European Journal of Ageing

, Volume 2, Issue 2, pp 149–158 | Cite as

Self-rated health among older adults: a cross-national comparison

  • Carola Bardage
  • Saskia M. F. Pluijm
  • Nancy L. Pedersen
  • Dorly J. H. Deeg
  • Marja Jylhä
  • Marianna Noale
  • Tzvia Blumstein
  • Ángel Otero
Original Investigation

Abstract

Self-rated health (SRH) may have different implications in various social and cultural settings. However, few studies are available concerning SRH among older persons across countries. The aim of this study was to analyse whether there are cross-national differences in the association between status characteristics, several diseases common among older persons, activities of daily living (ADL), and SRH. The study base was the Comparison of Longitudinal European Studies on Aging (CLESA), which includes data from six population-based studies on aging conducted in Finland, Israel, Italy, The Netherlands, Spain and Sweden. The study population comprised 5,629 persons, with participants from all countries except Italy. Logistic regression analyses were used to assess the relationship between status characteristics, health conditions, ADL and SRH. To examine whether the association among status characteristics, health conditions, ADL and outcome differed across the CLESA countries, interaction terms defined as “variable*country” were considered separately for each variable. Regression analyses revealed that sex, education, lifetime occupation, heart disease and respiratory disease were differently distributed across countries. Among homogeneous factors, marital status (OR=1.21), hypertension (OR=1.41), stroke (OR=1.67), diabetes (OR=2.15), cancer (OR=1.47), musculoskeletal diseases (OR=2.44), and ADL (OR=2.72) turned out to be significantly associated with fair or poor SRH. The results indicate that there are differences in self-ratings of health across countries. These differences cannot be explained entirely by status characteristics, self-reported diseases or functional ability. However, an important finding was that in all countries most of the indicators of medical and functional health were homogeneously associated with SRH.

Keywords

CLESA project Self-rated health Cross-national comparison Ageing 

References

  1. Angel R, Guarnaccia P (1989) Mind, body, and culture: somatization among Hispanics. Social Sci Med 28:1229–1238CrossRefGoogle Scholar
  2. Appels A, Bosma H, Grabauskas V, Gostautas A, Sturmans F (1996) Self-rated health and mortality in a Lithuanian and a Dutch population. Social Sci Med 42:681–689CrossRefGoogle Scholar
  3. Beekman ATF, Penninx BWJH, Deeg DJH, Ormel J, Braam AW, van Tilburg W (1997) Depression and physical health in later life: results from the Longitudinal Aging Study Amsterdam (LASA). J Affect Disord 46:219–231CrossRefPubMedGoogle Scholar
  4. Béland F, Zunzunegui MV (1995a) El diseño y la ejecución de la encuesta Envejecer en Leganés. Rev Gerontol 5:215–231Google Scholar
  5. Béland F, Zunzunegui MV (1995b) Presentación del estudio Envejecer en Leganés. Rev Gerontol 5:207–214Google Scholar
  6. Benyamini Y, Idler EL, Levental H, Levental EA (2000) Positive affect and function as influences on self-assessments of health: expanding our view beyond illness and disability. J Gerontol Psychol Sci 55B:107–116Google Scholar
  7. Bjørner JB, Søndergaard Kristensen T, Orth-Gomér K, Tibblin G, Sullivan M, Westerholm P (eds) (1996) Self-rated health; a useful concept in research, prevention and clinical medicine. The Swedish Council for Planning and Coordination of Research, Ord & Form AB, UppsalaGoogle Scholar
  8. Bobak M, Pikhart H, Rose R, Hertzman C, Marmot M (2000) Socio-economic factors, material inequalities, and perceived control in self-rated health: cross-sectional data from seven post-communist countries. Social Sci Med 51:1343–1350CrossRefGoogle Scholar
  9. Carlson P (1998) Self-perceived health in East and West Europe: another European health divide. Social Sci Med 46:1355–1366CrossRefGoogle Scholar
  10. Cockerham WC, Sharp K, Wilcox JA (1983) Aging and perceived health status. J Gerontol 38:349–355PubMedGoogle Scholar
  11. Davies L (1995) A closer look at gender and distress among the never married. Women Health 23:13–30PubMedGoogle Scholar
  12. de Bruin A, Picavet HSJ, Nossikov A (1996) Health interview surveys. Towards international harmonization of methods and instruments. WHO, Geneva, Regional Publications European Ser no 58Google Scholar
  13. Ferraro KF, Farmer MM, Wybraniec JA (1997) Health trajectories: long term dynamics among black and white adults. J Health Social Behav 38:38–54Google Scholar
  14. Ferrie JE, Shipley MJ, Davey Smith G, Stansfeld SA, Marmot MG (2002) Change in health inequalities among British civil servants: the Whitehall II study. J Epidemiol Community Health 56:922–926Google Scholar
  15. Figueiras A, Domenech-Massons J, Cadarso C (1998) Regression models: calculating the confidence interval of effects in the presence of interactions. Stat Med 17:2099–2105CrossRefPubMedGoogle Scholar
  16. Fylkesnes K, Førde O (1991) The Tromsø study. Predictors of self-evaluated health—has society adopted the expanded health concept? Social Sci Med 32:141–146CrossRefGoogle Scholar
  17. Fylkenes K, Førde OH (1992) Determinants and dimensions involved in self-evaluation of health. Social Sci Med 35:271–279CrossRefGoogle Scholar
  18. Grundy E, Sloggett A (2003) Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances. Social Sci Med 56:935–947CrossRefGoogle Scholar
  19. Idler EL (1992) Self-assessed health and mortality: a review of studies. Int Rev Health Psychol 1:33–54Google Scholar
  20. Idler EL (1993) Age differences in self-assessments of health: age changes, cohort differences, or survivorship? J Gerontol Social Sci 48:289–300Google Scholar
  21. Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Social Behav 38:21–37Google Scholar
  22. Johnson RJ, Wolinsky FD (1993) The structure of health status among older adults: disease, disability, functional limitations, and perceived health. J Health Social Behav 34:105–121Google Scholar
  23. Johnson TP, Stallones L, Garrity TF, Marx MB (1991) Components of self-rated health among adults: analyses of multiple data sources. Int Q Community Health Educ 11:29–41Google Scholar
  24. Jylhä M, Leskinen E, Alanen E, Leskinen A-L, Heikkinen E (1986) Self-rated health and associated factors among men of different ages. J Gerontol 41:710–717PubMedGoogle Scholar
  25. Jylhä M, Jokela J, Tolvanen E et al. (1992) The Tampere Longitudinal Study on Ageing. Description of the study. Basic results on health and functional ability. Scand J Social Med Suppl 47:1–4Google Scholar
  26. Jylhä M, Guralnik JM, Ferrucci L, Jokela J, Heikkinen E (1998) Is self-rated health comparable across cultures and genders? J Gerontol Social Sci 53:144–152Google Scholar
  27. Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 52:736–741Google Scholar
  28. Kleinbaum DG (1994) Logistic regression: a self-learning text. Springer, Berlin Heidelberg New YorkGoogle Scholar
  29. Kopp MS, Skrabski Á, Szedmák S (2000) Self-rated health and social transitions. In: Nilsson P, Orth-Gomér K (eds) Self-rated health in a European perspective. The Swedish Council for Planning and Coordination of Research, Ord & Form AB, Uppsala, pp 85–102Google Scholar
  30. Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol 49:1407–1417CrossRefPubMedGoogle Scholar
  31. Kunst AE, Bos V, Lahelma E, Bartley M et al. (2005) Trends in socio-economic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 34(2):295–305CrossRefPubMedGoogle Scholar
  32. Liang J, Bennett J, Whitelaw N, Maeda D (1991) The structure of self-reported physical health among the aged in the United States and Japan. Med Care 29:1161–1180PubMedGoogle Scholar
  33. MacIntyre S, Hunt K, Sweeting H (1996) Gender differences in health: are things really as simply as they seem? Social Sci Med 42:617–624CrossRefGoogle Scholar
  34. Maggi S, Zucchetto M, Grigoletto F et al. (1994) The Italian Longitudinal Study on Aging (ILSA): design and methods. Aging Clin Exp Res 6:464–473Google Scholar
  35. Manor O, Matthews S, Power C (2000) Dichotomous or categorical response? Analysing self-rated health and lifetime social class. Int J Epidemiol 29:149–157CrossRefPubMedGoogle Scholar
  36. Marmot MG, Davey Smith G, Stansfeld S et al. (1991) Health inequalities among British civil servants: the Whitehall II study. Lancet 337:1387–1393CrossRefPubMedGoogle Scholar
  37. Matthews S, Manor O, Power C (1999) Social inequalities in health: are there gender differences? Social Sci Med 48:49–60CrossRefGoogle Scholar
  38. McDonough P, Walters P (2001) Gender and health: reassessing pattern and explanations. Social Sci Med 52:547–559CrossRefGoogle Scholar
  39. Minicuci N, Noale M, Bardage C et al. (2003) Cross-national determinants of quality of life from six longitudinal studies on aging: the CLESA project. Aging Clin Exp Res 15:187–202PubMedGoogle Scholar
  40. Moum T (1992) Self-assessed health among Norwegian adults. Social Sci Med 35:935–947CrossRefGoogle Scholar
  41. Nilsson P, Orth-Gomér K (eds) (2000) Self-rated health in a European perspective. The Swedish Council for Planning and Coordination of Research, Ord & Form AB, UppsalaGoogle Scholar
  42. Noale M, Minicuci N, Bardage C et al. (2005) Predictors of mortality: an international comparison of socio-demographic and health characteristics from six longitudinal studies on aging: the CLESA project. Exp Gerontol 40:89–99CrossRefPubMedGoogle Scholar
  43. Nybo H, Gaist D, Jeune B, McGue M, Vaupel J, Christensen K (2001) Functional status and self-rated health in 2,262 nonagenarians: the Danish 1905 cohort survey. J Am Geriatr Soc 49:601–609CrossRefPubMedGoogle Scholar
  44. Pedersen NL, McClearn GE, Plomin R, Nesselroade JR, Berg S, de Faire U (1991) The Swedish Adoption Twin Study of Aging: an update. Acta Genet Med Gemellol 40:7–20PubMedGoogle Scholar
  45. Pluijm S, Bardage C, Nikula S et al. (2005) Harmonising a measure of ADL across six countries. J Clin Epidemiol (in press)Google Scholar
  46. Rakoski W, Fleishman JA, Mor VA, Bryant SA (1993) Self-assessments of health and mortality among older persons. Res Aging 15:92–116Google Scholar
  47. SAS Institute (1999–2001) SAS release 8.02. SAS Institute Inc, Cary, NCGoogle Scholar
  48. Shetterly SM, Baxter J, Mason LD, Hamman RF (1996) Self-rated health among Hispanic vs. non-Hispanic white adults: the San Luis Valley health and aging study. Am J Public Health 86:1798–1801PubMedGoogle Scholar
  49. Stoller EP (1984) Self-assessment of health by the elderly. The impact of informal assistance. J Health Social Behav 25:260–270Google Scholar
  50. Su YP, Ferraro KF (1997) Social relations and health assessments among older people: do the effects of integration and social contributions vary cross-culturally? J Gerontol Social Sci 52B:27–36Google Scholar
  51. Townsend P, Davidson N (1992) Inequalities in health. The Black Report. Penguin, LondonGoogle Scholar
  52. Walter-Ginzburg AW, Guralnik JM, Blumstein T, Gindin J, Modan B (2001) Assistance with personal care activities among the old-old in Israel: a national epidemiological study. J Am Geriatr Soc 49:1–8CrossRefPubMedGoogle Scholar
  53. van Doorslaer E, Wagstaff A, Bleichrodt H et al. (1997) Income-related inequalities in health: some international comparisons. J Health Econ 16:93–112CrossRefPubMedGoogle Scholar
  54. Verbrugge LM (1989) The Twain Meet: empirical explanations of sex differences in health and mortality. J Health Social Behav 30:282–304Google Scholar
  55. Verbrugge LM, Jette AM (1994) The disablement process. Social Sci Med 38:1–14CrossRefGoogle Scholar
  56. Zimmer Z, Natividad J, Lin H-S, Chayovan N (2000) A cross-national examination of the determinants of self-assessed health. J Health Social Behav 41:465–481Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Carola Bardage
    • 1
  • Saskia M. F. Pluijm
    • 2
  • Nancy L. Pedersen
    • 1
  • Dorly J. H. Deeg
    • 2
  • Marja Jylhä
    • 3
  • Marianna Noale
    • 4
  • Tzvia Blumstein
    • 5
  • Ángel Otero
    • 6
  1. 1.Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
  2. 2.Institute for Research in Extramural MedicineVrije UniversityAmsterdamThe Netherlands
  3. 3.School of Public HealthUniversity of Tampere and Pirkanmaa District Hospital Research UnitTampereFinland
  4. 4.Institute of Neuroscience, Aging UnitNational Council ResearchPadovaItaly
  5. 5.The Gertner Institute for Epidemiology and Health Policy ResearchChaim Sheba Medical CenterTel-HashomerIsrael
  6. 6.Centro Universitario de Salud PúblicaUniversidad Autónoma de MadridMadridSpain

Personalised recommendations