Unpacking Self-Rated Health and Quality of Life in Older Adults and Elderly in India: A Structural Equation Modelling Approach

The Study on global AGEing and adult health (SAGE) aims at improving empirical understanding of the health and well-being of older adults in low- and middle-income countries. A total of 321 adults aged 50 years and older were interviewed in rural Pune district, India, in 2007. We used Structural Equation Modelling (SEM) to examine the pathways through which social factors, functional disability, risk behaviours, and chronic disease experience influence self-rated health (SRH) and quality of life (QOL) amongst older adults in India. Both SRH and QOL worsened with increased age (indirect effect) and limitations in functional ability (direct effect). QOL, socio-economic status (SES), and social networking had no significant effect on SRH. Smoking was associated with the presence of at least one chronic illness, but this did not have a statistically significant effect on SRH. Higher social networking was seen amongst the better educated and those with regular income, which in turn positively affected the QOL rating. QOL had a direct, but statistically not significant, effect on SRH. In conclusion, the indirect effects of age on SRH mediated through functional ability, and the effects of SES on QOL mediated through social networking, provide new understanding of how age and socio-economic status affect SRH and QOL. By allowing for measurement errors, solving for collinearity in predictor variables by integrating them into measurement models, and specifying causal dependencies between the underlying latent constructs, SEM provides a strong link between theory and empirics.     

Determinants of Self-Rated Health Among Canadian Seniors Over Time: A Longitudinal Population-Based Study

Self-rated health has been found to be an effective and inexpensive measure of people’s overall health. Although cross-sectional studies have identified determinants of self-rated health (SRH), there is a limited insight into the determinants of SHR overtime and their impact on the change of SRH overtime. This present study compares determinants of SRH among a large community-dwelling cohort of Canadian seniors (N = 3255) at three points in time (1991, 1996, and 2001), and examines the effects of determinants on change in SRH over a 10-year period. Data analyzed were from the Canadian Study of Health and Aging—a large-scale longitudinal population-based study conducted between 1991 and 2001. The results showed that most seniors (over 80 %) rated their health as good, and their SRH remained surprisingly constant over time. Only a person’s physical and instrumental functioning and the number of chronic diseases were consistently associated with SRH at each point in time (1991, 1996, and 2001). Factors including cognition, daily functioning, chronic disease, and availability of help were significantly linked to self-rated health over time. These determinants should be considered important stimuli for improving health among seniors.     

Perceived Quality of Life and Self-Rated Health among First-Year University Students

This study compares health status and qualityof life assessments of first-year universitystudents with those of their same-age workingcounterparts. Subjects and materials for eachgroup were gathered in 1999 from twocross-sectional data sets from the Swedishregion of Östergötland, covering malesand females aged 20–34 years. Subjects'perceived quality of life (QoL) and self-ratedhealth (SRH) were assessed on a 10-point scale(Ladder scale) and a five-point scale,respectively. Gender-based comparison revealedthat, for both males and females, first-yearuniversity students' average perceived QoL waslower than that of their working counterparts(p < 0.0001 in all instances). A higherproportion of students than expected ratedtheir health as ``average' or as ``low'(p < 0.0001). Perceived QoL was significantlycorrelated with SRH in both groups. Differencesin perceived QoL and SRH exist between studentsand their full-time working peers, and thedeterminants of these differences deservesgreater attention. Knowledge of thedeterminants of SRH and perceived QoL amonguniversity students might then be translatedinto sound and effective public-health practiceand intervention programs.     

Acculturation and Self-rated Health Among Asian Immigrants: The Role of Gender and Age

Using the 2002–2003 National Latino and Asian American Study (NLAAS), we examine the relationship between acculturation and poor-to-fair self-rated health (SRH) among Asian immigrants (N?=?1639). Using latent class analysis, we construct a multidimensional measure of acculturation that considers dimensions of involvement in U.S. culture as well as attachment to Asian ethnic cultures and identify three classes of Asian immigrants: the assimilated, who most strongly adhere to U.S. culture; the integrated, who align with both U.S. and Asian ethnic cultures; and the separated, who are almost exclusively attached to Asian ethnic cultures. Logistic regression results revealed that among the pooled sample of Asian immigrant adults, the separated are significantly more likely to report poor-to-fair SRH than the assimilated. We then tested for gender and age differences in the acculturation–SRH relationship, and found that stratifying by gender yields noticeably different patterns. Among Asian immigrant women, the probability of reporting poor-to-fair SRH increases with age for the separated and the integrated, while it declines with age for the assimilated. Conversely, among Asian immigrant men, the probability of reporting poor-to-fair SRH increases most steeply with age for the assimilated, while it is shallower for the separated and the integrated. Future research should continue to develop a dynamic understanding of acculturation and examine its association with other health outcomes, including how these relationships differ across subsets of immigrant groups.

     

The Relevance of Objective and Subjective Social Position for Self-Rated Health: A Combined Approach for the Swedish Context

The study investigates the health effects of subjective class position stratified by objective social position. Four types of subjective class were analysed separately for individuals with manual or non-manual occupational background. The cross-sectional analysis is based on the Swedish Level-of-Living Survey from 2000 and includes 4,139 individuals. The dataset comprises information on perceived class affinity and occupational position that was combined to conduct logistic regression models on self-rated health. An inverse relationship between self-rated health and the eight combinations of objective and subjective social position was found. Lower socio-economic position was associated with poor health. The largest adverse health effects were found for lower subjective social position in combination with lower occupational position. When the covariates education, father’s occupational position and income were added to the model, adverse effects on health remained only for females. Subjective social position helps to explain health inequalities. Substantial gender differences were found. It can be assumed that subjective class position captures a wide range of perceived inequalities and therefore complements the measure of occupational position.     

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

Research examining gender differences in self-rated health (SRH) has typically not distinguished between age and cohort-related changes in the health of men and women over time. Using longitudinal data from the Panel Study of Income Dynamics, this study finds gender diffegrences in SRH may actually be an artifact of cohort. Prior to examining health across cohorts, women reported worse health than men. With the introduction of cohort to the models, no gender difference was found except in the earliest cohort (born 1924–1933). Historical context is therefore critical to understanding the health trajectories of women and men, which are not uniform across cohorts.     

Education and the Gender Gaps in Health and Mortality

The positive associations between education and health and survival are well established, but whether the strength of these associations depends on gender is not. Is the beneficial influence of education on survival and on self-rated health conditioned by gender in the same way, in opposite ways, or not at all? Because women are otherwise disadvantaged in socioeconomic resources that are inputs to health, their health and survival may depend more on education than will men??s. To test this hypothesis, we use data from the National Health Interview Survey-Linked Mortality Files (NHIS-LMF). We find that education??s beneficial influence on feeling healthy and on survival are conditional on gender, but in opposite ways. Education has a larger effect on women??s self-rated health than on men??s, but a larger effect on men??s mortality. To further examine the mortality results, we examine specific causes of death. We find that the conditional effect is largest for deaths from lung cancer, respiratory disease, stroke, homicide, suicide, and accidents. Because women report worse health but men??s mortality is higher, education closes the gender gap in both health and mortality.     

The Importance of Spousal Education for the Self-Rated Health of Married Adults in the United States

Education’s benefits for individuals’ health are well documented, but it is unclear whether health benefits also accrue from the education of others in important social relationships. We assess the extent to which individuals’ own education combines with their spouse’s education to influence self-rated health among married persons aged 25 and older in the United States (N = 337,846) with pooled data from the 1997–2010 National Health Interview Survey. Results from age- and gender-specific models revealed that own education and spouse’s education each share an inverse association with fair/poor self-rated health among married men and women. Controlling for spousal education substantially attenuated the association between individuals’ own education and fair/poor self-rated health and the reduction in this association was greater for married women than married men. The results also suggest that husbands’ education is more important for wives’ self-rated health than vice versa. Spousal education particularly was important for married women aged 45–64. Overall, the results imply that individuals’ own education and spousal education combine to influence self-rated health within marriage. The results highlight the importance of shared resources in marriage for producing health.     

Healthy,Wealthy, Wise,and Happy? Assessing Age Differences in Evaluative and Emotional Well-Being Among Mature Adults from Five Low- and Middle-Income Countries

This study assesses the relationship between age and two dimensions of subjective well-being—evaluative and emotional—among mature adults from five low-and middle-income countries. We use data from the World Health Organization’s Study on Global AGEing and Adult Health to contrast the associations of age with subjective well-being when controlling only for gender with the corresponding partial associations when including a richer set of covariates. Adjusting only for gender, we find negative associations of age with evaluative well-being, while the corresponding age gradients for emotional well-being are relatively flat. By contrast, adjusting for further socio-demographic factors results in positive associations of age with both evaluative and emotional well-being. Oaxaca-Blinder decompositions allow us to explore the roles of two factors to account for any unadjusted age differences in subjective well-being: age-group differences in individual characteristics and life circumstances, and age-specific associations of individual characteristics and life circumstances with subjective well-being. While adverse circumstances such as poor health and low income contribute to lower levels of evaluative well-being among older adults, age per se is—ceteris paribus—positively associated with subjective well-being. Even in poorer countries, older age does not need to be a time of low subjective well-being. Policies aimed at preserving income and limiting or compensating old-age disability appear to be key for maintaining subjective well-being among older adults.

     

From the Editor

This study examined risk factors associated with self-reported health (SRH) in a genetically informative sample of older African American female twins. An interview was conducted with a national sample of 180 African American female twin pairs. Questions included: SRH, demographics, health behaviors, chronic diseases, and functional status. SRH was dichotomized into negative (fair/poor) and positive (good/very good/excellent). Logistic regression for clustered data was used to estimate the odds ratios and 95% confidence intervals. In multivariable analyses, IADL limitations (OR?=?1.5, 95% CI?=?1.7–2.0) and a chronic disease index (OR?=?1.9, 95% CI?=?1.4–2.5) were associated with negative SRH. In multivariate within-twin pair analysis, controlling for genetics/shared familial environment, IADLs (OR?=?1.8, 95% CI?=?1.1–2.7), and increasing numbers of chronic diseases (OR?=?2.0, 95% CI?=?1.3–3.2) remained significantly associated with negative SRH.     

An analysis of the impact of education on family size

The impact of education on family size is divided into a direct effect (holding labor force participation and age at marriage constant) and an indirect effect (varying labor force participation and age at marriage). The results suggest that (1) the indirect effect of education is greater at higher levels of the wife's education, (2) the direct effect is greater at lower levels of education in most cases, (3) the indirect effects do not vary systematically with husband's education, (4) but the direct effect does vary systematically with husband's education if the education of the wife is low but not if wife's education is high.     

性别、家庭财富与不同年龄阶段儿童辍学行为——基于2006年中国营养与健康调查数据

基于2006年中国营养与健康调查截面数据中农村教育阶段儿童样本的研究,本文发现,儿童性别、教育阶段、母亲最高教育年限及父亲身体健康状况是影响儿童辍学的重要因素,然而,随着儿童年龄增长性别歧视和家庭财富状况的影响逐渐减弱,并且会在一定年龄阶段改变影响方向。儿童辍学行为的影响因素中家庭财富状况由家庭父母教育程度和职业内生决定。     

Health Profiles and Profile-Specific Health Expectancies of Older Women and Men: The Netherlands

SUMMARY

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65–85 years. For both women and men, six profiles were found: I. cancer; II. “other” chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.     

Exploring Perceived Discrimination Among LGBT Individuals in Turkey in Education,Employment, and Health Care: Results of an Online Survey

This article explores the discrimination practices encountered by lesbian, gay, bisexual, and transgender (LGBT) individuals in education, income, employment, and health care in Turkey. Limited quantitative data on LGBT individuals are available in Turkey. This study collected data from 2,875 LGBT individuals through a Web-based survey. The findings suggest that LGBT individuals report perceived direct and indirect discrimination in accessing education, employment, and health care. In a country where LGBT rights are not yet recognized and antidiscrimination legislation covering sexual orientation and gender identity is still nonexistent, findings demonstrate perceived discrimination of LGBTs rarely turns into a legal complaint. Even when they do, most LGBTs in our sample report that they did not feel that the justice system addressed their grievances.     

Family Structure and Self-Rated Health in Adolescence and Young Adulthood

While the relationship between family structure and child well-being is well-established, little is known about the specific impact of family structure on health in adolescence and young adulthood. Using data on 12,737 respondents from Waves I and III of Add Health, we examine the association between family structure (two biological/adoptive, stepfather, and single mother families at Wave I) and self-rated health in adolescence (Wave I) and young adulthood (Wave III). We build on previous literature by investigating whether the relationship between family structure and self-rated health is mediated by demographic background, socioeconomic status, parent–child relationships, external social support, and health characteristics and behaviors, and whether the influence of these factors endures into adulthood. Overall, we find that self-rated health is reduced for respondents who lived in stepfather or single mother families during adolescence, although this effect is attenuated in young adulthood. Family structure effects at both waves are explained by socioeconomic status, social support and competence, and health characteristics and behaviors. We find little evidence that demographic background or mother–child relationships mediate the relationship between family structure and self-rated health. By young adulthood, effects of most adolescent predictors are attenuated, but health assessments are largely influenced by changes in health characteristics and behaviors, and in family type.

Older Women on the U.S.-México Border: Exploring the Health of Hispanics and Non-Hispanic Whites

ABSTRACT

Research on ethnicity and socioeconomic status (SES) suggests that Hispanics are more likely than non-Hispanic Whites to experience poverty and low levels of education, which may relate to poorer health status. This study used a health survey to examine income, education, ethnicity, birthplace, and age on self-reported health factors of women age 60 and older on the U.S.-México border. Results show that income, age, and education were significantly associated with several health factors (Physical Health, Emotional Health, General Health, Energy Level, and Activity Potential). Older women with lower SES, regardless of ethnicity, reported poorer health than younger-old women with higher SES.     

Research on Health Status and Health Care of the Elderly in China

The issue of health status and care for the elderly in urban and rural areas is becoming increasingly serious in the rapid context of population aging in China.The paper analyzed the health status of urban and rural elderly in China in the two-week morbidity rate,prevalence rate of chronic diseases, disability status,self-rated health and healthy life expectancy of the elderly using the data from the 2006 Sampling Survey on the Status of Urban/ Rural Aged Population in China,the Fourth National Health Service Survey and the 2006 Second China National Sample Survey on Disability,to explore the current provision of sources of care for the elderly and try to make some policy recommendations about to improve the health and care for the elderly population facing the crisis of population aging.     

Barriers to Sexual and Reproductive Health Programming for Adolescents Living with HIV in Uganda

Despite revising their reproductive health policies in line with the 1994 International Conference on Population and Development (ICPD) Programme of Action, a major challenge facing many developing countries is the inability to fully implement the policies owing to lack of funds, bureaucratic delays, and limited awareness among various stakeholders. In some countries, the policies fail to adequately address sexual and reproductive health (SRH) needs of vulnerable groups. This study examines the barriers to SRH programming for adolescents living with HIV from the perspectives of key stakeholders involved in SRH issues in Uganda. The data are from qualitative interviews conducted in 2007 with 23 key informants from bilateral institutions, government ministries, and civil society organizations. The study findings confirm that policy and programmatic gaps exist in addressing the SRH needs of HIV-positive adolescents. This is attributable to: (1) lack of clear guidelines on how to address the SRH of HIV-positive adolescents; (2) challenges of dealing with adolescent SRH in general; (3) HIV/AIDS treatment, care, and support services that are either pediatric- or adult-oriented; and (4) limited institutional and provider capacity to offer SRH services to HIV-positive adolescents despite recognizing that this is an emerging area that requires intervention. These results suggest the need for: (1) clear guidelines on dealing with SRH of HIV-positive adolescents; (2) establishing transition clinics or youth-friendly corners to cater for the needs of adolescents who cannot fit in either pediatric or adult clinics; and (3) providing training and reorientation on SRH of HIV-positive adolescents to service providers/counsellors.     

Health profiles and profile-specific health expectancies of older women and men: The Netherlands

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65-85 years. For both women and men, six profiles were found: I. cancer; II. "other" chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.