A prospective study of limiting longstanding illness in early adulthood

BACKGROUND: Chronic illness and disability are of increasing public health importance but little is known about the lifetime influences involved in their onset and progression. We aim to (i) establish whether an individual's rating of limiting illness is stable over a 10-year period from age 23 to 33; (ii) assess the relationship between childhood and adult disability; and (iii) identify lifecourse influences on limiting illness in early adulthood. METHODS: Data were from the 1958 British birth cohort, including the original birth survey and follow-ups at ages 7, 11, 16, 23 and 33 years. Limiting longstanding illness was the outcome at both ages 23 and 33. Potential predictors included childhood health and physical development, socioeconomic conditions in early life and adulthood, and behavioural factors. We estimated the effect of potential explanatory factors using logistic regression, in both univariate and multivariate analyses, separately for limiting illness at 23 and 33 years. RESULTS: Prevalence of limiting illness increased from 5.1% (men) and 4.1% (women) at age 23 to 6% for both sexes at age 33. Risk of limiting illness at age 33 was greater for those reporting an illness at age 23 (29.4%, compared with 4.7% of those without illness), though the majority (66%) of 33-year limiting illnesses had no previous record at age 23 or for childhood. Multivariate analysis of limiting illness at age 23 confirmed the high risk for those with childhood disability and also established two further major predictors, namely, injury (adjusted odds ratio [OR] = 1.42, 95% CI: 1.09-1.86) and intermediate socio-emotional status (adjusted OR = 1.73, 95% CI: 1.29-2.31). Additional risks were identified for limiting illness at age 33, including: (i) injury in the preceding 10 years (adjusted OR = 1.55, 95% CI : 1.18-2.04); (ii) body mass index (BMI), for which the relationship was non-linear, with elevated risks for the underweight (adjusted OR = 1.53, 95% CI: 1.03-2.26) and overweight (OR = 1.28, 95% CI: 0.87-1.89); (iii) childhood disadvantage at either or both ages 7 and 11 (adjusted OR = 1.53, 95% CI : 1.07-2.17); and (iv) height at age 7, with a significant non-linear relationship (the adjusted OR for height less than 15th percentile was 1.43 and for height more than the 85th percentile, 1.30). CONCLUSIONS: Both childhood and adult factors predict limiting illness in early adulthood. Childhood is important because some adult illnesses originate in early life, and also because childhood environment influences the risk of adult limiting illness several years later. Our findings suggest that studies seeking to understand the causes of limiting illness, that currently tend to focus exclusively on contemporary factors, need also to consider the contribution of environment in early life.     

Childhood morbidity and adulthood ill health.

STUDY OBJECTIVE--The aim of the study was to investigate the relationship between the state of health in childhood and ill health in early adult life. DESIGN--The study used data collected as part of the National Child Development Study and related health at 7 years of age to that at 23. A wide range of information on child health in the cohort was available, which was used to construct a broader measure of health status than selected diagnostic categories. SETTING--The survey population was nationwide. PARTICIPANTS--The study population included all children born in the week 3-9 March 1958. They were followed up at 7, 11, 16, and 23 years. Of the target population of 17,733 births, 12,537 (76%) were retraced and interviewed at 23. MEASUREMENTS AND MAIN RESULTS--Children at age 7 were allocated to 13 morbidity groups; 20% of children had reported no ill-health apart from the common infectious diseases, but 10% were included in four or more of the morbidity groups. Children with no reported morbidity retained their health advantage into early adulthood: ratios of observed to expected ill health for four of the five indices examined at age 23 were all significantly below one (self rated health 0.81, asthma and/or wheezy bronchitis 0.63, allergies 0.79, emotional health 0.75). Children with more morbidity at age 7 had higher ratios of ill health in adulthood. A chronic condition in childhood was associated not only with excess morbidity in the short term but also with a poor health rating in early adult life (ratio = 1.38). Morbidity was significantly increased for most of the adulthood indices among children with asthma and/or wheezy bronchitis. However most ill health in young adulthood occurred in study members with a relatively healthy childhood. CONCLUSIONS--Although the state of health in childhood has long term implications, it does not form a substantial contribution to ill health in early adult life.     

Self-rated health and chronic morbidity in the EU-28 and Turkey

Journal of Public Health - In this article, self-perceived health in 11 European Union countries and Turkey was studied and the effects of socio-economic factors on self-rated health in Turkey were...     

Self-rated health and mortality in people with diabetes.

OBJECTIVES. This study examined whether self-rated health is an independent and significant predictor of mortality in people with diabetes, using data collected in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. METHODS. Participants were asked to rate their health in comparison with others their age. A proportional hazards model was used to regress survival time on self-rated health and a number of covariates measuring physical health. RESULTS. People with younger onset diabetes (n = 891) who rated their health relative to their peers as "worse" or "don't know" were no more likely to die than those rating their health as "the same" or "better" when physical health status was controlled. In contrast, those with older onset diabetes (n = 987) who rated their health as "worse" or "don't know" were almost twice as likely to die as those rating their health as "the same" or "better" when physical health status was controlled. CONCLUSIONS. Self-rated health is a significant predictor of mortality in people with older onset diabetes but not in those with younger onset diabetes when physical health status is controlled.     

Self-rated health in rural Appalachia: health perceptions are incongruent with health status and health behaviors

Background  

Appalachia is characterized by poor health behaviors, poor health status, and health disparities. Recent interventions have not demonstrated much success in improving health status or reducing health disparities in the Appalachian region. Since one's perception of personal health precedes his or her health behaviors, the purpose of this project was to evaluate the self-rated health of Appalachian adults in relation to objective health status and current health behaviors.     

Self-rated health in adolescence: a multifactorial composite

BACKGROUND AND AIMS: Self-rated health is an important health predictor, and it has only rarely been studied in adolescents. This study examined the relationships between self-rated health and a broad spectrum of structural, medical, psychological, and social variables. The association between these variables and negative health rating through to good health rating versus good to very good health rating was also compared. METHODS: Analyses were based on cross-sectional data from the Young-HUNT II study in Norway. A total of 2,800 students aged 16 to 20 years participated, with a response rate of 81%. Separate logistic regression analyses for each gender were performed for a broad set of independent variables with self-rated health as the dependent variable. The effect of the variables at the negative (poor/not good) and positive (very good) ends of the scale were estimated and compared. RESULTS: Self-rated health in adolescence was significantly associated with a broad spectrum of independent variables reflecting medical, social, and personal factors. The associations were also present in multivariate analyses controlling for the interrelations between the independent variables. The negative and positive ends of the scale were affected in much the same way. The association with general well-being was especially strong. CONCLUSIONS: Adolescents conceptualize health as a construct related to medical, psychological, social, and lifestyle factors. Positive rating of health was affected in a similar manner to negative rating. However, the absolute importance of hampering positive health may be greater because of the higher prevalence of such health ratings.     

Self-rated health and occupational conditions in Russia

A low level of health promotion and disease prevention awareness in Russia, such as disregard for personal health during periods of well-being or illness, have contributed to a decline in general population health over the past decade. The relationship of working conditions and health awareness was explored among a sample of adults in Russia. This research project was conducted, July-August, 1998, in the city of Kazan. Data was collected by probability sampling of addresses and personal interview. Working conditions influence general public and family health. The occupation of the spouse contributed significantly to family conflicts, and financial problems ranked first as the cause of marital conflict. Due to lack of material resources, one-third of respondents, even though employed, reported being dissatisfied with the quality of their nutritional status and one-fifth with the lack of leisure time. Although more than two-thirds were satisfied with their work, every fifth did not consider their wages sufficient, every fourth wanted to change occupations, and every third was afraid of being fired. The majority of employed respondents reported low salaries, worked a full 8-hour day at their primary occupations and one-fifth had a second job. Younger people were especially prone to disregard their health with intensive work schedules. About half of respondents reported being exposed to toxic health hazards in their past or current jobs. Almost one-fifth agreed to work at hazardous occupations because of higher salaries. Social status, indicated by a higher education, was associated with having the opportunity to chose work in more favourable circumstances, and consequently with less health risks. In summary, the research demonstrated that health was an instrumental value in Russia, exploited as a economic resource not only during periods of well-being but also during illness, by individuals not seeking preventive or timely health care because of the fear of losing their jobs.     

Self-rated health in Pakistan: results of a national health survey

Background  

Self-rated health (SRH) is a robust predictor of mortality. In UK, migrants of South Asian descent, compared to native Caucasian populations, have substantially poorer SRH. Despite its validation among migrant South Asian populations and its popularity in developed countries as a useful public health tool, the SRH scale has not been used at a population level in countries in South Asia. We determined the prevalence of and risk factors for poor/fair SRH among individuals aged ≥15 years in Pakistan (n = 9442).     

Self-rated health: a predictor of mortality among the elderly.

Data from the Manitoba Longitudinal Study on Aging (MLSA) were used to test the hypothesis that self-rated health (SRH) is a predictor of mortality independent of "objective health status" (OHS). Subjects were a random sample of non-institutionalized residents of Manitoba aged 65+ in 1971 (n = 3,128). A single item measure of SRH was obtained during a survey conducted in 1971; a baseline measure of OHS was derived from physician and self-reported conditions and health service utilization data. Occurrence and date of death during the years 1971-1977 were known. Analyses of the data revealed that, controlling for OHS, age, sex, life satisfaction, income and urban/rural residence, the risk of early mortality (1971-1973) and late mortality (1974-1977) for persons whose SRH was poor was 2.92 and 2.77 times that of those whose SRH was excellent. This increased risk of death associated with poor self-rated health was greater than that associated with poor OHS, poor life satisfaction, low income and being male. These findings provide empirical support for the long held, but inadequately substantiated, belief that the way a person views his health is importantly related to subsequent health outcomes.     

Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study.

The ability of self-rated health status to predict mortality was tested with data from the National Health and Nutrition Examination Survey (NHANES-I) Epidemiologic Follow-Up Study (NHEFS), conducted from 1971-84. The sample consists of adult NHANES-I respondents ages 25-74 years (N = 6,440) for whom data from a comprehensive physical examination at the initial interview and survival status at follow-up are available. Self-rated health consists of the response to the single item, "Would you say your health in general is excellent, very good, good, fair, or poor?" Proportional hazards analyses indicated that, net of its association with medical diagnoses given in the physical examination, demographic factors, and health related behaviors, self-rated health at Time 1 is associated with mortality over the 12-year follow-up period among middle-aged males, but not among elderly males or females of any age.     

Occupational class and the probability of long-term limiting illness.

The central purpose of this paper is to investigate, using data from the Sample of Anonymised Records of the 1991 Census for Britain on over 80,000 male and over 75,000 female employees between the ages of 41 and 67, the relationship between occupational class and health inequality. The specific aim of the investigation is to answer two questions. First, after controlling for non-class attributes, what was the contribution of occupational class to differences between the classes in the proportion of persons in them with a long-term limiting illness? Answer: a lot or very little depending on the classes that are being compared and whether the comparison is for men or for women. Second, how much of the inequality in the distribution, over the persons in the sample, in their probabilities of suffering from a long-term limiting illness was due to inequality between persons in the same occupation class (within-class inequality) and how much was due to inequality between persons in different occupational classes (between-class inequality)? Answer: for men, approximately one-quarter and, for women, approximately one-fifth of overall inequality in health status was the result of differences in occupational class.     

A developmental-contextual approach to understanding mental health and well-being in early adulthood

There is an increasing awareness of the social and economic burden of untreated mental illness. However, the question remains whether the individuals who are not identified as having a mental disorder are mentally healthy and socially functioning. This study aims to examine the sequence of Keyes's (Keyes, C. L. M. (2002). The mental health continuum: from languishing to flourishing in life. Journal of Health and Social Behavior, 43, 207–222.) mental health categories based on psychological status and well-being, and to identify qualitative differences in these categories by developmental-contextual factors and concurrent physical health status and social functioning. This study uses data from the UK 1958 National Child Development Study. Information was collected on the cohort members from childhood to age 33 years. Psychological distress (measured using the Malaise Inventory) and well-being (self-efficacy and appraisals of life circumstances) were assessed at age 33 years. Multinomial (polytomous) logistic regression models were used to examine the effects of individual characteristics and social contextual factors from childhood through adolescence on cross categorisations of psychological distress and well-being. Our findings suggest that there are similar early life predictors for both poor psychosocial functioning and mental ill-health. Our results also demonstrated a clear gradient of physical health and social functioning across mental health categories, even in the absence of mental disorder. Individual and social contextual factors in early life appear to offer clues as to why the absence of psychological distress does not always imply good mental health or social functioning.     

School racial composition and race/ethnic differences in early adulthood health

We investigate whether school racial composition is associated with racial and ethnic differences in early adult health. We then examine whether perceived discrimination, social connectedness, and parent support attenuates this relationship. Using U.S. data from Waves I and IV of the National Longitudinal Survey of Adolescent Health, we found that black adolescents attending predominantly white schools reported poorer adult health while Asians reported better health. Further research is warranted to understand whether there are qualitative differences in the treatment of racial and ethnic minorities within certain school contexts and how that differential treatment is related to adult health outcomes.     

The impact of local environmental health capacity on foodborne illness morbidity in Maryland

Objectives. We evaluated the relationship between local food protection capacity and service provision in Maryland''s 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level.Methods. We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention''s FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland''s local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs).Results. Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness.Conclusions. Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness.Protecting the food supply requires diligence from farm to fork—from ensuring that our produce is grown in sanitary conditions to inspecting restaurants to ensure that food service workers are using proper hand-washing techniques. However, foodborne outbreaks continue to dominate the media headlines. Approximately 48 million cases of foodborne illness (FBI) occur annually,¹ with 66% of foodborne outbreaks associated with restaurants and 9% with catered events.² Numerous studies demonstrate that a large percentage of outbreaks are related to poor food-handling procedures.^2,3,4 Shigella, hepatitis A, and norovirus, among many other infections, can all be readily transmitted to restaurant patrons through improper hand washing by infected food handlers.⁵ In Maryland, where restaurant sales were projected to reach $8.7 billion in 2010⁶ and nearly 55% of residents eat in sit-down restaurants on a weekly basis,⁷ 63% of foodborne outbreaks reported to the Maryland Department of Health and Mental Hygiene (DHMH) occurred in restaurants.⁸To prevent these outbreaks from occurring, a strong public health infrastructure is essential. In Maryland, ensuring that restaurants provide safe meals to consumers is the primary role of the state''s 24 county-level food protection programs (FPPs).⁹ Housed in the environmental health division of the county-level health department, these programs conduct routine inspections of restaurants (hereafter referred to as food service facilities [FSFs]), public notification programs (such as posting FSF closures in local media outlets), educational programs for both FSF workers and county residents, and collaboration with county-level legislators to develop and enforce food protection regulations, such as certified food manager programs. The ability of local FPPs to conduct these tasks and provide services is contingent on a robust infrastructure and strong internal capacity—that is, structural inputs, such as workforce size and internal budgets, that allow the FPP to deliver services such as FSF inspections.In light of new data indicating that FBI costs $156 billion a year,¹⁰ health departments are even more accountable to the public to reduce illnesses and their significant human and financial costs. With the resurgence of performance measurement at all levels of government, the need to measure local FPP capacity to protect the food supply and demonstrate the effectiveness of food protection programs, through measuring the impact of food protection programs on key public health outcomes, is more essential than ever to ensure sustained financial and political support for local programs. However, despite the longstanding importance of these food protection activities, in Maryland the relationship between county-level food protection capacity and services and FBI cases and outbreaks has not been evaluated. Using public health services and systems research methods, we sought to evaluate this relationship.     

Self-rated health in persons with spinal cord injury: relationship of secondary conditions, function and health status

Objective  Self-rated health is used frequently as a measure of health in the general population, and increasingly with persons with disabilities. However, its meaning and its relationship with other measures of self-reported health (health status and secondary conditions) are not well understood for this group. The purpose of the present study was to use a conceptual model to examine the structure of self-rated health with persons with spinal cord injuries. Methods  A US sample of 270 adults with mobility impairment stemming from spinal cord injury (SCI) provided data on three measures of self-reported health that differ in degree of subjectivity: physical problems common to SCI, four domains of health status from the SF-36, and a single item on self-rated health. Data were compared with the norm sample of the SF-36. The conceptual model was tested using path analyses. Results  SF-36 scores were lower on three of four domains compared with the norm sample. The conceptual model analyses indicated that 35% of variance in self-rated health is accounted for through direct relationship with physical secondary conditions common to persons with SCI and as mediated through SF-36 domains of Role Physical and Vitality. The SF-36 domain of Physical Function was statistically unrelated to self-rated health. Conclusion  The conceptual model of self-rated health was verified in a sample of persons with SCI. Importantly, the SF-36 domain of Physical Function does not relate to self-rated health for this group. Its inclusion in measures of self-reported for disability populations creates difficulty without apparent benefit.