Socioeconomic status, working conditions and self-rated health in Switzerland: explaining the gradient in men and women

Objectives:  Epidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. Methods:  A representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme. Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. Results:  Data show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. Conclusion:  The study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studies. Submitted: 24 August 2007; revised: 06 May 2008, 11 August 2008; accepted: 19 October 2008     

Socioeconomic, psychosocial, behavioural, and psychological determinants of BMI among young women: differing patterns for underweight and overweight/obesity

OBJECTIVES: Underweight, overweight, and obese women aged 18-34 years were compared with normal weight women of the corresponding age according to socioeconomic, psychosocial, health behaviour, self reported global and psychological health, and locus of control characteristics. METHODS: The 2000 public health survey in Scania is a cross-sectional study. A total 13,715 persons aged 18-80 years, of which 1967 were females of 18-34 years of age, were included in this study. They answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model adjusted for age was used to investigate the association between socioeconomic, psychosocial, health behaviour, self reported global and psychological health, locus of control, and the BMI categories. RESULTS: A 17.5% proportion of the women, aged 18-34 years, were underweight (BMI < 20.0), 18.4% were overweight, and 7.0% obese. The prevalence of underweight according to the BMI < 18.5 definition was 5.8% among women aged 18-34 years. Women who were underweight had significantly higher odds ratios for overtime work, being students, low emotional support, and poor self reported global as well as poor psychological health than normal weight women. Women who were overweight/obese were unemployed, had low education, low social participation, low emotional and instrumental support, were daily smokers, had a sedentary lifestyle, had poor self reported global health, and had lack of internal locus of control compared with normal weight women. CONCLUSIONS: Underweight women are more likely to have poorer psychological health than normal weight women. In contrast, overweight and obese women are more likely to have poor health related behaviours and lack of internal locus of control compared with normal weight women. These differing patterns suggest both different etiology and different preventive strategies to deal with the health risks of people who are underweight as opposed to those who are overweight/obese.     

Determinants of Poor Self-rated Health in Korean Adults With Diabetes

Objectives:

Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes.

Methods:

A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance.

Results:

We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]_{Frequent stress events}, 5.40; 95% confidence interval [CI], 4.63 to 6.29; OR_{Severe distress}, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A_1clevels of 6.5% or more, and comorbidities, were other correlates of poor reported health.

Conclusions:

Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.     

Self-Perceived Social Status and Health in Older Hong Kong Chinese Women Compared with Men

ABSTRACT

Economic and social factors are determinants of health, as are psychosocial factors. The present study compared self-perceived social status and its relation to health, health related quality of life and lifestyle in older women with men, adjusting for age, education level and maximum lifetime income. A cross-sectional study was conducted of 4,000 men and women aged 65 years and over in a community in the North Eastern part of Hong Kong, a Special Administrative Region in China. Participants were asked to rate their community status, education, income and occupation, on two ladders, each with ten rungs. The distributions of the two ladder scores differed, showing that although participants may not have been ranked highly in terms of money, education and job respectability, they may have ranked their community standing highly. Women and older participants tended to rank their community standing highly in spite of lower ratings in the objective measures. A social gradient in self-perceived social status, independent of objective socioeconomic measures, was noted for physical performance and health-related quality of life, rather than related to presence of specific chronic diseases or lifestyle. However, the different ratings of the two ladders suggested that mechanisms by which the gradient operates may differ between women and men. Further studies are needed to explore the health and psychosocial consequences of the gender difference in self-rated social status.     

Common symptoms in middle aged women: their relation to employment status, psychosocial work conditions and social support in a Swedish setting

STUDY OBJECTIVE: Over the past few decades there has been a growing interest among researchers, in women's overall life circumstances and their relation to women's health status. For example, paid employment has been considered an important part of women's living conditions in Western societies as the number of women entering the labour market has grown constantly over the past decades. When comparing men's and women's health, one of the most consistent findings is a higher rate of symptoms among women. The most commonly reported symptoms in women are depressive symptoms, symptoms of bodily tension and chronic pain from muscles and joints. The aim of this study was to investigate whether socioeconomic factors, employment status, psychosocial work conditions and social network/support are associated with middle aged women's health status in terms of common symptoms. DESIGN: A mailed questionnaire was used in a cross sectional design assessing socioeconomic factors, employment status, psychosocial work conditions according to the demand/control model, social network/support and an index based on the 15 most frequent symptoms presented by middle aged women when seeking health care. SETTING: A rural community with 13,200 inhabitants in the western part of Sweden. PARTICIPANTS: Women were randomly selected from the general population in the study area, 40 to 50 years of age. The response rate was 81.7 per cent. MAIN RESULTS: Women who were non-employed had a significantly increased odds of a high level of common symptoms (OR = 2.82; 95% confidence intervals 1.69, 4.70), as well as women exposed to job strain (OR = 3.27; 1.92, 5.57), independently of the level of social network/support. Furthermore, exposure to low social support, low social anchorage or low social participation independently showed significantly increased odds of a high level of common symptoms (OR = 2.75; 1.71, 4.42; OR = 2.91; 1.81, 4.69 and OR = 1.69; 1.10, 2.61, respectively). CONCLUSIONS: Work related factors, such as non-employment and job strain, and circumstances within the private sphere, such as social network/support, seem equally important for middle aged women's health status. These findings ought to have important policy implications and also to be of major importance in a primary health care setting when meeting women who seek health care because of common symptoms.     

Economic stress in childhood and adulthood, and self rated health: a population based study concerning risk accumulation, critical period and social mobility

ABSTRACT: BACKGROUND: Research in recent decades increasingly indicates the importance of conditions in early life for health in adulthood. Only few studies have investigated socioeconomic conditions in both childhood and adulthood in relation to health testing the risk accumulation, critical period, and social mobility hypotheses within the same setting. This study investigates the associations between economic stress in childhood and adulthood, and self-rated health with reference to the accumulation, critical period and social mobility hypotheses in life course epidemiology, taking demographic, social support, trust and lifestyle factors into account. METHODS: The public health survey in Skane (southern Sweden) in 2008 is a cross-sectional postal questionnaire study based on a random sample, in which 28,198 persons aged 18--80 years participated (55% participation). Logistic regression models were used to investigate associations between economic stress in childhood and adulthood, and self-rated health. RESULTS: Three life-course socioeconomic models concerning the association between economic stress and self-rated health (SRH) were investigated. The results showed a graded association between the combined effect of childhood and adulthood economic stress and poor SRH in accordance with the accumulation hypothesis. Furthermore, upward social mobility showed a protecting effect and downward mobility increased odds ratios of poor SRH in accordance with the social mobility hypothesis. High/severe economic stress exposures in both stages of life were independently associated with poor SRH in adulthood. Furthermore, stratifying the study population into six age groups showed similar odds ratios of poor SRH regarding economic stress exposure in childhood and adulthood in all age groups among both men and women. CONCLUSIONS: The accumulation and social mobility hypotheses were confirmed. The critical period model was confirmed in the sense that both economic stress in childhood and adulthood had independent effects on poor SRH. However, it was not confirmed in the sense that a particular window in time (in childhood or adulthood) had a specifically high impact on self rated health.     

The Swedish labour market in the 1990s: the very last of the healthy jobs?

BACKGROUND: The economic recession in Sweden in the 1990s influenced several aspects of the labour market, including the psychosocial work environment. This study examined psychosocial working conditions in relation to self-reported ill-health in the 1990s by means of the job strain model. METHODS: The study was based on two representative cross-sectional samples of Swedish employed men and women in 1991 (n=3,292) and 2000 (n=3,010), together with a panel of employees who were included for both years (n=1,953). The main outcome measures were psychological distress and self-rated poor health. The primary method used was logistic regression. RESULTS: The results suggested that although adverse psychosocial conditions increased during the 1990s, the association with health weakened. However, further analyses showed that poor health increased in most groups with various types of psychosocial conditions, and that reduced relative differences in poor health were discernible. Finally, a longitudinal analysis showed that long-term exposure to and experience of deteriorating psychosocial conditions was most detrimental for health at the end of the 1990s, once health status at baseline had been adjusted for. CONCLUSIONS: The increased prevalence of health problems among most groups with various psychosocial conditions during the 1990s, together with reduced relative differences in poor health, might make it more difficult for employers and policy-makers to direct health policies towards specific groups of employees, as the "healthy' job seems to have disappeared. Another important inference of the results is that psychosocial working conditions seem to be causally related to health.     

Perceived health as related to income, socio-economic status, lifestyle, and social support factors in a middle-aged Japanese

BACKGROUND: Few studies have examined the association of perceived health with socio-economic status, especially income, and social isolation and support in Japan. The purpose of this study is to clarify the associations among perceived health, lifestyle, and socio-economic status, as well as social isolation and support factors, in middle-aged and elderly Japanese. METHODS: Subjects were 9,650 participants aged 47-77 years who completed a self-administered questionnaire in 2000 in the second survey of a population-based cohort (the Komo-Ise study). The questionnaire included items on sociodemographic and socio-economic factors, social isolation and support, lifestyle, past history of chronic disease and perceived health. Perceived health was dichotomized into excellent or good health and fair or poor health. A logistic regression analysis was used to determine the odds ratios of socio-economic status, social characteristics and lifestyle in relation to self-reported fair or poor health. RESULTS: We found that household income, physical activity, sleeping, smoking habit, and BMI had a strong association with self-reported fair or poor health in middle-aged and elderly Japanese men and women. Male subjects tended to report fair or poor health as household income decreased. The results for women differed in that social isolation and low social support had a stronger association for self-reported fair or poor health than low household income. CONCLUSIONS: The results indicated that perceived health was associated with socio-economic and social characteristics among middle-aged and elderly residents in Japan.     

Self-rated health, chronic diseases, and symptoms among middle-aged and elderly men and women

The objective was to study the association between chronic diseases, symptoms, and poor self-rated health among men and women and in different age groups, and to assess the contribution of chronic diseases and symptoms to the burden of poor self-rated health in the general population. Self-rated health and self-reported diseases and symptoms were investigated in a population sample of 6,061 men and women aged 35-79 years in V?rmland County in Sweden. Odds ratios (OR) and population attributable risks (PAR) were calculated to quantify the contribution of chronic diseases and symptoms to poor self-rated health. Depression, neurological disease, rheumatoid arthritis, and tiredness/weakness had the largest contributions to poor self-rated health in individuals. Among the elderly (65-79 years), neurological disease and cancer had the largest contribution to self-rated health in men, and renal disease, rheumatoid arthritis, and cancer in women. Among the middle-aged (35-64 years), depression and tiredness/weakness were also important, especially in women. From a population perspective, tiredness/weakness explained the largest part of poor self-rated health due to its high prevalence in the population. Depression and musculoskeletal pains were also more important than other chronic diseases and symptoms at the population level. Even though many chronic diseases (such as neurological disease, rheumatoid arthritis, and cancer) are strongly associated with poor self-rated health in the individual, common symptoms (such as tiredness/weakness and musculoskeletal pains) as well as depression contribute more to the total burden of poor self-rated health in the population. More preventive measures should therefore be directed against these conditions, especially when they are not consequences of other diseases.     

Health-related lifestyle and mental health among inhabitants of a city in Japan

AIM: Few studies have linked mental health to lifestyle factors in the Japanese general population. The present investigation was conducted to examine whether mental health is associated with a health-related lifestyle and how the strength of the association, if any, differs across sex and age groups, using health survey data for inhabitants of Japan. METHODS: The data used were obtained from a questionnaire survey on lifestyle and health. In 1998, the questionnaires were mailed to 2,288 subjects selected from among the inhabitants of a city in Japan, of whom 1,642 subjects (71.8%) responded. The present study included 1,343 subjects who completed all the items that were used in the analysis. The General Health Questionnaire (GHQ) -12 was used as an indicator of mental health, with 4 points or higher (high score) indicating poor mental health. Information on eight different lifestyle parameters was also obtained. Logistic regression was used to calculate the odds ratio (OR) of having poor mental health for each lifestyle. RESULTS: Subjects in poor mental health had a lower mean score for a healthy lifestyle than those in good mental health. The difference in the mean score increased with age among men, while it decreased with age among women. The OR for having poor mental health among non-exercisers was higher in the older age group among men, while it was higher in the younger age group among women. A strong association between sleep hours and mental health was observed in the older age group among men, while it was seen in the younger age groups among women. Dietary factors in general showed a clearer association with mental health among women than among men, except for the consumption of salty foods, the association of which with mental health was more evident among men. CONCLUSIONS: Mental health was found to be significantly associated with health-related lifestyles in the Japanese population. The strength of the association for each lifestyle varied considerably across sex and age groups.     

The association of neighbourhood psychosocial stressors and self-rated health in Amsterdam, The Netherlands

OBJECTIVE: To investigate associations between neighbourhood-level psychosocial stressors (i.e. experience of crime, nuisance from neighbours, drug misuse, youngsters frequently hanging around, rubbish on the streets, feeling unsafe and dissatisfaction with the quality of green space) and self-rated health in Amsterdam, the Netherlands. PARTICIPANTS: A random sample of 2914 subjects aged > or = 18 years from 75 neighbourhoods in the city of Amsterdam, the Netherlands. DESIGN: Individual data from the Social State of Amsterdam Survey 2004 were linked to data on neighbourhood-level attributes from the Amsterdam Living and Security Survey 2003. Multilevel logistic regression was used to estimate odds ratios and neighbourhood-level variance. RESULTS: Fair to poor self-rated health was significantly associated with neighbourhood-level psychosocial stressors: nuisance from neighbours, drug misuse, youngsters frequently hanging around, rubbish on the streets, feeling unsafe and dissatisfaction with green space. In addition, when all the neighbourhood-level psychosocial stressors were combined, individuals from neighbourhoods with a high score of psychosocial stressors were more likely than those from neighbourhoods with a low score to report fair to poor health. These associations remained after adjustments for individual-level factors (i.e. age, sex, educational level, income and ethnicity). The neighbourhood-level variance showed significant differences in self-rated health between neighbourhoods independent of individual-level demographic and socioeconomic factors. CONCLUSION: Our findings show that neighbourhood-level psychosocial stressors are associated with self-rated health. Strategies that target these factors might prove a promising way to improve public health.     

Psychosocial work characteristics and self rated health in four post-communist countries

STUDY OBJECTIVES: To examine whether psychosocial factors at work are related to self rated health in post-communist countries. DESIGN AND SETTINGS: Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor health ("poor health") were estimated for a 1 SD increase in the scores of work related factors. MAIN RESULTS: The overall prevalence of poor health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. CONCLUSIONS: The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations.     

我国15岁及以上居民自评健康状况及其影响因素分析

目的:分析我国15岁及以上居民自评健康状况及其影响因素。方法:采用第五次国家卫生服务调查居民调查资料(n=273 688),测量指标包括调查对象的社会人口学特征、健康相关行为、健康相关生命质量、两周患病、慢性病患病和过去一年内住院情况。剔除无效数据之后有效样本量为188 697,采用有序多分类logistic回归分析对15岁及以上居民自评健康的影响因素进行分析。结果:我国15岁及以上居民自评健康存在明显的社会人口学差异,女性、老年人、低收入、城市(相比于农村)和西部(相比于东中部)居民自评健康等级较差;自评健康状态能够较好地反映中国居民的客观健康状况;健康相关行为良好的居民自评健康状况较好。结论:加强对重点人群(如女性、老年人、低收入人群等)健康状况的关注;改善健康相关行为方式,减少可控的危险因素,诸如不吸烟、不过量饮酒、有规律的体育锻炼等是改善居民自评健康状况的重要手段。     

Job strain and self-reported health among working women and men: an analysis of the 1994/5 Canadian National Population Health Survey

This paper explores the associations, for working women and men, of high strain jobs with self-rated health in the 1994/95 Canadian National Population Health Survey (NPHS). NPHS data were obtained on men (n = 4230) and women (n = 4043), aged 18-64 who answered an abbreviated version oF the job content questionnaire (JCQ). Using the upper and lower tertiles of psychological demands and decision latitude as cut points we classified workers into high strain and other jobs. Self-rated health was the outcome. We used polytomous logistic regression analyses and controlled for potential personal and home confounders; two risk parameters were estimated: for the odds of reporting poor/fair and good health both vs. very good/excellent health. High strain work was reported by 11% of women and 9% of men. After adjusting for potential confounders, high job strain was consistently associated with worse self-rated health in both models for each gender.     

Job insecurity and its association with health among employees in the Taiwanese general population

As employers respond to intensive global competition through the deregulation of labor, job insecurity has become a widespread problem. It has been shown to have significant health impacts in a growing number of workers, but less is known about its social distribution, the mechanisms through which it may act, and the moderating effects of gender, socioeconomic position, and company size. Utilizing data from a national survey of a representative sample of paid employees in Taiwan, we examined the prevalence of job insecurity and its associations with psychosocial work characteristics and health status. A total of 8705 men and 5986 women aged between 25 and 65 years old were studied. Information on perceived job insecurity, industrial and occupational types, psychosocial work characteristics as assessed by the Job Strain model, and various measures of health status were obtained by a self-administered questionnaire. The overall prevalence of job insecurity was high (50%). Job insecurity was more prevalent among employees with lower education attainment, in blue-collar and construction workers, those employed in smaller companies, and in older women. Insecure employees also reported lower job control, higher job demands, and poor workplace social support, as compared with those who held secure positions. Regression analyses showed that job insecurity was strongly associated with poor health, even with adjustment of age, job control, job demands, and work place social support. The deleterious effects of job insecurity appeared to be stronger in men than women, in women who held managerial or professional jobs than women in other employment grades, and in those working in larger companies than smaller ones. The findings of this study suggest that perceived job insecurity is an important source of stress, and it is accompanied with adverse psychosocial work conditions and poor health. High-risk groups were identified for further investigation.     

Cultural Capital and Self-Rated Health in Low Income Women: Evidence from the Urban Health Study, Beirut, Lebanon

This paper examines the association between cultural capital and self-rated psychosocial health among poor, ever-married Lebanese women living in an urban context. Both self-rated general and mental health status were assessed using data from a cross-sectional survey of 1,869 women conducted in 2003. Associations between self-rated general and mental health status and cultural capital were obtained using χ ² tests and odds ratios from binary logistic regression models. Cultural capital had significant associations with self-perceived general and mental health status net of the effects of social capital, SES, demographics, community and health risk factors. For example, the odds ratios for poor general and mental health associated with low cultural capital were 4.5 (CI: 2.95–6.95) and 2.9 (CI: 2.09–4.05), respectively, as compared to participants with high cultural capital. As expected, health risk factors were significantly associated with both measures of health status. However, demographic and community variables were associated with general health but not with mental health status. The findings pertaining to social capital and measures of SES were mixed. Cultural capital was a powerful and significant predictor of self-perceived general and mental health among women living in poor urban communities.Khawaja and Mowafi are with the Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Box: 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.     

Lifestyle and sociodemographic risk factors for death among middle-aged and elderly residents in japan from a five-year follow-up cohort study

To examine the relationship between lifestyle and sociodemographic risk factors and mortality, a population-based prospective cohort study was conducted in two areas of Gunma Prefecture, Japan, and a cohort consisting of 11,565 subjects aged 40-69 at baseline in 1993 was followed. During the five-year follow-up period, 201 men and 103 women died. The relative risks (RRs) of risk factors were estimated by the Cox proportional-hazards model. Significant RRs with multivariate adjustment for all-cause mortality was observed for body mass index (BMI). The curve for the relationship between BMI and all-cause mortality was L-shaped in men and U-shaped in women, with the lowest RRs at a BMI of 22-25 in both men and women. Other significant RRs for all-cause mortality were observed for obesity in the subjects' 30's in both men and women (RR: 2.42 and RR: 2.75), poor perceived health status in men (RR: 4.55), and having had a health examination in the past three years in both men and women (RR: 0.49 and RR: 0.46). These results suggested that increased risk of death was independently associated with a lower BMI, obesity in the subjects' 30's, and not undergoing health examinations, among both men and women, and poor perceived health status among men.     

The association between physical activity,cardiorespiratory fitness and self-rated health

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.     

Determinants of and inequalities in self-perceived health in Ukraine

Ukraine is the second most populous of the former Soviet Republics and since transition its economy has fared even more poorly than Russia. Although the impact of the collapse of the former Soviet Union on health in Russia has been investigated, little is known of its impact in other post-Soviet republics. We report a cross-sectional study undertaken in Ukraine in March 2000. A multi-stage random sampling technique was used and 1600 interviews completed (72% response rate) with a representative national sample of Ukrainian adults. We investigated socioeconomic and psychosocial determinants of self-perceived health, which has been shown to be a valid and reliable measure of overall health and predictive of mortality. Odds ratios for less than good physical health were calculated using logistic regression. The self-rated health of Ukrainians was poor, 25% of men and 43% of women rated their health as poor or very poor. This is worse than levels recorded in Russia and considerably worse than levels seen in western Europe. Marked gender, geographical and socioeconomic inequalities in health were recorded. Women are at increased risk of poor self-rated health compared with men (OR 3.58, 2.50-5.14) as are women living in villages compared with those in cities (OR 3.24, 1.30-8.07). Socioeconomic factors including poor material situation (OR 1.64, 1.01-2.67), and psychosocial factors including low control over life (OR 1.89, 1.15-3.11) were identified as independent health determinants. Control over life was found to account for the negative impact of low social position on health. Good family relations protected against poor health. The findings suggest that a decrease in control, arising from an increasingly uncertain political and economic environment, a reduction in material wealth and the stress of change may all have contributed to the decline in life expectancy seen with transition.     

Factors associated with poor self-rated health in elderly users of the Brazilian Unified National Health System

This article reports on prevalence of poor self-rated health and associated factors among elderly users of the Brazilian Unified National Health System (SUS) in Goiania, Goiás State, Brazil. The article is based on a cross-sectional study with a proportional sample of elderly in the nine health districts of Goiania. Data were collected after a pilot study and training of field staff. The measure of association was the prevalence ratio (PR) and respective confidence interval (95%CI). Multivariate analysis was performed using hierarchical Poisson regression. In 403 elderly, prevalence of poor self-rated health was 27.5% (95%CI: 23.2-32.2). The rate was 29.7% in women and 29.1% among seniors aged 60-64 years. Variables associated with poor self-rated health according to multivariate analysis were: less than one year of schooling, lack of physical exercise, use of five or more medications, and recent weight loss. The results showed high prevalence of poor self-rated health and associated factors, including both adverse social conditions and individual health and lifestyle factors.