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The determinants of health among the population aged 50 and over: evidence from Croatia
Šime Smolić*
Article | Year: 2017 | Pages: 85 - 108 | Volume: 41 | Issue: 1 Received: October 19, 2016 | Accepted: December 29, 2016 | Published online: March, 2017
|
FULL ARTICLE
FIGURES & DATA
REFERENCES
CROSSMARK POLICY
METRICS
LICENCING
PDF
Variable
|
|
Weighted %
|
SAH
|
Very bad
|
6.67
|
|
Bad
|
20.74
|
|
Fair
|
38.42
|
|
Good
|
22.35
|
|
Very good
|
11.82
|
Agea
|
50-65
|
50.05
|
|
65 and over
|
49.95
|
Gender
|
Male
|
40.88
|
|
Female
|
59.12
|
Educational
level
|
Primary or
below
|
34.75
|
|
Secondary
|
45.84
|
|
Tertiary
|
19.41
|
Marital
status
|
Married
|
62.91
|
|
Widowed
|
25.52
|
|
Never
married
|
5.47
|
|
Divorced/separated
|
6.10
|
Help
received
|
No help
received
|
65.69
|
|
Help from
household member(s)
|
23.12
|
|
Help outside
household
|
11.18
|
Living with
|
Living alone
|
23.07
|
|
Living with
spouse/partner
|
32.95
|
|
Living with
others
|
43.98
|
BMIb
|
Less than 30
|
71.82
|
|
Equal to or
greater than 30 (Obese)
|
28.18
|
Smoking
|
Current
smoker
|
23.69
|
|
Ex-smoker
|
23.75
|
|
Non smoker
|
52.26
|
Drinking
|
At least
once per week
|
34.06
|
Conditions
|
No diagnosed
condition
|
26.15
|
|
One or two
conditions
|
48.95
|
|
Three or
more conditions
|
24.90
|
Symptoms
|
No symptom
|
25.16
|
|
One or two
symptoms
|
43.46
|
|
Three or
more symptoms
|
30.38
|
(I)ADL
|
No (I)ADL
limitation
|
56.45
|
|
One or
two(I)ADL limitations
|
26.24
|
|
Three or
more (I)ADL limitations
|
17.31
|
Employment
status
|
Employed
|
16.37
|
|
Unemployed
|
9.30
|
|
Retired
|
60.30
|
|
At home
|
12.65
|
|
Other
|
1.38
|
Household
financial situationc
|
Some or
great difficulty
|
78.50
|
|
No
difficulty
|
21.50
|
a Mean age = 65.45 years. b Categories: underweight = BMI ≤ 18.49; normal weight = BMI 18.50–24.99; overweight = BMI 25.00–29.99; obese = BMI ≥ 30.00. c Reported income at the household level only. Source: Author calculations.
|
OR
|
95% CI
|
Age (50-64)
|
|
|
|
65 and over
|
0.82
|
0.57
|
0.57
|
Gender
(Male)
|
|
|
|
Female
|
1.61**
|
1.15
|
1.15
|
Educational
level (Tertiary)
|
|
|
|
Primary or
below
|
0.39***
|
0.25
|
0.25
|
Secondary
|
0.54***
|
0.37
|
0.37
|
Marital
status (Married)
|
|
|
|
Widowed
|
0.89
|
0.54
|
0.54
|
Never
married
|
0.70
|
0.33
|
0.33
|
Separated/Divorced
|
0.60
|
0.31
|
0.31
|
Help
received (No help received)
|
|
|
|
Help from
household member(s)
|
0.51**
|
0.32
|
0.32
|
Help outside
household
|
0.73
|
0.51
|
0.51
|
Living with
(Living alone)
|
|
|
|
Living with
spouse/partner
|
1.30
|
0.73
|
0.73
|
Living with
others
|
1.32
|
0.82
|
0.82
|
BMI equal to
or greater than 30
|
1.04
|
0.76
|
0.76
|
Smoke (Never
smoker)
|
|
|
|
Ex-smoker
|
1.13
|
0.79
|
0.79
|
Current
smoker
|
1.03
|
0.72
|
0.72
|
Drink
|
0.84
|
0.61
|
0.61
|
Conditions
(Three or more)
|
|
|
|
No diagnosed
condition
|
3.86***
|
2.42
|
2.42
|
One or two
conditions
|
1.78**
|
1.23
|
1.23
|
Symptoms
(Three or more)
|
|
|
|
No symptom
|
6.21***
|
3.84
|
3.84
|
One or two
symptoms
|
2.05***
|
1.41
|
1.41
|
(I)ADL
(Three or more)
|
|
|
|
No
limitation
|
7.46***
|
4.51
|
4.51
|
One or two
limitations
|
3.65***
|
2.28
|
2.28
|
Employment
status (Employed)
|
|
|
|
Unemployed
|
0.77
|
0.43
|
0.43
|
Retired
|
0.84
|
0.53
|
0.53
|
At home
|
0.83
|
0.44
|
0.44
|
Other
|
0.33
|
0.09
|
0.09
|
Household
financial situation (Some or great difficulty)
|
|
|
|
No
difficulty
|
2.07***
|
1.46
|
1.46
|
Note: * p<0.05; ** p<0.01; *** p<0.001. Reference category is in the brackets.
Author(s)
|
General research strategy
|
Time period
|
Countries included
|
Main findings
|
Bobak et al. (1998)
|
Cross-sectional
study in a national sample of the Russian population of social and
psychosocial determinants of two self-reported health indicators: self-rated
health and physical functioning. Logistic regression for two dichotomised
outcomes: poor self-rated health and low physical functioning.
|
|
Russia
|
Material
deprivation is strongly related to both outcomes. Education was inversely
related to self-rated health. Unmarried men reported poor physical
functioning substantially more often. Subjects not approving the economic
changes reported poorer health. Subjects who could not rely on informal
social structures when in problems reported worse health.
|
Bobak et al. (2000)
|
Study
examined the association between perceived control and several socioeconomic
variables and self-rated health in seven post-communist countries. The
associations between poor health and socioeconomic factors were estimated by
logistic regression.
|
1996-1998
|
Russia,
Estonia, Lithuania, Latvia, Hungary, Poland, Czech Republic
|
Education
and material deprivation are strongly related to self-rated health.
|
Damian et al. (1999)
|
The five-category dependent variable was grouped
into two categories: good and poor self-assessed health. Age, sex, social
class, use of physician services, number of chronic conditions, and
functional capacity were included as main explanatory factors. Adjusted odds
ratios were estimated through multiple logistic regression models.
|
1994-1995
|
Spain
|
Age, chronic conditions, and functional status
were the main determinants of perceived health among the Spanish elderly. The
effect of social class on perceived health markedly decreases with age.
|
Desesquelles, Egidi and Salvatore (2009)
|
The
prevalence of self-rated bad health is studied in a cross-national
comparative study based on the data of National Health Surveys conducted in
France and Italy. Logistic regression models were applied.
|
2002-2003 (France); 1999-2000 (Italy)
|
Italy, France
|
Differences
in population structure regarding the individual characteristics
(sociodemographic characteristics, diseases and disabilities, lifestyle, and
others) significantly affected the SAH in two countries.
|
Franks, Gold and Fiscella (2003)
|
Ordinary
linear regression analyses were used in this study of adjusted relationships
among baseline self-reported health, derived from SF-20 subscales (health
perceptions, physical function, role function and mental health) and
sociodemographics (age, sex, race/ethnicity, income and education) and
subsequent mortality.
|
1987
|
USA
|
Physical
function showed the greatest decline with age, whereas mental health
increased slightly.
Women
reported lower health for all scales except role function. Greater income was
associated with better health. Greater education was associated with better
health. Compared with whites, blacks reported lower health, whereas Latinos
reported higher health.
|
Hujits and Kraaykamp (2011)
|
Multilevel
regression analyses exploring the extent the often found association between
marital status and self-assessed health is influenced by the marital
composition of the country people live in.
|
2002, 2004, 2006
|
29 European countries
|
Living
in a country with a high proportion of married people appears to be
beneficial to the health of never married persons, but detrimental for
widowed people.
Divorced,
widowed, and never married persons may be worst off when living in countries
with high proportions of people who are in the same situation.
The
never married are worst off in countries with a high proportion of
cohabitants.
|
Hujits, Monden and Kraaykamp (2010)
|
Multilevel
regression analyses is applied to examine whether own educational level and
spouse’s educational level are independently associated with self-assessed
health throughout European societies.
|
2002, 2004, 2006
|
29 European countries
|
Educational
level and the spouse’s level of education positively affect SAH in Europe.
The degree of educational heterogamy does not influence the average level of
self-assessed health in a country.
|
Idler and Benyamini (1997)
|
Review
of 27 international studies
|
1982-1997
|
Sweden, Lithuania, Israel, UK, The Netherlands,
France, Poland, Hong Kong, Japan, Australia, Canada, USA
|
Global self-rated health is an independent
predictor of mortality in nearly all of the studies, despite the inclusion of
numerous specific health status indicators and other relevant covariates
known to predict mortality.
|
Jürges, Avendano and Mackenbach (2008)
|
Ordered probit regression on SHARE data. Study
compares the WHO recommended version (ranging from ‘very good’ to ‘very bad’)
with the US version (ranging from ‘excellent’ to ‘poor’) in European
countries.
|
2004
|
Germany, Spain, Greece, The Netherlands, Austria
|
Authors assessed the difference of answers of US and
WHO version so the SAH questions. They found less than 10% of respondents
provided discordant answers.
|
Jylhä (2009)
|
Paper
presents model describing the health assessment process to show how
self-rated health can reflect the states of the human body and mind. Based on
the proposed model, it examines the association of self-rated health with
mortality.
|
-
|
-
|
Analytic
distinction is made between the different types of information on which
people base their health assessments and the contextual frameworks in which
this information is evaluated and summarized.
|
Mackenbach [et al.], (2005)
|
The
proportion of respondents with SAH less than ‘good’ was measured in relation
to educational level and income level. Inequalities were measured by means of
age-standardized prevalence rates and odds ratios.
|
1980s-1990s
|
Finland,
Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria,
Italy, Spain
|
Socioeconomic
inequalities in self-assessed health showed a high degree of stability in
European countries.
The
relatively favourable trends in the Nordic countries suggest that these
countries’ welfare states were able to buffer many of the adverse effects of
economic crises on the health of disadvantaged groups
|
Leinsalu (2002)
|
Study
examined differences in self-rated health by eight main dimensions of the
social structure on the basis of the Estonian Health Interview Survey,
carried out in 1996/1997. A multistage random sample (n=4711) of the Estonian
population aged 15–79 was interviewed. This study includes those respondents
aged 25–79 (n=4011) with analyses being performed separately for men and
women.
|
1996/97
|
Estonia
|
Low
educational level, Russian nationality, low personal income, and for men
only, rural residence were the most influential factors underlying poor
health. Education had the biggest independent effect on health ratings.
Material resources, in this study measured by personal income, were important
factors in explaining some of the educational and ethnic differences in poor
self-rated health. No differences between men and women in their health
ratings were found.
|
Mackenbach
[et al.], (2005)
|
Study
examined the shape of the relationship between household equivalent income
and SAH. Data were obtained from nationally representative health, level of
living, or similar surveys and applied to men and women aged 25 years and
older in the 1990s.
|
1990s
|
Belgium,
Denmark, England, Finland, France, The Netherlands, Norway
|
A
higher household equivalent income is associated with better self-assessed
health among men and women in all countries, particularly in the
middle-income range.
|
McFadden [et al.], (2009)
|
Study
examined the relationship between SAH and mortality by occupational social class
in a prospective study of 22,457 men and women aged 39–79 years, without
prevalent disease.
|
1993-1997
|
Norfolk - UK
|
SAH
was related to subsequent mortality. The prevalence of poor or moderate SAH
was higher in manual than in non-manual classes. However, SAH was similarly
related to mortality in manual and non-manual classes.
|
Meng and D’Arcy (2016)
|
Study
compares determinants of SAH among a large community-dwelling cohort of
Canadian seniors (N = 3255) at three points in time (1991, 1996, and 2001),
and examines the effects of determinants on change in SAH over a 10-year
period. Multivariate ordinal logistic
regression on Canadian Study of Health and Ageing data
|
1991, 1996, 2001
|
Canada
|
Factors
including cognition, daily functioning, chronic disease, and availability of
help were significantly linked to self-rated health over time.
|
Nicholson et al. (2005)
|
Study
examined the influence of socioeconomic risk factors over the life course on
the SAH of older Russian men and women. A random sample 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.
|
2002
|
Russia
|
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.
|
Pirani and Salvini (2012)
|
Stepwise
multilevel logistic regression models using the data on health conditions
which come from a survey conducted by the Italian National Statistics
Institute (ISTAT).
|
2004-2005
|
Italy
|
Each
component of the socioeconomic status is autonomously correlated with
individual perceptions of health. The lack of a network of relationships was
also found to be strongly associated with a poor health status for elderly
Italians.
|
Reile and Leinsalu (2013)
|
Multinomial
logistic regression analysis was used to study the association of
socio-demographic, physical and psychological health and well-being
characteristics
with
positive (good or very good) and negative (bad or very bad) SAH as compared
to fair SAH.
|
2006
|
Estonia
|
Negative
SAH was related to male gender, the presence of chronic illnesses,
limitations in daily activities and physical functioning, emotional distress,
an external locus of control, and to low satisfaction with life and physical
fitness.
Positive
SAH was related to younger age, an Estonian ethnic identity, and to higher
education and income.
|
Schnittker and Bacak (2014)
|
Cox
regression of SAH predicting mortality on GSS data
|
1980-2002
|
Germany
|
More
schooling and more cognitive ability increase the predictive validity of SAH,
but neither of these influences explains the growing association between SAH
and mortality.
|
Sun et al. (2007)
|
Multivariate
logistic regression was used to identify the factors associated with good SAH
and sex specific effect was tested by stepwise logistic regression.
|
2005
|
Japan
|
Good
SAH is correlated with "can go out alone to distant places", no depression,
no weight loss, absence of self-rated chronic disease, good chewing ability,
and good visual ability in men; whereas with "can go out alone to
distant places", absence of self-rated chronic disease, no weight loss,
no depression, no risk of falling, independent IADL, good chewing ability,
good visual ability, and social integration (attend) in women.
|
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