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.
Similar content being viewed by others
References
Angel R, Guarnaccia P (1989) Mind, body, and culture: somatization among Hispanics. Social Sci Med 28:1229–1238
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 42:681–689
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 46:219–231
Béland F, Zunzunegui MV (1995a) El diseño y la ejecución de la encuesta Envejecer en Leganés. Rev Gerontol 5:215–231
Béland F, Zunzunegui MV (1995b) Presentación del estudio Envejecer en Leganés. Rev Gerontol 5:207–214
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:107–116
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, Uppsala
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 51:1343–1350
Carlson P (1998) Self-perceived health in East and West Europe: another European health divide. Social Sci Med 46:1355–1366
Cockerham WC, Sharp K, Wilcox JA (1983) Aging and perceived health status. J Gerontol 38:349–355
Davies L (1995) A closer look at gender and distress among the never married. Women Health 23:13–30
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 58
Ferraro KF, Farmer MM, Wybraniec JA (1997) Health trajectories: long term dynamics among black and white adults. J Health Social Behav 38:38–54
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 56:922–926
Figueiras A, Domenech-Massons J, Cadarso C (1998) Regression models: calculating the confidence interval of effects in the presence of interactions. Stat Med 17:2099–2105
Fylkesnes K, Førde O (1991) The Tromsø study. Predictors of self-evaluated health—has society adopted the expanded health concept? Social Sci Med 32:141–146
Fylkenes K, Førde OH (1992) Determinants and dimensions involved in self-evaluation of health. Social Sci Med 35:271–279
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 56:935–947
Idler EL (1992) Self-assessed health and mortality: a review of studies. Int Rev Health Psychol 1:33–54
Idler EL (1993) Age differences in self-assessments of health: age changes, cohort differences, or survivorship? J Gerontol Social Sci 48:289–300
Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Social Behav 38:21–37
Johnson RJ, Wolinsky FD (1993) The structure of health status among older adults: disease, disability, functional limitations, and perceived health. J Health Social Behav 34:105–121
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 11:29–41
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 41:710–717
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 47:1–4
Jylhä M, Guralnik JM, Ferrucci L, Jokela J, Heikkinen E (1998) Is self-rated health comparable across cultures and genders? J Gerontol Social Sci 53:144–152
Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 52:736–741
Kleinbaum DG (1994) Logistic regression: a self-learning text. Springer, Berlin Heidelberg New York
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 85–102
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 49:1407–1417
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):295–305
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 29:1161–1180
MacIntyre S, Hunt K, Sweeting H (1996) Gender differences in health: are things really as simply as they seem? Social Sci Med 42:617–624
Maggi S, Zucchetto M, Grigoletto F et al. (1994) The Italian Longitudinal Study on Aging (ILSA): design and methods. Aging Clin Exp Res 6:464–473
Manor O, Matthews S, Power C (2000) Dichotomous or categorical response? Analysing self-rated health and lifetime social class. Int J Epidemiol 29:149–157
Marmot MG, Davey Smith G, Stansfeld S et al. (1991) Health inequalities among British civil servants: the Whitehall II study. Lancet 337:1387–1393
Matthews S, Manor O, Power C (1999) Social inequalities in health: are there gender differences? Social Sci Med 48:49–60
McDonough P, Walters P (2001) Gender and health: reassessing pattern and explanations. Social Sci Med 52:547–559
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 15:187–202
Moum T (1992) Self-assessed health among Norwegian adults. Social Sci Med 35:935–947
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, Uppsala
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 40:89–99
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 49:601–609
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 40:7–20
Pluijm S, Bardage C, Nikula S et al. (2005) Harmonising a measure of ADL across six countries. J Clin Epidemiol (in press)
Rakoski W, Fleishman JA, Mor VA, Bryant SA (1993) Self-assessments of health and mortality among older persons. Res Aging 15:92–116
SAS Institute (1999–2001) SAS release 8.02. SAS Institute Inc, Cary, NC
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 86:1798–1801
Stoller EP (1984) Self-assessment of health by the elderly. The impact of informal assistance. J Health Social Behav 25:260–270
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:27–36
Townsend P, Davidson N (1992) Inequalities in health. The Black Report. Penguin, London
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 49:1–8
van Doorslaer E, Wagstaff A, Bleichrodt H et al. (1997) Income-related inequalities in health: some international comparisons. J Health Econ 16:93–112
Verbrugge LM (1989) The Twain Meet: empirical explanations of sex differences in health and mortality. J Health Social Behav 30:282–304
Verbrugge LM, Jette AM (1994) The disablement process. Social Sci Med 38:1–14
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 41:465–481
Acknowledgements
The CLESA Working Group: Finland: M. Jylhä (Principal Investigator), S. Nikula, V. Autio. Israel: J. Gindin (Principal Investigator; First Principal Investigator: the late Modan Baruch of the Chaim Sheba Medical Center), T. Blumstein, A. Chetrit, A. Walter-Ginzburg, K. Shamay. Italy: S. Maggi (Project Leader), N. Minicuci, M. Noale, C. Marzari. The Netherlands: D.J.H. Deeg (Principal Investigator), S.M.F. Pluijm. Spain: A. Otero (Principal Investigator), M.J. Garcia de Yebenes, A. Rodríguez-Laso, M.V. Zunzunegui. Sweden: N.L. Pedersen (Principal Investigator), C. Bardage. The CLESA Project is supported by EU QoL2000-00664. LASA is supported by The Netherlands Ministry of Health, Welfare and Sports and the Vrije Universiteit. ILSA was supported by the CNR (National Research Council) and the Italian Department of Health—National Institutes of Health. Aging in Leganés is supported by the Spanish Health Research Fund (FIS), the Madrid Regional Research Fund and private foundations (La Caixa, BBVA). CALAS was supported by the US National Institute on Aging grants R01-5885-03 and R01-5885-06. The TamELSA is supported by the Academy of Finland, the Juho Vainio Foundation, the Yrjö Jahnsson Foundation, and the Medical Research Fund of Tampere University Hospital. SATSA is supported by the US National Institute on Aging (AG 04563, 10175) and the Swedish Social Research Council.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bardage, C., Pluijm, S.M.F., Pedersen, N.L. et al. Self-rated health among older adults: a cross-national comparison. Eur J Ageing 2, 149–158 (2005). https://doi.org/10.1007/s10433-005-0032-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10433-005-0032-7