test were employed to assess mediation. RESULTS Self-rated health seems to have a mediating effect on the association between functional status and health-related quality of life. The Sobel test confirmed an indirect effect of functional status via self-rated health on health-related quality of life and showed a statistically significant indirect effect of functional status on health-related quality of life via self-rated health against the direct route without the mediator. CONCLUSIONS Self-rated health partially mediates the deteriorating effect of functional status on health-related quality of life. RELEVANCE TO CLINICAL PRACTICE Supportive and adaptation psychosocial intervention programmes leading to restored self-rated health may enhance the quality of life regardless of disability in Parkinson's disease.
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Affiliation(s)
- Radka Ghorbani Saeedian
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Institute of Public Health, Department of Social Medicine, Faculty of Medicine, Safarik University, Kosice, Slovak Republic
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Eriksen L, Curtis T, Grønbæk M, Helge JW, Tolstrup JS. The association between physical activity, cardiorespiratory fitness and self-rated health. Prev Med 2013; 57:900-2. [PMID: 24099878 DOI: 10.1016/j.ypmed.2013.09.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 08/16/2013] [Accepted: 09/27/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the joint association between self-reported physical activity as well as cardiorespiratory fitness and self-rated health among healthy women and men. METHOD Data from 10,416 participants in The Danish Health Examination Survey 2007-2008 which took part in 13 Danish municipalities were analyzed. Leisure time physical activity level and self-rated health were based on self-reported questionnaire data. Optimal self-rated health was defined as "very good" or "good" self-rated health. Cardiorespiratory fitness (mL O2·min(-1)·kg(-1)) was estimated from maximal power output in a maximal cycle exercise test. RESULTS A strong dose-response relation between cardiorespiratory fitness and self-rated health as well as between physical activity level and self-rated health among both women and men was found. Within categories of physical activity, odds ratios for optimal self-rated health increased with increasing categories of cardiorespiratory fitness, and vice versa. Hence, participants who were moderately/vigorously physically active and had a high cardiorespiratory fitness had the highest odds ratio for optimal self-rated health compared with sedentary participants with low cardiorespiratory fitness (odds ratio=12.2, 95% confidence interval: 9.3-16.1). CONCLUSION Although reluctant to conclude on causality, this study suggests that an active lifestyle as well as good cardiorespiratory fitness probably increase self-rated health.
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Affiliation(s)
- Louise Eriksen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 1353 Copenhagen K, Denmark.
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Hansen AW, Beyer N, Flensborg-Madsen T, Grønbæk M, Helge JW. Muscle strength and physical activity are associated with self-rated health in an adult Danish population. Prev Med 2013; 57:792-8. [PMID: 24029557 DOI: 10.1016/j.ypmed.2013.08.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 08/26/2013] [Accepted: 08/31/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe associations of muscle strength, physical activity and self-rated health. METHOD Isometric muscle strength by maximal handgrip strength (HGS) or muscle strength by 30s repeated chair stand test (30s-CS) was combined with leisure time physical activity. Using logistic regression odds ratio was calculated for good self-rated health according to the combined associations among 16,539 participants (59.7% women), mean age 51.9 (SD: 13.8) years, from a cross-sectional study in Denmark 2007-2008. RESULTS Good self-rated health was positively associated with higher levels of physical activity and greater muscle strength. Regarding HGS the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high HGS (OR=6.84, 95% CI: 4.85-9.65 and OR=7.34, 95% CI: 5.42-9.96 for men and women, respectively). Similarly the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high scores in the 30s-CS test (6.06, 95% CI: 4.32-8.50 and 13.38, 95% CI: 9.59-18.67 for men and women, respectively). The reference groups were sedentary participants with low strength (HGS or 30s-CS). CONCLUSION The combined score for physical activity level with either HGS or 30s-CS was strongly positively associated with self-related health.
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Affiliation(s)
- Andreas W Hansen
- National Institute of Public Health, University of Southern Denmark, Denmark.
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Mikkelsen SS, Mortensen EL, Flensborg-Madsen T. A prospective cohort study of quality of life and ischemic heart disease. Scand J Public Health 2013; 42:60-6. [PMID: 24037798 DOI: 10.1177/1403494813504504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To examine the role of self-rated quality of life, as a whole, on the risk of developing ischemic heart disease. METHODS Information on self-rated quality of life and covariates was obtained from 4497 people from the Copenhagen Perinatal Cohort. The study population, consisting of both men and women aged 31-33 years at baseline, was followed for registration of ischemic heart disease in national registers. Two different follow-up periods were examined. RESULTS Using a follow-up of 13 years, the basis-adjusted hazard ratio among women who rated their quality of life as poor was 2.93 (95% CI: 1.09-7.86), compared with women who rated their quality of life as very good. The hazard ratio of women who rated their quality of life as good, compared to very good, was 2.99 (95% CI: 1.22-7.29). When analyzing 16 years of follow-up, estimates among women were lower and some of the hazard ratios were insignificant. All hazard ratios among men were below two and none were statistically significant. CONCLUSIONS Among women, the risk for ischemic heart disease was two to four times greater for those who rated their quality of life as poor or good, than for women with the most positive rating. For men, the association was not statistically significant.
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Affiliation(s)
- Stine Schou Mikkelsen
- 1National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
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Onadja Y, Bignami S, Rossier C, Zunzunegui MV. The components of self-rated health among adults in Ouagadougou, Burkina Faso. Popul Health Metr 2013; 11:15. [PMID: 23926951 PMCID: PMC3750468 DOI: 10.1186/1478-7954-11-15] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 08/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background Although the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in Africa. In this study, we examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, age, and education level. Methods This study was based on 2195 individuals aged 15 years or older who participated in a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System. Logistic regression models were used to analyze the associations of poor SRH with chronic diseases, functional limitations, and depression, first in the whole sample and then stratified by sex, age, and education level. Results Poor SRH was strongly correlated with chronic diseases and functional limitations, but not with depression, suggesting that in this context, physical health probably makes up most of people’s perceptions of their health status. The effect of functional limitations on poor SRH increased with age, probably because the ability to circumvent or compensate for a disability diminishes with age. The effect of functional limitations was also stronger among the least educated, probably because physical integrity is more important for people who depend on it for their livelihood. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, or depression. Conclusions Our findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou, Burkina Faso. In-depth studies are needed to understand why and how these groups do so.
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Affiliation(s)
- Yentéma Onadja
- Département de démographie, Université de Montréal, 3150 rue Jean-Brillant, local C-5043, H3T 1N8 Montréal (Québec), Canada
| | - Simona Bignami
- Département de démographie, Université de Montréal, 3150 rue Jean-Brillant, local C-5043, H3T 1N8 Montréal (Québec), Canada
| | - Clémentine Rossier
- Institut Supérieur des Sciences de la Population (ISSP), Université de Ouagadougou, 03 BP 7118, Ouagadougou 03, Burkina Faso ; Institut national d'études démographiques (INED), 133 Boulevard Davout, 75980 Paris Cédex 20, France
| | - Maria-Victoria Zunzunegui
- Département de médecine sociale et préventive, Université de Montréal, 1420 Mont-Royal, H2V 4P3 Montréal (Québec), Canada ; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, 3875 rue Saint Urbain, 5e étage, H2W 1V1 Montréal (Québec), Canada
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Riise HKR, Riise T, Natvig GK, Daltveit AK. Poor self-rated health associated with an increased risk of subsequent development of lung cancer. Qual Life Res 2013; 23:145-53. [PMID: 23771730 DOI: 10.1007/s11136-013-0453-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE Self-rated health has shown to be a strong predictor of mortality and some major chronic diseases. The purpose of this study was to investigate whether poor self-rated health also was related to an increased risk of subsequent development of cancer. METHODS Information on self-rated health, life-style factors, and other health-related risk factors was ascertained in a cohort of 25,532 persons participating in the Hordaland Health Study in 1997-1999. Information on development of cancer during 10 years of follow-up was obtained from the Norwegian Cancer Registry. The relationship between self-rated health and development of cancer was examined using Cox regression analysis adjusting for smoking and other life-style factors. RESULTS Respondents reporting a poor health showed a non-significant increased risk of overall cancer. Sub-analysis of the four most common types of cancer showed a statistically significant association between self-rated health and lung cancer. The adjusted hazard ratio was 3.88 (95% CI; 0.99, 15.8) for those rating their health as poor compared to very good (p for trend = 0.038). For the other types of cancer, we found a non-significant elevated risk associated with poor self-rated health. CONCLUSION Respondents who perceive their health as poor had an increased risk of developing lung cancer also after adjusting for smoking. This suggests that self-rated health reflects a broad range of factors important for development of this cancer type. Nevertheless, due to the explorative analysis of the specific cancer types, these findings need to be repeated before elaborate interpretations can be made.
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Affiliation(s)
- Hilde Kristin Refvik Riise
- Department of Global Public Health and Primary Care, University of Bergen, Postbox 7804, 5020, Bergen, Norway,
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van der Linde RM, Mavaddat N, Luben R, Brayne C, Simmons RK, Khaw KT, Kinmonth AL. Self-rated health and cardiovascular disease incidence: results from a longitudinal population-based cohort in Norfolk, UK. PLoS One 2013; 8:e65290. [PMID: 23755212 PMCID: PMC3670935 DOI: 10.1371/journal.pone.0065290] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/24/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Self-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). In a population-based cohort, we examined the association between SRH and incident CVD and whether this association was independent of socio-demographic, clinical and behavioural participant characteristics. METHODS Population-based prospective cohort study (European Prospective Investigation of Cancer-Norfolk). 20,941 men and women aged 39-74 years without prevalent CVD attended a baseline health examination (1993-1998) and were followed for CVD events/death until March 2007 (mean 11 years). We used a Cox proportional hazards model to quantify the association between baseline SRH (reported on a four point scale--excellent, good, fair, poor) and risk of developing CVD at follow-up after adjusting for socio-demographic, clinical and behavioural risk factors. RESULTS Baseline SRH was reported as excellent by 17.8% participants, good by 65.1%, fair by 16.0% and poor by 1.2%. During 225,508 person-years of follow-up, there were 55 (21.2%) CVD events in the poor SRH group and 259 (7.0%) in the excellent SRH group (HR 3.7, 95% CI 2.8-4.9). The HR remained significant after adjustment for behavioural risk factors (HR 2.6, 95% CI 1.9-3.5) and after adjustment for all socio-demographic, clinical and behavioural risk factors (HR 3.3, 95% CI 2.4-4.4). Associations were strong for both fatal and non-fatal events and remained strong over time. CONCLUSIONS SRH is a strong predictor of incident fatal and non-fatal CVD events in this healthy, middle-aged population. Some of the association is explained by lifestyle behaviours, but SRH remains a strong predictor after adjustment for socio-demographic, clinical and behavioural risk factors and after a decade of follow-up. This easily accessible patient-centred measure of health status may be a useful indicator of individual and population health for those working in primary care and public health.
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Affiliation(s)
- Rianne M van der Linde
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom.
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