We investigated the role that different health aspects play in the explanation of socioeconomic differences in self-assessed health. Socioeconomic differences in self-assessed health were investigated in relation to chronic disease, functional limitations, psychosomatic symptoms, and perceived discomfort/distress. In multiple logistic regression analyses, for three cutoff points of self-assessed health, significant socioeconomic differences in self-assessed health could be observed after adjusting for age and gender. After separate adjustment for each of the four health aspects, the analyses showed that for a health assessment as less-than-good and less-than-fair, psychosomatic symptoms were the most powerful explanatory factor. Perceived discomfort/distress proved to be the most powerful factor for a poor health assessment. We found that socioeconomic differences in self-assessed health could, to a large extent (72–80%), be explained through socioeconomic differences in the prevalence of the four types of health problems included in the study. For all cutoff points, objective health aspects accounted for a relatively small part of the socioeconomic variability in self-assessed health. More subjective aspects of health accounted for more of the variability.
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Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., and Syme, S. L. (1994). Socioeconomic status and health. The challenge of the gradient. Am. Psychol. 49: 15–24.
Andersen, M., and Lobel, M. (1995). Predictors of health self-appraisal: What's involved in feeling healthy? Basic Appl. Soc. Psychol. 16: 121–136.
Anderson, N. B., and Armstead, C. A. (1995). Toward understanding the association of socioeconomic status and health: A new challenge for the biopsychosocial approach. Psychosom. Med. 57: 213–225.
Baart, A. (1973). The Older Dock-Worker. Aspects of His Cardiorespiratory Condition, Erasmus University Rotterdam, Rotterdam (in Dutch).
Beckett, E. M., McEwen, J., and Hunt, S. M. (1981). Health and Quality of Life. Report of the Social Science Research Council, SSRC, London.
Blane, D. (1995). Social determinants of health: Socioeconomic status, social class, and ethnicity [Editorial]. Am. J. Public Health 85: 903–905.
Blaxter, M. (1985). Self-definition of health status and consulting rates in primary care. Q. J. Soc. Affairs 1: 131–171.
Blaxter, M. (1997). Whose fault is it? People's own conceptions of the reasons for health inequalities. Soc. Sci. Med. 44: 747–756.
Blazer, D. G., and Houpt, J. L. (1979). Perception of poor health in the healthy older adult. J. Am. Geriatr. Soc. 27: 330–334.
Central Bureau of Statistics (1992). Netherlands Health Interview Survey 1981–1991, Sdu/CBS, The Hague.
Cockerham, W. C., Sharp, K., and Wilcox, J. A. (1983). Aging and perceived health status. J. Gerontol. 38: 349–355.
De Forge, B. R., Sobal, J., and Krick, J. P. (1989). Relation of perceived health with psychosocial variables in elderly osteoarthritis patients. Psychol. Rep. 64: 147–156.
Dirken, J. M. (1967). Measuring Stress in Industrial Situations, Groningen University, Groningen (in Dutch).
Dixon, J. K., Dixon, J. P., and Hickey, M. (1993). Energy as a central factor in the self-assessment of health. ANS 15: 1–12.
Du Florey, C., and Leeder, S. R. (1982). Methods for Cohort Studies of Chronic Airflow Limitation, WHO, Copenhagen.
Fillenbaum, G. G. (1979). Social context and self-assessment of health among the elderly. J. Health Soc. Behav. 20: 45–51.
Fylkesnes, K., and Forde, O. H. (1991). The Trömsö study: Predictors of self-evaluated health—Has society adopted the expanded health concept? Soc. Sci. Med. 32: 141–146.
Garrity, T. F., Somes, G. W., and Marx, M. B. (1978). Factors influencing self-assessment of health. Soc. Sci. Med. 12: 77–81.
Goldstein, M. S., Siegel, J. M., and Boyer, R. (1984). Predicting changes in perceived health status. Am. J. Public Health 74: 611–613.
Hirdes, J. P., and Forbes, W. F. (1993). Factors associated with the maintenance of good self-rated health. J. Aging Health 5: 101–122.
Hooker, K., and Siegler, I. C. (1992). Separating apples from oranges in health ratings: Perceived health includes psychological well-being. Behav. Health Aging 2: 81–92.
Hosmer, D. W., and Lemoshow, S. (1989). Applied Logistic Regression, John Wiley & Sons, New York.
Hunt, S. M., McEwen, J., and McKenna, S. P. (1985). Measuring health status: A new tool for clinicians and epidemiologists. J. R. Coll. Gen. Pract. 35: 185–188.
Idler, E. L. (1993). Perceptions of pain and perceptions of health. Motiv. Emot. 17: 205–224.
Idler, E. L., and Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. J. Health Soc. Behav. 38: 21–37.
Idler, E. L., and Kasl, S. (1991). Health perceptions and survival: Do global evaluations of health status really predict mortality? J. Gerontol. 46: S55-S65.
Jylhä, M., Leskinen, E., Alanen, E., Leskinen, A., and Heikkinen, E. (1986). Self-rated health and associated factors among men of different ages. J. Gerontol. 41: 710–717.
Krause, N. M., and Jay, G. M. (1994). What do global self-rated health items measure? Med. Care 32: 930–942.
Kuorinka, I., Jonsson, B., Kilbom, A., Vinterberg, H., Biering-S örensen, F., Anderson, G., and Jörgensen, K. (1987). Standadised Nordic questionnaire for the analysis of muscoloskeletal symptoms. Appl. Ergon. 18: 133–137.
Laffrey, S. C. (1986). Development of a health conception scale. Res. Nurs. Health 9: 107–113.
Levkoff, S. E., Cleary, P. D., and Wetle, T. (1987). Differences in the appraisal of health between aged and middle-aged adults. J. Gerontol. 42: 114–120.
Liang, J., Bennett, J., Whitelaw, N., and Maeda, D. (1991). The structure of self-reported physical health. Med. Care 29: 1161–1180.
Linn, B. S., and Linn, M. W. (1980). Objective and self-assessed health in the old and very old. Soc. Sci. Med. 14A: 311–315.
Mackenbach, J. P., Van den Bos, J., Joung, I.M. A., Van de Mheen, H., and Stronks, K. (1994a). The determinants of excellent health: Different from the determinants of ill-health? Int. J. Epidemiol. 23: 1273–1281.
Mackenbach, J. P., van de Mheen, H., and Stronks, K. (1994b). A prospective cohort study investigating the explanation of socio-economic inequalities in health in the Netherlands. Soc. Sci. Med. 38: 299–308.
Maddox, G. L., and Douglass, E. B. (1973). Self-assessment of health: A longitudinal study of elderly subjects. J. Health Soc. Behav. 14: 87–93.
McCallum, J., Shadbolt, B., and Wang, D. (1994). Self-rated health and survival:A 7-year followup study of Australian Elderly. Am. J. Public Health 84: 1100–1105.
McWhinnie, J. R. (1979). Disability Indicators for Measuring Well-Being. The OECD Social Indicators Programme, OECD, Paris.
Meesters, C., and Appels, A. (1996). An interview to measure vital exhaustion. I. Development and comparison with the Maastricht Questionnaire. Psychol. Health 11: 557–571.
Mootz, M. (1986). Health indicators. Soc. Sci. Med. 22: 255–263.
Mossey, J. M., and Shapiro, E. (1982). Self-rated health: A predictor of mortality among the elderly. Am. J. Public Health 72: 800–808.
Murray, J., Dunn, G., and Tarnopolsky, A. (1982). Self-assessment of health: An exploration of the effects of physical and psychological symptoms. Psychol. Med. 12: 371–378.
Okun, M. A., and George, L. K. (1984). Physician-and self-ratings of health, neuroticism and subjective well-being among men and women. Pers. Indiv. Diff. 5: 533–539.
Ongaro, F., and Salvini, S. (1995). Understanding self-perceived health in the elderly. Eur. J. Popul. 11: 123–141.
Pennings-Van der Eerden, L. (1984). Self-Care and Motivation of Patients with Diabetes Mellitus, Department of Public Health and Epidemiology, Utrecht University, Utrecht (in Dutch).
Rodin, J., and McAvay, G. (1992). Determinants of change in perceived health in a longitudinal study of older adults. J. Gerontol. 47: 373–384.
Rose, G., and Blackburn, H. (1968). Cardiovascular survey methods. WHO Monogr. 56: 1–88.
Rosier, R. E. (1989). Questionnaire of The Rotterdam Study, Department of Epidemiology and Biostatistics, Erasmus University Rotterdam, Rotterdam (in Dutch).
Ross, C. E., and Wu, C. L. (1996). Education, age, and the cumulative advantage in health. J. Health Soc. Behav. 37: 104–120.
Shadbolt, B. (1997). Some correlates of self-rated health for Australian women. Am. J. Public Health 87: 951–956.
Shanas, E., Townsend, P., Wedderburn, D., Friis, H., Milhoj, P., and Stehouwer, J. (1968). The psychology of health. In Neugarten, B. L. (ed.), Middle Age and Aging: A reader in Social Psychology, University of Chicago Press, Chicago.
Strain, L. A. (1993). Good health:What does it mean in later life? J. Aging Health 5: 338–364.
Tessler, R., and Mechanic, D. (1978). Psychological distress and perceived health status. J. Health Soc. Behav. 19: 254–262.
Tissue, T. (1972). Another look at self-rated health among the elderly. J. Gerontol. 27: 91–94.
Van Dalen, H., Williams, A., and Gudex, C. (1994). Lay people's evaluations of health: Are there variations between different subgroups? J. Epidemiol. Commun. Health 48: 248–253.
Van der Lende, R., Jansen-Koster, E. J., Knijpstra, S., Meinesz, A. F., Wever, A. M. J., and Orie, N. G. M. (1975). Definition of asthma/COPD in epidemiology and prevention. Nederlands Tijdschrift Geneeskunde 119: 1975–1987 (in Dutch).
Van der Meer, J. B. W., Looman, C. W. N., and Mackenbach, J. P. (1996). The Longitudinal Study on Socioeconomic Differences in Utilisation of Health Services, Department of PublicHealth, Erasmus University Rotterdam, Rotterdam (in Dutch).
Sonsbeek, J. L. A. (1996). Tell Me, What's the Matter. A Study into Content and Methodological Aspects of Five Commonly Used Health Indicators in Interview Studies, University of Nijmegen, Nijmegen (in Dutch).
Wan, T. T. H. (1976). Predicting self-assessed health status: A multivariate approach. Health Serv. Res. 11: 464–477.
Wolinsky. F. D., Coe, R. M., Miller, D. K., and Prendergast, J. M. (1984). Measurement of the global and functional dimensions of health status in the elderly. J. Gerontol. 39: 88–92.
Worsley, A. (1990). Laypersons' evaluation of health: An exploratory study of an Australian population. J. Epidemiol. Commun. Health 44: 7–11.
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Simon, J.G., van de Mheen, H., van der Meer, J.B.W. et al. Socioeconomic Differences in Self-Assessed Health in a Chronically Ill Population: The Role of Different Health Aspects. J Behav Med 23, 399–420 (2000). https://doi.org/10.1023/A:1005552814010
- self-assessed health
- socioeconomic differences
- chronic disease
- functional limitations
- psychosomatic symptoms
- perceived discomfort/distress