European Journal of Ageing

, Volume 6, Issue 3, pp 213–226 | Cite as

Key elements composing self-rated health in older adults: a comparative study of 11 European countries

  • Georgia VerropoulouEmail author
Original Investigation


Self-rated health (SRH) is a multidimensional measure, predictive of morbidity and mortality. Comparative studies of determinants, however, are rare due to a lack of comparable cross-national data. This paper contributes towards filling in this gap, using data for persons aged 50 or higher in 11 European countries from the SHARE study (2004). The analysis aims at identifying key elements composing SRH using multinomial logistic regression models. In addition, the homogeneity of associations across populations is assessed. The findings indicate that education, depression, chronic conditions, mobility difficulties, somatic symptoms and levels of physical activity constitute important components of SRH; ADLs and obesity, on the other hand, are not significant and IADLs are important only in a few countries. All these associations point to the expected direction and are homogeneous across countries. However, demographic factors, age and gender, though significant in many countries have divergent associations. Effects of smoking also differentiate between southern and northern Europe.


Self-rated health SHARE Cross-national comparison Multinomial logistic regression Determinants Homogeneity across countries 



The author is thankful to two anonymous referees for their constructive and helpful criticism. This paper uses data from release 2 of SHARE 2004. The SHARE data collection has been primarily funded by the European Commission through the 5th framework programme (project QLK6-CT-2001-00360 in the thematic programme Quality of Life). Additional funding came from the US National Institute on Ageing (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, Y1-AG-4553-01 and OGHA 04-064). Data collection in Austria (through the Austrian Science Foundation, FWF), Belgium (through the Belgian Science Policy Office) and Switzerland (through BBW/OFES/UFES) was nationally funded. The SHARE data collection in Israel was funded by the US National Institute on Aging (R21 AG025169), by the German–Israeli Foundation for Scientific Research and Development (G.I·F.), and by the National Insurance Institute of Israel. Further support by the European Commission through the 6th framework program (projects SHARE-I3, RII-CT-2006-062193, and COMPARE, CIT5-CT-2005-028857) is gratefully acknowledged. For details see Börsch-Supan et al. (2005a).


  1. Angel R, Guarnaccia P (1989) Mind, body and culture: somatization among hispanics. Soc Sci Med 28(12):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. Soc Sci Med 42(5):681–689CrossRefGoogle Scholar
  3. Arber S, Cooper H (1999) Gender differences in health in later life: the new paradox? Soc Sci Med 48:61–76CrossRefGoogle Scholar
  4. Bardage C, Pluijm SMF, Pedersen NL, Deeg DJH, Jylhä M, Noale M, Blumstein T, Otero A (2005) Self-rated health among older adults: a cross-national comparison. Eur J Ageing 2:149–158CrossRefGoogle Scholar
  5. Baron-Epel O, Kaplan G (2001) General subjective health status or age-related subjective health status: does it make a difference? Soc Sci Med 53(10):1371–1481CrossRefGoogle Scholar
  6. Boffetta P, McLaughlin JK, La Vecchia C, Tarone RE, Lipworth L, Blot WJ (2008) False-positive results in cancer epidemiology: a plea for epistemological modesty. J Natl Cancer Inst 100:988–995CrossRefGoogle Scholar
  7. Börsch-Supan A, Brugiavini A, Jürges H, Mackenbach J, Siegrist J, Weber G (eds.) (2005a) Health, ageing and retirement in Europe, first results from the survey of health, ageing and retirement in Europe. Mannheim Research Institute for the Economics of Ageing (MEA), MannheimGoogle Scholar
  8. Börsch-Supan A, Hank K, Jürges H (2005b) A new comprehensive and international view on ageing: introducing the “Survey of health, ageing and retirement in Europe”. Eur J Ageing 2(4):245–253CrossRefGoogle Scholar
  9. Burström B, Fredlund P (2001) Self rated health: Is it as good a predictor of subsequent mortality among adults in lower as well as in higher Social classes. J Epidemiol Community Health 55(11):836–840CrossRefGoogle Scholar
  10. Chan YH (2005) Biostatistics 305. Multinomial logistic regression. Singapore Med J 46(6):259–269Google Scholar
  11. D’Uva TB, O’Donnell O, van Doorslaer E (2008) Differential health reporting by education level and its impact on the measurement of health inequalities among older Europeans. Int J Epidemiol 37:1375–1383CrossRefGoogle Scholar
  12. De Luca G, Peracchi F (2005) Survey Participation in the First Wave of SHARE. In: Börsch-Supan A, Jürges H (eds) The survey of health, ageing and retirement in Europe—methodology, Mannheim Research Institute for the Economics of Ageing (MEA), Mannheim, pp 88-101Google Scholar
  13. Delbès C, Gaymu J, Springer S (2006) Women grow old alone, but men grow old with a partner. A European overview. Population and Societies 419 INED, FranceGoogle Scholar
  14. DeSalvo KB, Bloser N, Reynolds K, He J, Munter P (2005) Mortality prediction with a single general self-rated question: a meta analysis. J Gen Intern Med 21(3):267–275CrossRefGoogle Scholar
  15. Dowd JB, Zajacova A (2007) Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US? Int J Epidemiol 36:1214–1221CrossRefGoogle Scholar
  16. Dyer AR (1986) A method for combining results from several prospective epidemiological studies. Stat Med 5:303–317CrossRefGoogle Scholar
  17. Eriksson I, Undén AL, Elofsson S (2001) Self-rated health. Comparisons between three different measures. Results from a population study. Int J Epidemiol 30:326–333CrossRefGoogle Scholar
  18. Fonda S, Herzog A (2004) Documentation of physical functioning measured in the Health and Retirement Study and the Asset and Health Dynamics among the Oldest Old Study. HRS/AHEAD Documentation ReportGoogle Scholar
  19. Gilmore A, McKee M, Rose R (2002) Determinants of and inequalities in self-perceived health in Ukraine. Soc Sci Med 55:2177–2188CrossRefGoogle Scholar
  20. Grundy E, Holt G (2001) The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health 55(12):895–904CrossRefGoogle Scholar
  21. Hsu HC (2005) Gender disparity of successful aging in Taiwan. Women Health 42:1–21CrossRefGoogle Scholar
  22. Huisman M, Kunst AE, Mackenbach JP (2003) Socio-economic inequalities in morbidity among the elderly: a European overview. Soc Sci Med 57:861–873CrossRefGoogle Scholar
  23. Huisman M, Kunst AE, Mackenbach JP (2005) Inequalities in the prevalence of smoking in the European Union: comparing education and income. Prev Med 40:756–764CrossRefGoogle Scholar
  24. Huisman M, van Lenthe F, Mackenbach J (2007) The predictive ability of self-assessed health for mortality in different educational groups. Int J Epidemiol 36:1207–1213CrossRefGoogle Scholar
  25. Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37CrossRefGoogle Scholar
  26. Idler EL, Kasl SV (1991) Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 46(2):S55–S65Google Scholar
  27. Idler EL, Hudson SV, Leventhal H (1999) The meanings of self-ratings of health: a qualitative and quantitative approach. Res Aging 21:458–476CrossRefGoogle Scholar
  28. Ioannidis JPA (2005) Why most published research findings are false. PLoS Med 2(8)-e124:696–701Google Scholar
  29. Jürges H (2007) True health vs. response styles: exploring cross-country differences in self-reported health. Health Econ 16:163–178CrossRefGoogle Scholar
  30. Jürges H, Avendano M, Mackenbach J (2007) How comparable are different measures of self-rated health? Evidence from five European countries. Discussion Paper 137 Mannheim Research Institute for the Economics of Aging, MannheimGoogle Scholar
  31. Kalwij A, van Soest (2005) Item non-response and alternative imputation procedures. in: Börsch-Supan A, Jürges H (eds) the Survey of Health, Ageing and Retirement in Europe—Methodology, Mannheim Research Institute for the Economics of Ageing (MEA), Mannheim, pp 128–150Google Scholar
  32. Katz S (1983) Assessing self maintenance: activities of daily living, mobility and instrumental activities of daily living. J Am Geriatr Soc 31(12):721–726Google Scholar
  33. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardised measure of biological and psychological function. JAMA 185:914–919Google Scholar
  34. Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10:20–30Google Scholar
  35. Kivinen P, Halonen P, Evonen M, Nissinen A (1998) Self-rated health, physician-rated health and associated factors among elderly men: the Finnish cohorts of the seven countries study. Age Ageing 27(1):41–47CrossRefGoogle Scholar
  36. Klevmarken AN, Swensson B, Hesselins P (2005) The SHARE sampling procedures and calibrated design weights. In: Börsch-Supan A, Jürges H (eds) The survey of health, ageing and retirement in Europe—methodology, Mannheim Research Institute for the Economics of Ageing (MEA), Mannheim, pp 28–37Google Scholar
  37. Kunst AE, Bos V, Lahelma E, Bartley M, Lissau I, Regitor E, Mielck A, Cardano M, Daalstra J, Geurts J, Helmert U, Lennartsson C, Ramm J, Spadea T, Stronegger W, Mackenbach J (2005) Trends in socioeconomic inequalities in mortality in self-assessed health in 10 European countries. Int J Epidemiol 34(2):295–305CrossRefGoogle Scholar
  38. Lahelma E, Martikainen P, Rahkonen O, Silventoinen K (1999) Gender differences in illhealth in Finland: patterns, magnitude and change. Soc Sci Med 48:7–19CrossRefGoogle Scholar
  39. Lahelma E, Martikainen P, Rahkonen O, Roos E, Saastamoinen P (2005) Occupational class inequalities across key domains of health: Results from the Helsinki study. Eur J Public Health 15(5):504–510CrossRefGoogle Scholar
  40. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186Google Scholar
  41. Lindeboom M, Van Doorslaer E (2004) Cut-point shift and index shift in self-reported health. J Health Econ 23:1083–1099Google Scholar
  42. Macintryre S, Der G, Norrie J (2005) Are there socioeconomic differences in responses to a commonly used self report measure of chronic illness? Int J Epidemiol 34:1284–1290CrossRefGoogle Scholar
  43. Mackenbach JP, Kunst AE, Cavelaars A, Groenhof F, Geurts J (1997) Socioeconomic inequalities in morbidity and mortality in western Europe. Lancet 349:1655–1659CrossRefGoogle Scholar
  44. Mackenbach JP, Stirbu I, Roskam AR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481CrossRefGoogle Scholar
  45. Murray C, Salomon J, Mathers C, Lopez A (2002) Summary measures of population health: concepts, ethics, measurement and applications. WHO, GenevaGoogle Scholar
  46. National Statistical Service of Greece (2004) 2001 Census data. Available Accessed 29 January 2009
  47. Nicholas S, Huppert FA, McWilliams B, Melzer D (2003) Physical and cognitive function. In: Marmot M, Banks J, Blundell R, Lessof C, Nazroo J (eds) Health, wealth and lifestyles of the older population in England: the 2002 english longitudinal study of ageing, IFS, London, pp 249-271Google Scholar
  48. Noale M, Minicuci N, Bardage C, Gindin J, Nikula S, Pluijm S, Rodriguez-Laso A, Maggi S (2005) Predictors of mortality: an international comparison of socio-demographic and health characteristics from six longitudinal studies on aging: the CLESA project. Exp Gerontol 40:89–99CrossRefGoogle Scholar
  49. Ongaro F, Salvini S (1995) Understanding self-perceived health in the elderly: an analysis of 1986 Italian data. Eur J Popul 11:123–141CrossRefGoogle Scholar
  50. Paccagnella O, Weber G (2005) Household income. In: Börsch-Supan A, Brugiavini A, Jürges H, Mackenbach J, Siegrist J, Weber G (eds.) Health, ageing and retirement in Europe, first results from the survey of health, ageing and retirement in Europe. Mannheim Research Institute for the Economics of Ageing (MEA), Mannheim, pp 296–301Google Scholar
  51. Prince MJ, Reischies F, Beekam ATF, Fuhrer R, Jonker C, Kivela SL, Lawlor BA, Lobo A, Magnusson H, Fichter M, Van Oyen H, Roelands M, Skoog I, Turrina C, Copeland JRM (1999a) Development of the EURO-D scale—a European Union initiative to compare symptoms of depression in 14 European centres. Br J Psychiatry 174:330–338CrossRefGoogle Scholar
  52. Prince MJ, Beekam ATF, Deeg DJH, Fuhrer R, Jonker C, Kivela SL, Lawlor BA, Lobo A, Magnusson H, Meller I, Van Oyen H, Reischies F, Roelands M, Skoog I, Turrina C, Copeland JRM (1999b) Depression symptoms in late life assessed using the EURO-D scale. Br J Psychiatry 174:339–345CrossRefGoogle Scholar
  53. Quesnel-Valée A (2007) Self-rated health: caught in the crossfire of the quest for ‘true’ health? Int J Epidemiol 36:1161–1164CrossRefGoogle Scholar
  54. Robine JM, Jagger C, Euro-REVES group (2003) Creating a coherent set of indicators to monitor health across Europe. Eur J Public Health 13(3 supplement):6–14CrossRefGoogle Scholar
  55. SHARE documentation online (2008) Sample. Available Accessed 23 December 2008
  56. Simon JG, De Boer JB, Joung IMA, Bosma H, Mackenbach JP (2005) How is your health in general? A qualitative study on self-assessed health. Eur J Public Health 15(2):200–208CrossRefGoogle Scholar
  57. Singh-Manoux A, Dugravot A, Shipley MJ, Ferrie JE, Martikainen P, Goldberg M, Zins M (2007) The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study. Int J Epidemiol 36:1222–1228CrossRefGoogle Scholar
  58. Statistics Netherlands (CBS) (2004) Institutionalised population no longer decreasing. Available Accessed 15 January 2009
  59. United Nations Educational Scientific and Cultural Organization. (2006) International Standard Classification of Education, ISCED 1997. Re-edition, UIS/TD/06-01, UNESCO-UIS Available, Accessed 5 July 2008
  60. Van Doorslaer E, Gerdtham UG (2003) Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data. Soc Sci Μed 57:1621–1629CrossRefGoogle Scholar
  61. Van Ourti T (2003) Socio-economic inequality in ill-health amongst the elderly. Should one use current income or permanent income? J Health Econ 22:187–217CrossRefGoogle Scholar
  62. Van Oyen H (2001) The institutionalised population in health surveys. United Nations Statistics Division. ESA/STAT/AC.81/7-6. Available Accessed 15 Jan 2009
  63. Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38:1–14CrossRefGoogle Scholar
  64. Verropoulou G, Tsimbos C (2007) Socio-demographic and health-related factors affecting depression of the Greek population in later life: an analysis using SHARE data. Eur J Ageing 4(3):171–181CrossRefGoogle Scholar
  65. World Health Organization (1996) Health interview surveys: towards international harmonization of methods and instruments. WHO Regional Publications European Series no. 58 WHO Regional Office for Europe, CopenhagenGoogle Scholar
  66. Zimmer Z, Natividad J, Lin HS, Chayovan N (2000) A cross-national examination of the determinants of self-assessed health. J Health Soc Behav 41(4):465–481CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Statistics and Insurance ScienceUniversity of PiraeusPiraeusGreece
  2. 2.Centre for Longitudinal Studies, Institute of EducationUniversity of LondonLondonUK

Personalised recommendations