The role of gender in the association of social capital, social support, and economic security with self-rated health among older adults in deprived communities in Beirut

Purpose

To examine gender variations in the association of self-rated health (SRH) with social capital, social support, and economic security among older adults from three deprived communities in the suburbs of metropolitan Beirut.

Methods

A population-based cross-sectional study using the Older Adult Component of the Urban Health Survey. Face-to-face interviews were conducted with 328 older men and 412 older women aged 60 years and above. SRH was assessed by a single question and treated as a dichotomous outcome, and several indicators of social capital, social support, and economic security were examined as independent variables.

Results

Women were significantly more likely to report poor SRH compared to men (37.2 vs. 25.9 %, respectively). Better social capital indicators decreased significantly the odds of poor SRH among both men (OR = 0.76, 95 % CI: 0.65–0.89) and women (OR = 0.71, 95 % CI: 0.62–0.82). Social support was strongly associated with SRH among women (OR = 0.56), but not among men (OR = 0.94). The reverse situation was observed for economic security (OR = 0.57 among men, OR = 0.80 among women).

Conclusions

In these deprived neighborhoods, social and economic factors may have gender-specific effects on the promotion of well-being among older adults, with social support being more salient to women’s SRH and economic security being more salient to men’s SRH. In health studies among older people, SRH captures not only social and physical health but also broader economic well-being.     

Factors Associated With Social Isolation in Older Adults: A Systematic Review and Meta-Analysis

ObjectiveSocial isolation is a global health issue that affects older adults throughout their lives. This study aimed to identify the factors associated with social isolation in older adults.DesignSystematic review and meta-analysis.Setting and ParticipantsAdults aged 60 years and older.MethodsWe searched for observational studies without language restrictions in 11 databases from inception to August 2022. Pooled odds ratio (OR) and 95% CI were calculated using the R software (version 4.2.1). The modified Newcastle-Ottawa Scale was used to evaluate the risk of bias.ResultsEighteen factors were grouped into 5 themes. The following 13 factors were statistically significant: (1) demographics theme: aged 80 years and older (OR: 2.41; 95% CI: 1.20–4.85), less than or equal to a high school degree (OR: 1.68; 95% CI: 1.44–1.97), smoking (OR: 1.43; 95% CI: 1.18–1.73), and male (OR: 1.38; 95% CI: 1.01–1.89); (2) environment theme: low social support (OR: 7.77; 95% CI: 3.45–17.50) and no homeownership (OR: 1.38; 95% CI: 1.25–1.51); (3) role theme: no social participation (OR: 3.18; 95% CI: 1.30–7.80) and no spouse (OR: 2.61; 95% CI: 1.37–4.99); (4) physical health: hearing loss (OR: 2.78; 95% CI: 1.54–5.01), activities of daily living impairment (OR: 2.38; 95% CI: 1.57–3.61), and poor health status (OR: 1.52; 95% CI: 1.32–1.74); and (5) mental health: cognitive decline (OR: 1.85; 95% CI: 1.40–2.45) and depression (OR: 1.72; 95% CI: 1.21–2.44).Conclusions and ImplicationsSocial isolation in older adults is associated with various factors. Hence, focused intervention should be adopted for older adults. In addition, further longitudinal studies are required to confirm a direct link between multiple factors and social isolation.     

Crush: A Randomized Trial to Evaluate the Impact of a Mobile Health App on Adolescent Sexual Health

PurposeMobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents.MethodsWe recruited 1,210 women aged 14–18 years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app. At 3 and 6 months post randomization, we compared changes from baseline in behaviors, attitudes, self-efficacy, perceived social norms, birth control knowledge, perceived control and use intentions, and SRH service utilization. Odds ratios were estimated with multivariable logistic regression and adjusted for baseline outcome, age, race/ethnicity, mother's education, and sexual experience.ResultsThere was no difference in accessing SRH services according to study group. Three months post baseline, Crush users had higher odds (p < .05) than control participants of reporting confidence in accessing SRH services (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1–2.3) and of believing that it is a good thing to use birth control consistently (aOR = 2.3, 95% CI: 1.4–3.8). Six months after baseline, Crush users had higher odds than control participants of reporting they can control whether birth control is used every time they have sex (aOR = 1.8, 95% CI: 1.2–2.6) and perceiving they would get pregnant if they did not use birth control (aOR: 1.5, 95% CI: 1.1–2.2). Impacts on other behavioral constructs were also found.DiscussionCrush was associated with improvements in knowledge, attitudes, and self-efficacy related to key SRH behaviors and may be a strategy to deliver SRH education to adolescent women. Studies including larger numbers of sexually active adolescents are needed to demonstrate behavioral impacts.     

A cross-sectional survey of environmental health in remote Aboriginal communities in Western Australia

Introduction: The Australian Aboriginal population experiences significantly poorer health than the non-Aboriginal population. The contribution of environmental risk factors in remote communities to this health disparity is poorly understood.

Objective: To describe and quantify major environmental risk factors and associated health outcomes in remote Aboriginal communities in Western Australia.

Methods: The association between environmental health indicators, community infrastructure and reported health outcomes was analysed using linear and logistic regression of survey data.

Results: Housing/overcrowding was significantly associated with increased reports of hearing/eyesight (OR 3.01 95?% CI 1.58–5.73), skin (OR 2.71 95?% CI 1.31–5.60), gastrointestinal (OR 3.51 95 % CI 1.49–8.26) and flu/colds (OR 2.47 95 % CI 1.27–4.78) as health concerns. Dust was significantly associated with hearing/eyesight (OR 3.16 95 % CI 1.82–5.48), asthma/respiratory (OR 2.48 95 % CI 1.43–4.29) and flu/colds (OR 3.31 95 % CI 1.88–5.86) as health concerns.

Conclusion: Poor environmental health is prevalent in remote Aboriginal communities and requires further delineation to inform environmental health policy.     

健康生态学视角下我国60岁及以上老年人自评健康的影响因素研究

目的 基于健康生态学视角,探讨我国60岁及以上老年人群自评健康的影响因素。方法 采用横断面调查的方法,以CHARLS 2015的387例60岁以上老年人为研究对象。采用logistic回归分析老年人自评健康的影响因素。结果 老年人自评健康比例仅28.2%。童年健康状况不好（OR=2.928, 95%CI: 2.298~3.826）、住宅商用（OR=1.528, 95%CI: 1.024~2.281）、居住地为农村（OR=1.467, 95%CI: 1.164~1.85）、夜间睡眠时间（OR=0.862, 95%CI: 0.828~0.91）、饮酒（OR=0.735, 95%CI: 0.583~0.927）、戒酒（OR=1.862, 95%CI: 1.301~2.665）、人际交往（OR=0.791, 95%CI: 0.651~0.962）、工作类型非农业（OR=0.608, 95%CI: 0.44~0.84）、住房有洗澡设施（OR=0.817, 95%CI: 0.669~0.999）与老年人自评健康有关。结论 需要将老年健康干预时间前移,并从个体到环境因素加强对老年健康的干预。     

Social patterning of cardiovascular and metabolic risk in Colombian adults

Objectives: To test for differences in cardiovascular and metabolic risk (CMR) by educational attainment and physical capital. To compare CMR among black, indigenous, and mixed populations, accounting for socioeconomic status (SES).

Design: We conducted multivariate analyses using cross-sectional data from a national survey of Colombian adults (n?=?10,814) to examine the social patterning of CMR. In sex/gender-stratified models, a CMR index was regressed on educational attainment, physical capital, ethnicity/race, and age.

Results: Women with a primary education (OR?=?1.64, 95% CI: 1.25, 2.15) had higher age- and ethnicity/race-adjusted odds of CMR than women with more than secondary education. Men with a primary education (OR?=?0.67, 95% CI: 0.48, 0.92) had significantly lower adjusted odds of CMR than men with more than secondary education; these associations did not remain significant after adjustments for physical capital. Men in the first (OR?=?0.45, 95% CI: 0.36, 0.57) and second (OR?=?0.72, 95% CI: 0.57, 0.91) physical capital tertiles had significantly lower adjusted odds of CMR than those in the highest tertile. There was not a significant patterning of CMR by ethnicity/race for women or men, or by physical capital for women.

Conclusions: Findings suggest that for Colombian adults CMR is patterned by SES; these associations differ by sex/gender.     

Factores asociados a mala calidad de sueño en población brasilera a partir de los 40 años de edad: estudio VIGICARDIO

ObjectiveThe prevalence of poor sleep quality in men and women ≥ 40 years old from the VIGICARDIO Study was determined, and sociodemographic, health, lifestyle and social capital factors associated with poor sleep quality were identified.MethodsA population-based study conducted in 2011 among 1,058 non-institutionalised individuals randomly selected from Cambé, Paraná State, Brazil. Logistic regression was used to evaluate the association between sleep quality and sociodemographic, health, lifestyle and social capital factors in men and women.ResultsThe prevalence of poor sleep quality was 34% in men and 44% in women. Having bad/regular self-rated health status was a factor associated with poor sleep quality in men (OR: 1.79; 95% CI: 1.17-2.72) and women (OR: 2.43; 95% CI: 1.68-3.53). Being obese (OR: 1.67; 95% CI: 1.13-2.46), having depression (OR: 2.09; 95% CI: 1.41-3.13) and presenting temporal orientation difficulties (OR: 1.95; 95% CI: 1.08-3.52) were associated factors in women. Difficulty to understand what is explained (OR: 2.18; 95% CI: 1.16-4.09) and alcohol abuse (OR: 1.85; 95% CI: 1.21-2.83) were associated factors in men.ConclusionFactors affecting sleep quality are different for men and for women. These factors should be taken into consideration when devising activities that promote good sleep quality, with a view to improving their effectiveness.     

Explaining the gender difference in self-rated health among university students in Egypt

ABSTRACT

In this study the authors assessed gender differences in the relationships between self-rated health (SRH) and demographic factors, physical health, health service use, infections, a variety of symptoms and health conditions, and wider well-being features. A self-administered questionnaire was administered to 3,271 students at Assiut University, Egypt during 2009–2010. Multiple logistic regression was used (with excellent/very good SRH as dependent variable) to assess the variables that might explain the gender difference in SRH. Females had more symptoms, infectious diseases/illness periods, substantially lower quality of life, and more burdens, although their health awareness and satisfaction with social support were higher than males. The unadjusted odds ratio (OR) suggested that females were less likely than males to rate their SRH as excellent/very good [OR 0.56, 95% confidence interval (CI) 0.47–0.68]. Adjusting only for relevant physical health and health service use variables, the OR for excellent/very good SRH for females increased, but nevertheless still remained significantly lower than that of males. With further adjustment for physical health, health service use, and also for wider well-being variables, the gender difference in SRH became no longer statistically significant. Poorer physical health indicators and a lower level of wider well-being features explained the lower SRH among female Egyptian university students. Health promotion and prevention programs should consider these factors in attempting to address gender health disparities.     

Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey

Objective

To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50–70 years old enrolled in the US 2010 health and retirement survey.

Methods

Multivariable logistic regression models estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2 years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1–2, 3–4 or 5+ events. HCU included hospitalization (any vs. none) and physician visits (<20 vs. ≥20) over 2 years.

Findings

Hospitalization odds declined by 25 % (OR 0.75, 95 %CI 0.64–0.86), odds of ≥20 physician visits declined by 47 % (OR 0.53, 95 % CI 0.45–0.63) and the odds of SRH improvement increased by 49 % (OR 1.49, 95 % CI 1.17–1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 % elevated for participants that reported 1–2, 3–4 and 5+ versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician’s visits and hospitalizations.

Conclusion

In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.

     

Food Insecurity Is Associated With Dysfunctional Eating Behaviors Among Adults in Puerto Rico

ObjectiveTo examine the association between food insecurity and dysfunctional eating behaviors among adults in Puerto Rico.MethodsData from 865 participants were obtained from baseline interviews from the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) cohort. The association between food insecurity and emotional eating (EE) and uncontrolled eating (UE) (categorized as no/moderate/high) was examined using multinomial logistic models. Potential mediation by perceived stress was explored.ResultsThe prevalence of food insecurity was 20.3%. Compared with adults with food security, adults with food insecurity had higher odds of both moderate EE (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.18–3.09) and high EE (OR, 2.85; 95% CI, 1.75–4.64), and both moderate UE (OR, 1.78; 95% CI, 0.91–3.50) and high UE (OR, 3.28; 95% CI, 1.70–6.33). Perceived stress slightly attenuated these associations.Conclusions and ImplicationsFood insecurity was associated with a higher likelihood of engaging in dysfunctional eating behaviors. Interventions alleviating food insecurity or stress might help adults sustain healthy eating behaviors.     

Racial-ethnic disparities in self-reported health status among US adults adjusted for sociodemographics and multimorbidities,National Health and Nutrition Examination Survey 2011–2014

ABSTRACT

Objective: To investigate racial-ethnic disparities in self-reported health status adjusting for sociodemographic factors and multimorbidities.

Design: A total of 9499 adult participants aged 20 years and older from the United States (US); reported by the National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey – for years 2011–2014. The main outcome measure was self-reported health status categorized as excellent/very good, good (moderate), and fair/poor.

Results: Of the NHANES participants, 40.7% reported excellent/very good health, 37.2% moderate health and 22.1% fair/poor health. There were 42.8% who were non-Hispanic whites, 20.2% were Hispanic, 23.8% were non-Hispanic blacks, and 13.2% were non-Hispanic Asians. Compared to non-Hispanic whites, Hispanics [Odds Ratio (OR)?=?2.91, 95% Confidence Interval (CI)?=?2.28–3.71] and non-Hispanic blacks [OR?=?1.51, 95% CI?=?1.26–1.83] were more likely to report fair/poor health, whereas, non-Hispanic Asians [OR?=?1.42, 95% CI?=?1.14–1.76] were more likely to report moderate health than excellent/very good health. Compared to those with no chronic conditions, participants with two or three chronic conditions [OR?=?9.35, 95% CI?=?7.26–12.00] and with four or more chronic conditions [OR?=?38.10, 95% CI?=?26.50–54.90] were more likely to report fair/poor health than excellent/very good health status.

Conclusion: The racial-ethnic differences in self-reported health persisted even after adjusting for sociodemographics and number of multimorbidities. The findings highlight the potential importance of self-reported health status and the need to increase health awareness through health assessment and health-promotional programs among the vulnerable minority US adults.     

Varying Levels of Food Insecurity Associated with Clinically Relevant Depressive Symptoms in U.S. Adults Aged 60 Years and Over: Results from the 2005–2014 National Health and Nutrition Survey

Abstract

Food insecurity refers to restricted or uncertain access to and ineffective utilization of nutritious and safe foods. Although food insecurity is linked to poorer physical health consequences among older adults, national estimates are not well known on food insecurity and depression. Using the 2005–2014 National Health and Nutrition Examination Survey, this study examines the associations between varying food insecurity levels and clinically relevant depressive symptoms (defined by PHQ-9?≥?10) among adults ≥60?years old (n?=?7969). Rates of clinically relevant depressive symptoms in marginal, low, and very low food security were 12.3, 16.3, and 25.2%, respectively. Marginal, low, and very low food security were significantly associated with clinically relevant depressive symptoms: odds ratio (OR)?=?1.12 (95% confidence intervals [CI] 1.07–1.18), OR?=?1.07 (95% CI 1.03–1.12), and OR?=?1.24 (95% CI 1.16–1.32), respectively. Given the intersection of food insecurity and depression, geriatric health professionals should work to improve health and nutrition programs for older adults at risk for or experiencing both public health concerns.     

Are Health Behaviors and Self-Rated Health Related to Cardiovascular Health and Functional Performance? Results from the Lookup 7+ Cross-Sectional Survey among Persons Aged 65+

Objectives

Cardiovascular health (CVH) and physical performance (PP) are key factors of successful ageing. This study investigated whether self-reported CVH behaviours and self-rated health (SRH) are related to ideal CVH and PP.

Design

Cross-sectional survey.

Setting

Public places in Italy (e.g. exhibitions, malls, health promotion campaigns), outside of conventional healthcare settings.

Participants

1415 community-living persons aged 65+ years (mean age 72.2 ± 5.4; 58.4% female).

Measurements

Three ideal CVH behaviors [regular physical activity (PA), healthy diet, no smoking] and SRH (1 excellent — 4 poor) were assessed through a brief questionnaire. Four ideal CVH factors [iBMI ≤ 25 kg/m2, untreated random total blood cholesterol ≤200 mg/dl, absence of diabetes (untreated random blood glucose ≤200 mg/dl), untreated blood pressure (iBP) <140/90mmHg] and two ideal PP factors [grip strength (iGrip), 5-repetition chair-stand test <10 seconds (iStand)] were measured.

Results

Adjusted for age and gender, regular PA was positively related to CVH factor score (β = 0.1; p = <.001), iBMI (OR = 1.8; 95% CI = 1.5-2.3), iBP (OR = 1.3; 95% CI = 1.1-1.6) and iStand (OR = 1.6; 95% CI = 1.3-2.1). Healthy diet was positively related to CVH factor score (β = 0.1; p = <.05) and iGrip (OR = 1.4; 95% CI = 1.1-1.8). Participants rating SRH as “good” (OR = 2.0; 95% CI = 1.1-3.9) and “not so good” (OR = 2.3; 95% CI = 1.2-4.5) met iDiabetes more often than those with poor SRH. Moreover, iStand (OR = 3.2; 95% CI = 1.6-6.6) and iGrip (OR = 4.2; 95% = CI 2.0-8.8) were more prevalent among participants with excellent SRH compared with those with poor SRH.

Conclusions

Physical activity, diet and self-rated health may provide quick and easy-to-assess metrics to identify persons aged 65+ years at risk of cardiovascular events and functional impairment, who could particularly benefit from engaging in health promotion programs.

     

Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement

ObjectivesUnderstand the association between social determinants of health and community discharge after elective total joint arthroplasty.DesignRetrospective cohort design using Optum de-identified electronic health record dataset.Setting and ParticipantsA total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018.MethodsLogistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics.ResultsMean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity [hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76–0.85; knee: OR 0.73, 95% CI 0.69–0.77], current smoking (hip: OR 0.82, 95% CI 0.77–0.88; knee: OR 0.90, 95% CI 0.85–0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50–0.60; knee: OR 0.57, 95% CI 0.53–0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively.Conclusions and ImplicationsSocial determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder.     

Polygamy and poor mental health among Arab Bedouin women: do socioeconomic position and social support matter?

Objectives. Polygamy is a complex phenomenon and a product of power relations, with deep cultural, social, economic, and political roots. Despite being banned in many countries, the practice persists and has been associated with women's marginalization and mental health sequelae. In this study, we sought to improve understanding of this ongoing, complex phenomenon by examining the contribution of socioeconomic position (SEP) and social support to the excess of depressive symptoms (DS) and poor self-rated health (SRH) among women in polygamous marriages compared to women in monogamous marriages. Measuring the contribution of these factors could facilitate policies and interventions aimed at protecting women's mental health.

Design. The study was conducted among a sample of Arab Bedouin women living in a marginalized community in southern Israel (N=464, age 18–50). The women were personally interviewed in 2008–2009. We then used logistic regression models to calculate the contribution of SEP (as defined by the women's education, family SEP, and household characteristics) and social support to excess of depressive symptoms and poor SRH among participants in polygamous versus monogamous marriages.

Results. About 23% of the participants were in polygamous marriages. These women reported almost twice the odds of depressive symptoms (OR=1.91, 95%CI=1.22, 2.99) and poorer SRH (OR=1.73, 95%CI=1.10, 2.72) than those in monogamous marriages. Women's education changed these associations slightly, but family SEP and household characteristics resulted in virtually no further change. Social support reduced the odds for poor SRH and DS by about 23% and 28%, respectively.

Conclusion. Polygamy is associated with higher risk for poor mental health of women regardless of their SEP and education. Social support seems to have some protective effect.     

Household food security status and its associated factors in Baft-Kerman,IRAN: a cross-sectional study

ABSTRACT

Food insecurity is prevalent in both developed and developing countries, which has considerable health impacts on the social, physical, and psychological status. This study aimed to examine the food security status and its related sociodemographic factors among the households living in Baft city of Iran. A sample of 702 households was selected by a simple random sampling method from January to March 2017. Using U.S. Department of Agriculture Food Security questionnaire, 34.3% of households showed some degree of food insecurity. Lower household size (OR = 0.84, CI: 0.73–0.97, P = .02), higher welfare facilities (OR = 1.55, CI: 1.32–1.81, P < .001), educational levels of the mothers and their spouse (being diploma as compared to under-diploma) (OR = 1.57, CI: 0.98–2.53, P = .04 and OR = 1.65, CI: 1.05–2.57, P = .02), governmental employment as compared to unemployment of the spouse (OR = 1.85, CI: 1.14–2.99, P = .01), and house ownership (rent compared to owner house; OR = 0.41, CI: 0.21–0.81, P = .01) were significantly associated with food security. The findings showed food insecurity was associated with some sociodemographic factors among households in Baft. These findings demonstrate that the government needs to continue its efforts to provide appropriate funding for population-based programs and policies, to enhance food security of the people living in this city.     

Food insecurity,socio-economic factors and weight status in two Iranian ethnic groups

Objective. To study the association of weight status with food insecurity (FI) and socio-economic status (SES) in Azeri and Kurd ethnic groups living in Urmia city, North-Western Iran.

Design. In this cross-sectional study, 723 participants (427 women and 296 men) aged 20–64 years old, from two ethnic groups (445 Azeri and 278 Kurd), were selected through a combination of cluster, random and systematic sampling methods. Demographic and socio-economic characteristics were assessed by a valid questionnaire, and household food security status was analyzed using an adapted household food insecurity access scale through face-to-face interviews at homes. General and central obesities were measured and evaluated using standard methods.

Results. Based on the findings, moderate-to-severe FI, as well as low SES, was more dominant in Kurds, compared to Azeris. After adjusting for confounders, being female(OR?=?4.33, CI 95%: 2.35–7.97) and moderate-to-severe FI (OR?=?2.00, CI 95%: 1.01–3.97) in Azeris and being female (OR?=?5.39, CI 95%: 2.28–12.23) and higher total cost of household/capita (OR?=?1.005, CI 95%: 1.002–1.009) in Kurds were related to higher odds of general obesity while low (OR?=?0.41, CI 95%: 0.18–0.91) and moderate(OR?=?0.13, CI 95%: 0.02–0.60) education levels were linked to lower chance of general obesity. Furthermore, the chance of central obesity was lower in Azeris with high educational levels (OR?=?0.64, CI 95%: 0.21–0.94), females (OR?=?0.72, CI 95%: 0.34–0.86), home owners (OR?=?0.56, CI 95%: 0.31–0.91) and females Kurds (OR?=?0.60, CI 95%: 0.37–0.97) with moderate-to-severe FI and higher total income per capita. In contrast, the chance of central obesity increased in Kurds with increased age (OR?=?1.06, CI 95%: 1.02–1.10) and total cost of household per capita (OR?=?1.004, CI 95%: 1.000–1.008).

Conclusion. These findings show that the association between moderate-to-severe FI and risk of general/central obesity varies in Azeris, compared to Kurds. However, better SES decreased the chance of general/central obesity in both ethnic groups.     

Job dissatisfaction as a predictor of poor health among middle-aged workers: a 14-wave mixed model analysis in Japan

Objective:This study aimed to examine the association between job dissatisfaction (JD) and health outcomes among middle-aged workers.Methods:This study used longitudinal data comprising 156 823 observations of 24 056 workers (13 177 men and 10 879 women) collected from a 14-wave nationwide population-based survey in Japan that began in 2005, involving individuals aged 50–59 years. Mixed models were estimated to examine the association between JD and the risk of psychological distress (PD), poor self-rated health (SRH), and health-related resignation (HRR).Results:Across all waves, 20.9–32.5% of participants were dissatisfied with their jobs for at least one year before each wave. Mixed model results showed that this JD experience was associated with higher risks of PD, poor SRH, and HRR, with odds ratios (OR) of 1.96 [95% confidence interval (CI) 1.75–2.20], 1.33 (95% CI 1.26 –1.40), and 1.57 (95% CI 1.40 –1.75), respectively. A longer JD duration was associated with a higher risk of poor health. No substantial differences between genders were found regarding the association between JD and health outcomes. A separate analysis showed reverse causation from poor health to JD; poor health was significant in predicting later JD even when it was controlled for.Conclusions:The results confirm that JD was predictive of poor health among middle-aged workers. Therefore, policymakers and managers should monitor the JD of their employees and improve their work environments to enhance their occupational health.     

Frailty Predicts Increased Health Care Utilization Among Community-Dwelling Older Adults: A Longitudinal Study in China

ObjectivesFrailty, a multidimensional syndrome characterized by vulnerability to stressors, is an emerging public health priority with high prevalence in older adults. Frailty has been identified to predictive negative health outcomes, yet quantified evidence regarding its effect on health care systems is scarce. This study examines how frailty affects health care utilization, and explores whether these associations varied by gender.DesignCohort study with a 2-year follow-up.Settingand Participants: Data were derived from 2 waves (2011 and 2013) of the China Health and Retirement Longitudinal Study, and 3119 community-dwelling participants aged ≥60 years were analyzed.MethodsFrailty was assessed by a validated frailty phenotype scale, and measures for health care utilization were self-reported. Panel data approach of mixed-effects regression models was used to examine the associations.ResultsLongitudinal results demonstrated that compared with robustness, prefrailty and frailty were both significantly associated with increased likelihood of outpatient visit, inpatient visit, and inpatient length of stay, even after adjusting for multimorbidity in multivariate analyses (all P < .05). Every 1-component increase in frailty was also found to significantly increase the risk for health care utilization [any outpatient visit: adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 1.14–1.48; number of outpatient visits: adjusted incident rate ratio (IRR) 1.34, 95% CI 1.18–1.53; any inpatient visit: adjusted OR 1.44, 95% CI 1.22–1.71; number of inpatient visits: adjusted IRR 1.40, 95% CI 1.20–1.62; inpatient length of stay: adjusted IRR 1.50, 95% CI 1.18–1.92]. The preceding associations were similarly observed irrespective of gender.Conclusions and ImplicationsFrailty is a significant predictor for increased health care utilization among community-dwelling older adults. These findings have important implications for routine clinical practice and public health investment. Early screening and intervention for potentially modifiable frailty could translate into considerable savings for households and health care systems.