Socioeconomic inequalities in self-rated health among middle-aged and older adults

Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females' decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.     

Gender and health inequalities among adolescents and adults in Brazil, 1998.

OBJECTIVES: To assess the extent of gender inequalities in health status and health services utilization among adolescents and adults in Brazil. METHODS: A representative sample of 217,248 individuals from 15 to 64 years of age was obtained from the National Household Sample Survey (Pesquisa Nacional de Amostras por Domicílios, PNAD) conducted in 1998 by the Brazilian Institute of Geography and Statistics and funded by the Ministry of Health. The study focused on three outcome variables (self-assessed health status, medical visits, and hospitalizations (except childbirth)) and five exposure variables (age, gender, ethnicity, income, and education). Unconditional logistic regression and Mantel-Haenszel stratified analysis was employed. Prevalence rate ratios were calculated for each stratum. Confidence intervals were calculated using the Taylor series, with a 95% confidence interval (95% CI). RESULTS: Women were more likely to report fair or poor health than men (odds ratio (OR) = 1.33; 95% CI: 1.31-1.35). Gender disparities were significant for all ages, household income brackets, and education levels, and were always unfavorable to women (1.17 < or = OR < or = 1.44). Gender disparities for medical visits were higher for those in good health; tended to fall as age, income, and education increased; and were always favorable for women (1.12 < or = OR < or = 2.06). Gender disparities in hospitalization rates decreased with age, varied according to income and education level in each age group, and were always favorable for women (1.16 < or = OR < or = 1.66). CONCLUSIONS: The difference in self-reported health status for men and women became even greater after adjusting for socioeconomic variables, suggesting that poorer women have more pronounced, relative differences than men do. The impact of structural determinants, such as education and income, is considerably smaller than the social construct of gender, although the former are more important predictors. Women use health services more often than men do, which is consistent with their health needs. However, medical visit rates show an inverse relationship to health care needs, suggesting an inequitable access to outpatient care, mainly preventive care.     

Income inequalities in oral health among older adults in four Ontario communities.

We used data from telephone interviews, personal interviews and clinical examinations to assess income inequalities in oral health among older adults living in four Ontario communities. Lower income groups had significantly higher rates of edentulism than upper income groups. In dentate subjects aged 50 to 64 years, significant associations were observed between income and 9 of 10 clinical, functional and subjective oral health indicators. Among those aged 65 years and over, associations were found for only 5 of these indicators. The data suggested that the association between income and clinical and functional measures of oral health was stronger among those aged 50 to 64 years, while the association between income and subjective indicators was stronger among those aged 65 years and over. No association was noted between income and oral health status among edentulous subjects. These observations are difficult to explain because of the cross-sectional nature of the study and the complexity of the processes which may lead to social inequalities in health. Nevertheless, the data do suggest the need for the targeting of oral health promotion programs and appropriate dental services at disadvantaged groups.     

Gender and use of health care among older adults in Egypt and Tunisia

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls’ excess mortality persists.     

中老年人群性健康

随着人类期望寿命的延长,人口老龄化危机正在世界各地蔓延。性健康是中老年人群全面健康不可或缺的一部分。50~60岁阶段处于生理变化（如女性经历更年期）和社会阶段变化（如工作状态和社会身份的变化）的过渡阶段。≥60岁中老年人群仍有性需求,然而关于该年龄段的性健康研究较少。在此背景下,本文深入探讨≥50岁中老年人群性健康相关话题,了解性健康在老龄化不同阶段的演变过程和影响因素,以制定相关政策,促进该人群的全面健康。     

Gender and race differences in the predictors of daily health practices among older adults

Preventive health behaviors are crucial for older adults' well-being. This study examined the factors that influence the practice of positive daily health behaviors over time in a sample of older adults (N = 1266) and investigated whether explanatory factors differ by health behavior, gender or race. Physical activity, weight maintenance, smoking, alcohol consumption and sleep patterns were examined as dependent variables. Independent variables included demographic characteristics, baseline health behavior, health status variables, psychological factors and social network characteristics. Results indicate that age and health status are important predictors of preventive health behaviors. However, the factors that predict preventive health behaviors vary by behavior, gender and race. The independent variables included in this study were most successful in explaining cigarette smoking and weight maintenance, and least successful in explaining amount of sleep. In addition, results suggest that social network variables are particularly influential for women's health behaviors, while health status is more influential among men. Greater education predicts better health behaviors among whites, while formal social integration seems particularly important for the health behaviors of older black women. These results indicate that examining older adults' health behaviors by race and gender leads to a fuller understanding of these behaviors.     

Health inequalities among older adults in Sweden 1991-2002

BACKGROUND: Current research has shown a decline in health among older adults in Sweden. This study examines health inequalities among older adults in Sweden in 1991-1992 and 2000-2002 and explores the development of these inequalities during this period. METHODS: A data set was constructed out of four levels of living surveys, comprising 4085 individuals aged 55 and above. Multivariate logistic regressions were used to assess the association between social class, sex, age and four different domains of self-reported health: global self-rated health, impaired mobility, musculoskeletal pain and psychological distress. Adjustments were made for period of interview. Interaction terms were also used to assess change over time. Levin's attributable risk was used to assess the magnitude of the health inequalities. RESULTS: The results indicate an increase in reports of all specific health problems, but not in the global health measure during the period. Significant sex differences and a clear social gradient in health were discernible during both periods. Women were more likely than men to report problems with impaired mobility, pain and psychological distress. Manual workers were significantly more likely than non-manuals to report problems in all four domains of health. However, both the sex differences and the social gradient seemed to remain constant during the period. CONCLUSION: Although it seems there are significant differences in health depending on sex and social class among older adults in Sweden, these inequalities appear to be unaffected by the general increase in ill health that has been observed in these groups over the last decade.     

Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002

Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of non-institutionalized adults in China aged 65 years and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.     

Assessing health numeracy among community-dwelling older adults

Quantitative information occupies a central role within health care decision making. Despite this, numeracy has attracted little research attention. Therefore, the purpose of this study was to (1) describe the health numeracy skill of a nonclinical, Canadian community-based senior population and (2) determine the relationship between health numeracy skill and prose health literacy, education, and math anxiety in this population. A convenience sample of 140 men and women, 50 + years, completed a questionnaire assessing demographic details, math anxiety, functional health literacy (Shortened Test of Functional Health Literacy for Adults STOFHLA), general context numeracy, and health context numeracy skills. Most participants had adequate functional health literacy (prose and numeracy) as measured by the STOFHLA, poorer general context numeracy skill, higher health context numeracy skill, and moderate math anxiety. Approximately 36% of the variation in general context numeracy scores and 26% of the variation in health context numeracy scores were explained by prose health literacy skill (STOFHLA), math anxiety, and attained education. This research offers an initial assessment of health numeracy skills as measured by three existing numeracy scales among a group of independently functioning older Canadian adults. This work highlights the need for clarification of the numeracy concept and refinement of health numeracy assessment instruments. Moreover, identifying patients' numeracy strengths and weaknesses will enable the development of focused numeracy interventions and may contribute to moving individuals further along the continuum of health literacy proficiency.     

Self-rated oral health among Brazilian adults and older adults in Southeast Brazil: results from the SB-Brasil Project, 2003

The aim of this study was to determine which characteristics (predisposing and enabling, oral health, perceived need for dental treatment, and behavior) are independently associated with self-rated oral health among adults and older adults in Southeast Brazil. The study was based on 3,240 participants in the SB-Brasil Project/ Southeast. The characteristics of those who rated their oral health as good/very good were compared to those who rated it as fair, poor, or very poor. The following characteristics were significantly and independently associated with better self-rated oral health among adults: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, place of residence in cities with > 50,000 inhabitants, and visit to the dentist > 3 years previously. Among older adults the factors were: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, and 1-19 permanent teeth. Our results confirm those observed in other countries, showing associations between self-rated oral health and predisposing and enabling factors, oral health, perceived need for dental treatment, and behavior.     

Socioeconomic differences in health among older adults in Mexico

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES-health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education-obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES-health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US.     

Gender differences in physical activity patterns among older adults who fall

ObjectiveThis study describes gender differences in the level and pattern of physical activity in groups of older adults who were frequent fallers, intermittent fallers, or non-fallers.MethodsInterviews were conducted with adults aged 50 years and older (N = 1834) at senior centers across Pennsylvania from 2010 to 2011. Self-reported falls and validated measures of physical activity were collected at baseline and at 6- and 12-month follow-up assessments.ResultsComplete follow-up data were available for 1487 participants. Men who fell frequently decreased in recreational/leisure activity and household/yard work compared to the intermittent fallers and non-fallers. This association remained even when controlling for baseline health status. All women—regardless of fall group—engaged in similar levels of recreational/leisure activity and household/yard work over time. For both men and women, frequent fallers also showed a greater decrease in walking activities compared to intermittent fallers and non-fallers.DiscussionFrequent falling among older adults is associated with declines in common leisure, household, and walking activities. The effect of falling frequency on physical activity appears to affect men and women differently, generating the hypothesis that interventions to promote physical activity among fallers need to be gender specific.     

Gender inequalities in health among workers: the relation with family demands

OBJECTIVES: To analyse whether there are gender inequalities in health among male and female workers who are married or cohabiting and to assess whether there are gender differences in the relation between family demands and health. Additionally, for both objectives it will be examined whether these gender patterns are similar for manual and non-manual workers. DESIGN AND SETTING: The data have been taken from the 1994 Catalonian Health Survey (CHS), a cross sectional survey based on a representative sample of the non-institutionalised population of Catalonia, a region in the north east of Spain that has about 6 million inhabitants. The dependent variables were four ill health indicators (self perceived health status, limiting longstanding illness, having at least one chronic condition and mental health) and two health related behaviours closely related to having time for oneself (no leisure time physical activity and sleeping six hours or less a day). Family demands were measured with three variables: household size, living with children under 15 years and living with adults older than 65 years. The analysis was separated for gender and social class (manual and non-manual workers) and additionally adjusted for age. Gender differences for all dependent and independent variables were first tested at the bivariate level using the chi(2) test for categorical variables and the t test for age. Secondly, multivariate logistic regression models were fitted. PARTICIPANTS: Persons who were employed, married or cohabiting, aged 25 to 64 years (2148 men and 1185 women). RESULTS: A female excess for all the ill health indicators was found, while there were no gender differences in the health related behaviours analysed. Family demands had a greater impact on health and health related behaviours of female manual workers. In this group household size was positively related to four dependent variables. The adjusted odds ratios (ORs) to living in family units of more than four persons versus living only with the spouse were 2.74 (95%CI=1.22, 6.17) for poor self perceived health status, 3.16 (95%CI=0.98, 10.15) for limiting long standing illness, 3.28 (95%CI=1.45, 7.44) for having at least one chronic condition, and 2.60 (95%CI=1.12, 6.00) for sleeping six hours or less a day. Among female manual workers living with children under 15 years was positively associated with no leisure time physical activity (adjusted OR=2.37; 95% CI=1.43, 3.92) and with sleeping six hours or less a day (adjusted OR=1.91; 95% CI=1.13, 3.32). Living with adults older than 65 years had an unexpected negative relation with poor self perceived health status (adjusted OR=0.33; 95%CI=0.16, 0.66), and with chronic conditions (adjusted OR=0.45; 95%CI=0.24, 0.87) in female manual workers. Among male manual workers living with children under 15 years was positively associated with longstanding limiting illness (adjusted OR=2.44; 95%CI=1.36, 4.38). CONCLUSION: When gender differences in health are analysed, both the paid and the non-paid work should be considered as well as the interaction between these two dimensions, gender and social class. In Catalonia, as probably in Spain and in other countries, private changes such as sharing domestic responsibilities, as well as active public policies for facilitating family care are needed in order to reduce gender health inequalities attributable to the unequal distribution of family demands.     

Gender inequalities in occupational health in Spain

Objectives

To analyze gender inequalities in employment and working conditions, the work-life balance, and work-related health problems in a sample of the employed population in Spain in 2007, taking into account social class and the economic sector.

Methods

Gender inequalities were analyzed by applying 25 indicators to the 11,054 workers interviewed for the VI edition of the National Working Conditions Survey. Multivariate logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI), stratifying by occupational social class and economic sector.

Results

More women than men worked without a contract (OR = 1.83; 95% CI: 1.51-2.21) and under high-effort/low-reward conditions (1.14:1.05-1.25). Women also experienced more sexual harassment (2.85:1.75-4.62), discrimination (1.60:1.26-2.03) and musculoskeletal pain (1.38:1.19-1.59). More men than women carried out shift work (0.86:0.79-0.94), with high noise levels (0.34:0.30-0.40), and high physical demands (0.58:0.54-0.63). Men also suffered more injuries due to occupational accidents (0.67:0.59-0.76). Women white-collar-workers were more likely than their male counterparts to have a temporary contract (1.34:1.09-1.63), be exposed to psychosocial hazards and discrimination (2.47:1.49-4.09) and have occupational diseases (1.91:1.28-2.83). Gender inequalities were higher in the industry sector.

Conclusions

There are substantial gender inequalities in employment, working conditions, and work-related health problems in Spain. These gender inequalities are influenced by social class and the economic sector, and should be considered in the design of public policies in occupational health.     

Gender differences in discharge destination among older adults following traumatic brain injury

Traumatic brain injury (TBI) is a leading cause of death and disability, and the highest in-patient admission rates are among older adults. We identified that gender independently influences discharge destination following TBI in older adults. In this cross-sectional study, we examined discharge destinations of patients admitted to acute care over a 4-year period, as captured by the Ontario Trauma Registry (n = 3,480). Following TBI, women were significantly more likely than men to be sent to long term care facilities rather than home settings (p < .05), controlling for age, injury severity, mechanism of injury, and comorbidities.     

Social and economic background and class inequalities in health among young adults

This paper considers which socio-economic factors in childhood and early adulthood are most strongly associated with social class differences in health at age 23. Longitudinal data from the 1958 (NCDS) cohort were used for this purpose. By age 23 class gradients were evident for several health measures, including self-rated health, 'malaise', psychological morbidity and height. The contribution of earlier socio-economic background was established by assessing how far class differences in the health indicators were reduced by controlling for earlier circumstances. While class differentials were not eliminated after taking account of earlier circumstances, substantial reductions were associated with a number of factors in childhood, in particular social class, housing tenure, crowding, family size and receipt of free school meals. More recent experiences of unemployment and family formation were also important.     

Health literacy and health risk behaviors among older adults

BACKGROUND: Limited health literacy is associated with poorer physical and mental health, although the causal pathways are not entirely clear. In this study, the association between health literacy and the prevalence of health risk behaviors was examined among older adults. METHODS: A cross-sectional survey of 2923 new Medicare, managed-care enrollees was conducted in four U.S. metropolitan areas (Cleveland OH; Houston TX; Tampa FL; Fort Lauderdale-Miami FL). Health literacy was measured using the short form of the Test of Functional Health Literacy in Adults. Behaviors investigated included self-reported cigarette smoking, alcohol consumption, physical activity, body mass index, and seat belt use. RESULTS: Individuals with inadequate health literacy were more likely to have never smoked (46.7% vs. 38.6, p =0.01); to completely abstain from alcohol (75.6% vs. 57.9, p <0.001); and to report a sedentary lifestyle (38.2% vs. 21.6%, p <0.001) compared to those with adequate health literacy. No significant differences were noted by mean body mass index or seat belt use. In multinomial logistic regression models that adjusted for relevant covariates, inadequate health literacy was not found to be significantly associated with any of the health risk behaviors investigated. CONCLUSIONS: Among community-dwelling elderly, limited health literacy was not independently associated with health risk behaviors after controlling for relevant covariates.     

Probabilities of transition among health states for older adults

Goal: To estimate the probabilities of transition among self-rated health states for older adults, and examine how they vary by age and sex. Methods: We used self-rated health (excellent, very good, good, fair, poor, dead) collected in two longitudinal studies of older adults (mean age 75) to estimate the probability of transition in 2 years. We used the estimates to project future health for selected cohorts. Findings: These older adults were most likely to be in the same health state 2 years later, but a substantial proportion changed in both directions. Transition probabilities varied by initial health state, age and sex. Men were more likely than women to transition to excellent or dead. Women were more likely than men to transition to good or fair health. Although women aged 70 will have more years of life and more years of healthy life than men, they also have more years of unhealthy life, and the proportion of remaining life that is healthy is slightly higher for men. When observed and predicted years of healthy life (YHL) were compared in various subgroups, the YHL of persons with less favorable baseline characteristics was lower than predicted, and vice-versa. Differences, however, were small (about 5%). Conclusions: These transition probability estimates can be used to predict the future health of individuals or groups as a function of current age, sex, and self-rated health. This revised version was published online in June 2006 with corrections to the Cover Date.