Oral Health,Disability and Physical Function: Results From Studies of Older People in the United Kingdom and United States of America

ObjectivesStudies examining the associations between oral health and disability have limited oral health measures. We investigated the association of a range of objectively and subjectively assessed oral health markers with disability and physical function in older age.Design, Setting, and ParticipantsCross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising men aged 71 to 92 years (n = 2147) from 24 British towns, and the Health, Aging, and Body Composition (HABC) Study comprising men and women aged 71 to 80 years (n = 3075) from the United States. Assessments included oral health (periodontal disease, tooth count, dry mouth, and self-rated oral health), disability, and physical function (grip strength, gait speed, and chair stand test).ResultsIn the BRHS, dry mouth, tooth loss, and cumulative oral health problems (≥3 problems) were associated with mobility limitations and problems with activities of daily living and instrumental activities of daily living; these remained significant after adjustment for confounding variables (for ≥3 dry mouth symptoms, odds ratio (OR) 2.68, 95% confidence interval (CI) 1.94–3.69; OR 1.76, 95% CI 1.15–2.69; OR 2.90, 95% CI 2.01, 4.18, respectively). Similar results were observed in the HABC Study. Dry mouth was associated with the slowest gait speed in the BRHS, and the weakest grip strength in the HABC Study (OR 1.75, 95% CI 1.22, 2.50; OR 2.43, 95% CI 1.47–4.01, respectively).Conclusions and ImplicationsMarkers of poor oral health, particularly dry mouth, poor self-rated oral health, and the presence of more than 1 oral health problem, were associated with disability and poor physical function in older populations. Prospective investigations of these associations and underlying pathways are needed.     

Do childhood and adult socioeconomic circumstances influence health and physical function in middle-age?

This study examines the joint and separate contribution of social class in early and adult life to differences in health and physical function in middle-aged men. We use data from the Metropolit project which includes men born in 1953 in Copenhagen and a study of middle-aged Danish twins (MADT). In total 6292 Metropolit participants in a follow-up survey on health in 2004 were included in the study together with 2198 male twins of which 1294 were part of a male twin pair (N = 647 pairs). Logistic regression was used to investigate the association between social class in early and adult life, respectively and health in midlife, measured as limitations in running 100 m, poor dental status, poor self-rated health, and fatigue. In both datasets, men with low childhood or adult social class had a higher risk of being unable to run 100 m, having poor dental status, having poor self-rated health and fatigue than men from the highest social classes. When childhood and adult social class were mutually adjusted, the estimates for both measures were attenuated. Adjustment for living without a partner, body mass index (BMI) and smoking in midlife, which were also related to the four outcomes, had marginal effects on the estimates for childhood social class, but attenuated the effect of adult social class somewhat. Among male twin pairs discordant on adult social class, the twin in the lowest class seemed to be unable to run 100 m, rate own health poorer and being fatigued more often than the high class co-twin, while there seemed to be no twin pair difference in dental status. This suggests that the associations of adult social class with functional limitations, poor self-rated health and fatigue may partly be due to causal effects related to adult social class exposures, while social class differences in dental status might be consistent with an effect of factors mainly operating early in life.     

Disability and self-rated health among older women and men in rural Guatemala: The role of obesity and chronic conditions

Unprecedented population aging in poorer settings is coinciding with the rapid spread of obesity and other chronic conditions. These conditions predict disability and poor self-rated health and often are more prevalent in women than men. Thus, gender gaps in obesity and other chronic conditions may account for older women’s greater disability and worse self-rated health in poor, rural populations, where aging, obesity, and chronic conditions are rapidly emerging. In a survey of 604 adults 50 years and older in rural Guatemala, we assessed whether gender gaps in obesity and other chronic conditions accounted for gender gaps in disability and self-rated health. Obesity strongly predicted gross mobility (GM) disability, and the number of chronic conditions strongly predicted all outcomes, especially in women. Controlling for gender gaps in body-mass index (BMI) and especially the number of chronic conditions eliminated gender gaps in GM disability, and controlling for gender gaps in the number of chronic conditions eliminated gender gaps in self-rated health. We recommend conducting longitudinal cohort studies to explore interventions that may mitigate adult obesity and chronic conditions among poor, rural older adults. Such interventions also may reduce gender gaps in later-life disability and self-rated health.     

Prevalence of disability among adolescents and adults in rural China

BackgroundDisability affects health status and quality of life; however, insufficient research has been done in developing countries using internationally accepted measurements.ObjectiveWe investigated disabilities, sociodemographics, health indicators, and health behaviors using a sample of rural residents in northern China. We reported disability prevalence by age for our study sample and for a sample of rural residents who participated in the 1999-2002 Colorado Disability Survey.MethodsFace-to-face interviews were conducted in 2008, and complete questionnaires were obtained from 2199 individuals 15 years old or older. The definition of disability was conceptually based on the International Classification of Functioning, Disability and Health.ResultsOf those who completed the survey, 154 (7.0%) reported having disabilities. The prevalence was 2.3% for limitations in activities of daily living (ADL) and 3.1% for limitations in instrumental activities of daily living (IADL). Significant differences in the disability prevalence were found across the categories of education, age, and marital status. Among individuals with disabilities, 54.6% rated their health status as poor or very poor compared to 13.4% of people without a disability. A strong association was seen between disability status and injury. A large proportion (79.9%) of persons with disabilities, as well as 82.2% of persons without disabilities, reported paying for their medical expenses out-of-pocket. The age pattern of disabilities (ADL and IADL) was similar to that seen in a rural Colorado population.ConclusionsMany rural Chinese individuals with disabilities report poor general health and may face further limitations in their daily activities and social participation without accessible and affordable health care.     

Comparison of the effects of low childhood socioeconomic position and low adulthood socioeconomic position on self rated health in four European studies

BACKGROUND: Socioeconomic inequalities in health are a persistent feature throughout Europe. Researchers and policy makers are increasingly using a lifecourse perspective to explain these inequalities and direct policy. However, there are few, if any, cross national lifecourse comparisons in this area. METHODS: Associations between socioeconomic position (SEP) in childhood and in adulthood and poor self rated health among men and women at midlife were tested in four European studies from England (n = 3615), France (n = 11 595), Germany (n = 4183), and the Netherlands (n = 3801). RESULTS: For women, mutually adjusted analyses showed significant associations between poor self rated health and low SEP in both childhood and adulthood in England and the Netherlands, only low childhood SEP in Germany and neither childhood nor adulthood SEP in France. For men, mutually adjusted analyses showed significant associations between poor self rated health and low SEP in both childhood and adulthood in France and the Netherlands, only with adult SEP in England and only with childhood SEP in Germany. CONCLUSION: In most countries adult SEP showed stronger associations with self rated health than childhood SEP. There are both gender and national differences in the associations between childhood and adulthood SEP. Policies designed to reduce inequalities in health need to incorporate a lifecourse perspective that is sensitive to different national and gender issues. Ultimately, more cross national studies are required to better understand these processes.     

Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites

BackgroundThe oldest old represent a unique group of older adults. This group is rapidly growing worldwide and yet there are gaps in the knowledge related to their health condition. Ethnic differences in disease prevalence and mortality must be understood to better care for the oldest old.ObjectiveTo compare prevalence of common health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites.MethodsThis study included 568 community-dwelling Mexican Americans (MA) aged 85 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly 2004–2005 and 933 non-Hispanic whites (NHW) of the same age from the Health and Retirement Study 2004. Measures included sociodemographic variables, self-reported medical conditions, activities of daily living (ADLs), and instrumental activities of daily living. Logistic regression analysis was used to examine 2-year mortality in both populations.ResultsHeart attack was significantly more prevalent in oldest old NHW compared with MA, regardless of gender. Conversely, diabetes was significantly more prevalent among MA men and women compared with their NHW counterparts. Compared with NHW men, MA men had significantly higher prevalence of cognitive impairment and hypertension. Additionally, prevalence of hip fracture was significantly higher for MA women compared with NHW women. Significant differences in ADL disability were observed only between both groups of women, whereas significant differences in instrumental activities of daily living disability were observed only between men. MA men and women had higher prevalence of obesity compared with NHW. Predictors of 2-year mortality for both ethnic groups included older age, male gender, and ADL disability. Cognitive impairment was a mortality predictor only for NHW. Similarly, lung disease was a predictor only for MA.ConclusionHealth-related conditions that affect the oldest old vary by gender and ethnicity and entail careful evaluation and monitoring in the clinical setting. Better care requires inclusion of such differences as part of the comprehensive evaluation of the oldest old adults.     

Gender differences in physical disability among an elderly cohort

OBJECTIVES: We analyzed the role of sociodemographic factors, chronic-disease risk factors, and health conditions in explaining gender differences in disability among senior citizens. METHODS: We compared 1348 men and women (mean age = 79 years) on overall disability and compared their specific activities of daily living, instrumental activities of daily living (IADL), and mobility limitations. Analysis of covariance adjusted for possible explanatory factors. RESULTS: Women were more likely to report limitations, use of assistance, and a greater degree of disability, particularly among IADL categories. However, these gender differences were largely explained by differences in disability-related health conditions. CONCLUSIONS: Greater prevalence of nonfatal disabling conditions, including fractures, osteoporosis, back problems, osteoarthritis and depression, contributes substantially to greater disability and diminished quality of life among aging women compared with men.     

Migration and self-rated health: a comparison between Finns living in Sweden and Finns living in Finland

AIMS: There is a lack of studies comparing health among immigrant groups with health among the population in their country of origin. This study compared the prevalence of self-rated poor health between Finns living in Sweden and Finns living in Finland. METHODS: Data were obtained from the Swedish Annual Level of Living Survey between 1996 and 2003 and the Finnish national survey "Health 2000'. Odds ratios (OR) of self-rated poor health were estimated adjusting for age, marital status, education, employment and smoking. The participants were 21,991 Swedes and 836 Finns living in Sweden, and 5,096 Finns living in Finland. RESULTS: For Finnish women living in Sweden the odds of self-rated poor health was significantly higher (OR=1.25, 95% CI=1.02-1.54) than for Finnish women living in Finland. An opposite pattern appeared among men; Finnish men living in Finland tended to have higher odds of self-rated poor health than Finnish men living in Sweden, although not to a statistically significant extent. In addition, Finns in Finland and in Sweden rated their health poorer than Swedes. CONCLUSIONS: Migration may have a different effect on Finnish men's and women's self-rated health. Further studies are needed to investigate the complex pathways between country of residence and self-rated health among immigrants.     

Health among the oldest-old in China: Which living arrangements make a difference?

This study aims to (1) examine the association of living arrangements and health among oldest-old Chinese, and (2) investigate gender differences in the association of living arrangements and health. Data were from the first two waves of the Chinese Longitudinal Healthy Longevity Survey, which included 9093 Chinese averaging 92 years old. Living arrangements had six mutually exclusive categories: living alone, with spouse, with children, with spouse and children, with others and in institutions. Using multinomial logistic regression, we found that baseline living arrangements are significantly associated with mortality, activities of daily living (ADL) disability, and self-rated health at Wave 2, controlling for baseline health, sociodemographic characteristics and availability of children. Further, the linkages between living arrangements and mortality vary by gender. Among the different living arrangements, having a spouse in the household (either with a spouse only or with both a spouse and children) provides the best health protection. Living alone and living with children are associated with both health advantages and disadvantages. Institutional living lowers mortality risk for men but not women. Living with others provides the least health benefits. Our study has extended the research on living arrangements and health to a unique population—the oldest-old in China—and clarified the health advantages and disadvantages of different living arrangements. Future research should examine the mechanisms linking living arrangements and health, and the experience of institutional living for men and women in China.     

Childhood adversities and health variations among middle-aged men: a retrospective lifecourse study

BACKGROUND: Using a lifecourse approach, this study examines whether childhood adversities act on adult health as latent or pathway effects, and whether not only childhood ill health and material deprivation, but also an adverse psychosocial environment in terms of stressful relations with parents contribute to later ill health. METHODS: Lifecourse interviews with 380 men born in 1946 were conducted. Outcome variables were perceived health, number of medical conditions, and activity limitations. Ordinal scales indicating levels of exposures as regards childhood health/growth, childhood material deprivation, stressful relations with parents, educational level, and unhealthy adult behaviours were made. Statistical analyses were performed by non-parametric correlation, logistic regression and OLS regression with dummy variables. RESULTS: Simple regression analyses showed a consistent pattern of more negative health outcomes with higher exposures on each of the lifecourse health determinants, but associations were relatively often not statistically significant. In multivariate analyses, the overall pattern remained with few alterations. The lifecourse determinants differed somewhat in their effects on the three health outcomes. Stressful relations with parents were significantly associated with perceived health and activity limitations. CONCLUSIONS: Childhood adversities influence later health to a large extent as latent effects. Stressful relations with parents were relatively important for two of the health outcomes, suggesting that not only ill health and material deprivation during childhood, but also an adverse psychosocial environment contributes to ill health among middle-aged men. KEY POINTS: The study asks whether childhood adversities influence middle-aged men's health through latent or pathway effects. Adjusted for adult circumstances, childhood health problems were associated with activity limitations and medical problems among men aged 55. Stressful relations to parents during childhood had direct negative effects on perceived overall health and activity limitations. Results indicate that childhood adversities often affect adult health as latent effects. Health promotion policies should consider that childhood psychosocial difficulties may have longterm negative health consequences.     

Self-rated health showed a graded association with frequently used biomarkers in a large population sample

BACKGROUND AND OBJECTIVES: Self-rated health is a widely used measure of health status, but its biologic foundations are poorly understood. We investigated the association of frequently used biomarkers with self-rated health, and the role of these biomarkers in the association of self-rated health with mortality. METHODS: The relation of self-rated health to blood levels of albumin, white blood cell count, hemoglobin, HDL cholesterol, and creatinine was examined in a population-based sample of 4,065 men and women aged 71 years or older. A Cox proportional hazards model was used to determine the association of self-rated health with mortality during 4.9 years. Sociodemographic factors, diagnosed chronic conditions, and activities of daily living disability were controlled for in these analyses. RESULTS: All the biomarkers showed a graded relationship with self-rated health. After adjusting for other indicators, hemoglobin and white cell count were significantly associated with fair or poor self-rated health. When biomarkers and other indicators were adjusted for, self-rated health still was a significant predictor of mortality. CONCLUSION: Self-rated health has a biologic basis, and it can be a sensitive barometer of physiologic states. Self-rated health is likely to predict mortality because it covers the spectrum of health conditions better than the variables measured in the study.     

The contribution of self-rated health and depressive symptoms to disability severity as a predictor of 10-year mortality in European elderly men

OBJECTIVES: To investigate the effect of disability severity and the contribution of self-rated health and depressive symptoms to 10-year mortality. METHODS: Longitudinal data were collected from 1141 men aged 70 to 89 years from the Finland, Italy, and the Netherlands Elderly Study from 1990 to 2000. Disability severity was classified into 4 categories: no disability, instrumental activities, mobility, and basic activities of daily living. Self-rated health and depressive symptoms were classified into 2 and 3 categories, respectively. Multivariate Cox proportional hazard models were used to calculate mortality risks. RESULTS: Men with severe disability had a risk of mortality that was more than 2-fold higher (hazard ratio [HR]=2.41; 95% confidence interval [CI]=1.84, 3.16) than that of men without disability. Men who had severe disability and did not feel healthy had the highest mortality risk (HR = 3.30; 95% CI = 2.52, 4.33). This risk was lower at lower levels of disability and higher levels of self-rated health. The same trend was observed for depressive symptoms. CONCLUSIONS: For adequate prognoses on mortality or for developing intervention strategies, not only physical aspects of health but also other health outcomes should be taken into account.     

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.     

健康指标对老年人发生死亡预测价值的前瞻性研究

目的 探讨日常生活自理能力(生活依赖)、健康自评及认知功能等健康评价指标对老年人死亡的预测价值。方法 1992年采取分层、整群、随机抽取样本,问卷调查3257例55岁以上人群,并于1994、1997和2000年对该样本进行随访,8年累计死亡1155例,失访399例。对死亡与生存的相关因素进行对比分析。结果 老年人死亡与生存在性别、年龄、文化及地区上存在明显不同。有生活依赖、健康自评差和认知水平低的老年人死亡危险性高。控制混杂因素(性别、年龄、文化、地区及慢性病史)后,上述趋势依然存在。进一步分析在控制生活依赖以外的所有因素,结果生活依赖与死亡存在独立的关系,联系更密切(OR=2.279,95％CI:1.573～3.302)。以相同的方法分析健康自评和认知功能也存在同样的结果(健康自评较差者OR=1.920,95％CI:1.412～2.412;认知功能异常者OR=1.888,95％CI:1.316～2.709)。结论 老年人日常生活能力、健康自评以及认知功能分别对死亡有较高的预测价值,它们对死亡既有共同作用,也是相对独立的预测指标。对于评估老年人的健康预后及生活质量具有重要的应用价值。     

Mapping the health and environmental situation in informal zones in Aleppo, Syria: report from the Aleppo household survey

Objectives: Despite large communities living in informal zones around major cities in Syria, there is currently no information on the health and environmental situations in these areas. From May to August 2004, the Syrian Center for Tobacco Studies (SCTS) conducted the first household survey aiming to provide a baseline map of main health problems and exposures affecting these communities in Aleppo, the second largest city in Syria (2,500,000 inhabitants). Methods: Information on 1,021 participants randomly selected using stratified cluster sampling were available (46% males, mean age 34±11.7, age range 18–65 years, response rate 86%), including self-reported health/disability, exposures, and saliva cotinine measurement. Results Some positive findings include better than expected access to electricity, piped water, city sewage, and the use of propane for cooking. Particular areas of concern include high fertility rates, overcrowded housing conditions, and gender inequality in education and work. Household features likely to reflect negatively on residents health include the use of diesel chimneys for heating and lack of smoking restrictions. Overall, residents of informal zones suffer from substantial physical and mental health problems and are exposed to high levels of indoor air pollution. All seem to affect women and the elderly disproportionately, while men are more affected by smoking, occupational respiratory exposures, and injuries. Both infectious and non-infectious respiratory outcomes were very common among study participants. Chronic and degenerative disease, including CVD and joint problems, were a source of substantial morbidity among the studied communities. Conclusions: This study highlights major health and environmental specificities of marginalized populations living in Aleppo, where women seem to bear a disproportionate burden of poor health and disability. Smoking and exposure to tobacco smoke seem among the major exposures facing these populations.     

Role of weight history on functional limitations and disability in late adulthood: the ARIC study

OBJECTIVE: To examine associations of weight history with functional limitations and disability in white and African-American men and women. RESEARCH METHODS AND PROCEDURES: Data were from the Atherosclerosis Risk in Communities study (n = 11,177). Associations of recalled weight status at age 25 and weight change from age 25 to ages 45 to 64 with functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at follow-up (ages 52 to 75) were examined using logistic regression. RESULTS: Obesity (BMI > or = 30 kg/m2) at age 25 was associated with functional limitations and ADL and IADL impairment at follow-up in white and African-American men and women. For example, obese compared with normal weight (BMI, 18.5 to 24.9 kg/m(2)) white women had higher odds of mild [odds ratio (95% confidence interval), 1.97 (1.18 to 3.29)] and severe [9.81 (5.92 to 16.27)] functional limitations and ADL [3.48 (2.36 to 5.13)] and IADL [2.95 (2.00 to 4.33)] impairment. In African-American women, obesity was associated with higher odds of mild [2.71 (1.14 to 6.41)] and severe [6.01 (2.53 to 14.26)] functional limitations and ADL [1.82 (1.10 to 3.00)] and IADL [2.39 (1.47 to 3.90)] impairment. Similar associations were found in men. Compared with weight maintenance (+/-10 lbs), large weight gain (>30 lbs) from age 25 to ages 45 to 64 was also associated with functional limitations and ADL and IADL impairment in white and African-American men and women. DISCUSSION: Maintenance of a healthy body weight throughout adulthood may play a role in preventing or delaying the onset of functional limitations and disability, resulting in increased quality of life and decreased health care costs.     

Disability in instrumental activities of daily living among older adults: gender differences

OBJECTIVE

To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults.

METHODS

The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome.

RESULTS

The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women.

CONCLUSIONS

The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.     

空间全生命周期流行病学在慢性病研究中的应用

近年来, 慢性病致病因素的研究从专注行为生活方式等非空间因素逐渐向地理环境等空间因素延伸。空间全生命周期流行病学是健康地理学的分支方向。作为全生命周期流行病学和空间流行病学的融合, 空间全生命周期流行病学结合先进的地理信息、测绘遥感、移动定位、人工智能等技术, 对个体的全生命周期暴露史(暴露组)进行精准回溯、测量及模拟, 采用累积风险模型和关键期/敏感期风险模型等全生命周期模型研究暴露史在个体全生命周期不同阶段对健康的影响。本文对空间全生命周期流行病学在慢性病研究中的理论基础、分析策略及重点研究内容进行综述, 旨在促进其在慢性病领域的致病因素研究中的应用, 为后续研究提供参考和建议, 推动健康地理学的发展, 最终实现全生命周期精准健康管理。     

Determinants of self-rated health among elderly persons in S?o Paulo, Brazil]

OBJECTIVES: To investigate the influence that demographic determinants, socioeconomic determinants, chronic diseases, and functional capacity have on self-rated health among elderly persons (60 years and older) living in the city of S?o Paulo, S?o Paulo, Brazil, and to investigate the existence of differences between men and women in terms of their self-rated health. METHODS: The study was carried out using data collected in the city of S?o Paulo as part of a project called Health, Well-being, and Aging in Latin America and the Caribbean (the "SABE project"). We analyzed data on 2,135 elderly individuals (58.6% women; mean age, 69.4 years; median age, 68.0 years). The dependent variable was self-rated health (good or poor). The following independent variables were considered: (1) demographic ones (age, sex, marital status, and living arrangements (whether the elderly person lived alone or with others)), (2) socioeconomic ones (schooling and income), (3) the number of chronic diseases (hypertension, arthritis or rheumatism, cardiovascular disease, diabetes, asthma, bronchitis or emphysema, embolism or stroke, and cancer), and (4) functional capacity. To estimate the association between self-rated health and the independent variables and to study gender differences, a multiple binary logistic regression analysis was performed. RESULTS: The presence of chronic diseases in association with gender was the strongest determinant of self-rated health among the elderly in S?o Paulo. Among men with four or more chronic diseases, they were 10.53 times as likely to characterize their health as poor; among women with four or more chronic diseases, the ratio was 8.31. Functional capacity, schooling, and income were also strongly associated with self-rated health, and the influence of age was significant. The elderly women were more likely to report good self-rated health than were men when the women or men either had no chronic diseases or had two or more. CONCLUSIONS: Our results indicate the need for simultaneous, comprehensive actions in the health sector, social services, and the economic sector to address the main determinants of self-rated health in order to promote well-being and quality of life among the elderly.     

Socio-economic influences on self-rated health in Russian men and women--a life course approach

Socio-economic differentials in health in Russia are not well understood and the life course approach has been relatively neglected. This paper examines the influence of socio-economic risk factors over the life course on the self-rated health of older Russian men and women. A random sample (response rate 61%) of the general population of the Russian Federation in 2002 included 1004 men and 1930 women aged 50 years and over in a cross-sectional study. They provided information concerning their childhood circumstances, including going to bed hungry; education; current social conditions, including per capita household income; health behaviours and self-rated health. There was considerable tracking of adverse social conditions across the life course with men and women who reported hunger in childhood having lower educational achievements, and current household income was strongly influenced by educational attainment. The effect of these socio-economic risk factors on health accumulated with an odds ratio of poor health of 1.87 [1.07-3.28] for men with one risk factor, 3.64 [2.13-6.22] for two risk factors and 4.51 [2.57-7.91] for all three compared to men with no risk factors. For women, the odds ratios were 1.44 [1.05-2.01], 2.88 [2.10-3.93] and 4.27 [3.03-6.00] for one, two and three risk factors, respectively. Current income was the strongest individual predictor for men, and education for women. Adjustment for health behaviours reduced the odds ratios only marginally. The results suggest that self-rated health in older Russians reflects social exposures accumulated over the life course, with the differentials observed only partially explained by current social conditions. Health behaviours were not involved in mediating social differences in self-rated health. Our results indicate that a life course approach may contribute to the understanding of health in Russia.