Are there gender differences in the trajectories of self-rated health among chinese older adults? an analysis of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

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Abstract

Background

Self-rated health (SRH) is a good predictor of morbidity and mortality. Extensive research has shown that females generally report poorer SRH than males but still tend to live longer. Previous studies used cross-sectional or pooled data for their analyses while ignoring the dynamic changes in males’ and females’ SRH statuses over time. Furthermore, longitudinal studies, especially those that focus on older adults, typically suffer from the incompleteness of data. As such, the effect of dropout data on the trajectories of SRH is still unknown. Our objective is to examine whether there are any gender differences in the trajectories of SRH statuses in Chinese older adults.

Methods

The trajectories of SRH were estimated using the pattern-mixture model (PMM), a special latent growth model, under non-ignorable dropout data assumption. We analyzed the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data of 15,613 older adults aged 65 years and above, collected from 2005 to 2014.

Results

The results demonstrated the effect of non-ignorable dropout data assumptions in this study. The previous SRH score was negatively associated with the likelihood of dropping out of the study at the next follow-up survey. Our results showed that both males and females in China perceive their SRH as decreasing over time. A significant gender difference was found in the average SRH score (female SRH was lower than male SRH) in this study. Nonetheless, based on the results obtained using the PMM, there are no gender differences in the trajectories of SRH at baseline as well as in the rate of decline among the total sample. The results also show that males and females respond to SRH predictors similarly, except that current drinking has a more pronounced positive effect on males and healthcare accessibility has a more pronounced positive effect on females.

Conclusions

Our results suggest that missing data have an impact on the trajectory of SRH among Chinese older adults. Under the non-ignorable dropout data assumptions, no gender differences were found in trajectories of SRH among Chinese older adults. Males and females respond to SRH predictors similarly, except for current drinking habit and healthcare accessibility.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02484-4.

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Most cited references 50

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Gender differences in the utilization of health care services.

K D Bertakis, R Azari, L J Helms … (2000)

Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services. New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses. Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations. Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.

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What is self-rated health and why does it predict mortality? Towards a unified conceptual model.

Marja Jylhä (2009)

The association of self-rated health with mortality is well established but poorly understood. This paper provides new insights into self-rated health that help integrate information from different disciplines, both social and biological, into one unified conceptual framework. It proposes, first, a model describing the health assessment process to show how self-rated health can reflect the states of the human body and mind. Here, an 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. The model helps us understand why self-ratings of health may be modified by age or culture, but still be a valid measure of health status. Second, based on the proposed model, the paper examines the association of self-rated health with mortality. The key question is, what do people know and how do they know what they know that makes self-rated health such an inclusive and universal predictor of the most absolute biological event, death. The focus is on the social and biological pathways that mediate information from the human organism to individual consciousness, thus incorporating that information into self-ratings of health. A unique source of information is provided by the bodily sensations that are directly available only to the individual him- or herself. According to recent findings in human biology, these sensations may reflect important physiological dysregulations, such as inflammatory processes. Third, the paper discusses the advantages and limitations of self-rated health as a measure of health in research and clinical practice. Future research should investigate both the logics that govern people's reasoning about their health and the physiological processes that underlie bodily feelings and sensations. Self-rated health lies at the cross-roads of culture and biology, therefore a collaborative effort between different disciplines can only improve our understanding of this key measure of health status.

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Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study

Yi ZENG, Qiushi Feng, Therese Hesketh … (2017)

The oldest-old (those aged ≥80 years) are the most rapidly growing age group globally, and are most in need of health care and assistance. We aimed to assess changes in mortality, disability in activities of daily living, and physical and cognitive functioning among oldest-old individuals between 1998 and 2008.

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Author and article information

Contributors

Xiangyang Zhang: zxyanghero@126.com

Chun Chen: chenchun408@126.com

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 18 October 2021

Publication date PMC-release: 18 October 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 563

Affiliations

[1 ]GRID grid.268099.c, ISNI 0000 0001 0348 3990, School of Public Health and Management, , Wenzhou Medical University, ; Tongren Building 7B304, Zhejiang 325035 Wenzhou, China

[2 ]GRID grid.5342.0, ISNI 0000 0001 2069 7798, International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, , Ghent University, ; 9000 Ghent, Belgium

[3 ]GRID grid.46078.3d, ISNI 0000 0000 8644 1405, Department of Sociology and Legal Studies, , University of Waterloo, ; 200 University Avenue West, N2L 3G1 Waterloo, Ontario Canada

[4 ]GRID grid.268099.c, ISNI 0000 0001 0348 3990, School of Innovation and Enterpreneurship, , Wenzhou Medical University, ; Zhejiang 325035 Wenzhou, China

[5 ]GRID grid.414906.e, ISNI 0000 0004 1808 0918, The First Affiliated Hospital of Wenzhou Medical University, ; Zhejiang 325000 Wenzhou, China

[6 ]GRID grid.268099.c, ISNI 0000 0001 0348 3990, Center for Health Assessment, , Wenzhou Medical University, ; 325035 Wenzhou, Zhejiang China

Article

Publisher ID: 2484

DOI: 10.1186/s12877-021-02484-4

PMC ID: 8522225

PubMed ID: 34663221

SO-VID: 30cad4a1-8797-40c6-87c3-8a231f9b3512

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 25 January 2021

Date accepted : 17 September 2021

Funding

Funded by: National Natural Science Foundation of China

Award ID: 71603187

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: self-rated health,gender differences,latent growth model,older adults,dropout

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: self-rated health, gender differences, latent growth model, older adults, dropout

Are there gender differences in the trajectories of self-rated health among chinese older adults? an analysis of the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

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Hearing Loss and Restoration

Most cited references 50

Gender differences in the utilization of health care services.

What is self-rated health and why does it predict mortality? Towards a unified conceptual model.

Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study

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