Determinants of self rated health and mortality in Russia – are they the same?

Perlman Francesca, Bobak, Bobak Martin

Description

Research into Russia's health crisis during the 1990s includes studies of both mortality and self-rated health, assuming that the determinants of the two are the same. In this paper, we tested this assumption, using data from a single study on both outcomes and socioeconomic, lifestyle and psychological predictor variables. Methods We analysed data from 7 rounds (1994–2001) of the Russia Longitudinal Monitoring Survey, a panel study of a general population sample (11,482 adults aged over 18 living in households of 2 or more people). Self-rated health was measured on a 5 point scale and dichotomised by combining responses "very poor" and "poor" into poor health. Deaths (n = 782) during a mean follow up of 4.1 years were reported by another household member. Associations between several predictor variables and poor or very poor self-rated health and mortality were measured using logistic regression and Cox proportional hazards analysis respectively. Results Poor self-rated health was significantly associated with mortality; hazard ratios, compared with very good, good or average health, were 1.69 (1.36-2.10) in men and 1.74 (1.38-2.20) in women. Low education predicted both mortality and poor self-rated health, but income predicted subjective health more strongly. Smoking doubled the risk of death but was unrelated to subjective wellbeing. Frequent drinkers experienced greater mortality than occasional drinkers, despite reporting better health. In contrast, dissatisfaction with life predicted poor self-rated health, but not mortality. Conclusion Differences between the predictors of subjective health and mortality, even though these outcomes were strongly associated, suggest that influences on subjective health are not restricted to serious disease. These findings also suggest the presence of risk factors for relatively sudden deaths in apparently well people, although further research is required. Meanwhile, caution is required when using studies of self-rated health in Russia to understand the determinants of mortality.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2008
• Nombre de lectures: 7
• Langue: English

Extrait

International Journal for Equity in Health

BioMedCentral

Open Access Research Determinants of self rated health and mortality in Russia – are they the same? 1 2 Francesca Perlman*and Martin Bobak

1 2 Address: ECOHOST,London School of Hygiene and Tropical Medicine, London, UK andDepartment of Epidemiology and Public Health, University College London, London, UK Email: Francesca Perlman*  [e-mail]; Martin Bobak  [e-mail] * Corresponding author

Published: 25 July 2008Received: 31 October 2007 Accepted: 25 July 2008 International Journal for Equity in Health2008,7:19 doi:10.1186/14759276719 This article is available from: http://www.equityhealthj.com/content/7/1/19 © 2008 Perlman and Bobak; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background:Research into Russia's health crisis during the 1990s includes studies of both mortality and selfrated health, assuming that the determinants of the two are the same. In this paper, we tested this assumption, using data from a single study on both outcomes and socioeconomic, lifestyle and psychological predictor variables. Methods:We analysed data from 7 rounds (1994–2001) of the Russia Longitudinal Monitoring Survey, a panel study of a general population sample (11,482 adults aged over 18 living in households of 2 or more people). Selfrated health was measured on a 5 point scale and dichotomised by combining responses "very poor" and "poor" into poor health. Deaths (n = 782) during a mean follow up of 4.1 years were reported by another household member. Associations between several predictor variables and poor or very poor selfrated health and mortality were measured using logistic regression and Cox proportional hazards analysis respectively. Results:Poor selfrated health was significantly associated with mortality; hazard ratios, compared with very good, good or average health, were 1.69 (1.362.10) in men and 1.74 (1.382.20) in women. Low education predicted both mortality and poor selfrated health, but income predicted subjective health more strongly. Smoking doubled the risk of death but was unrelated to subjective wellbeing. Frequent drinkers experienced greater mortality than occasional drinkers, despite reporting better health. In contrast, dissatisfaction with life predicted poor selfrated health, but not mortality. Conclusion:Differences between the predictors of subjective health and mortality, even though these outcomes were strongly associated, suggest that influences on subjective health are not restricted to serious disease. These findings also suggest thepresence of risk factors for relatively sudden deaths in apparently well people, although further research is required. Meanwhile, caution is required when using studies of selfrated health in Russia to understand the determinants of mortality.

Background Life expectancy in Russia stagnated during the 1960s, and then lagged progressively further behind the rising longev

ity of the countries of Western Europe [1]. After a brief improvement in life expectancy in Russia during the 1980s, the fall of Communism in 1991 heralded an

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