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What does age-comparative self-rated health measure?: A cross-sectional study from the Northern Sweden MONICA Project
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Arcum)ORCID iD: 0000-0002-1773-6896
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2016 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 3, 233-239 p.Article, review/survey (Refereed) Published
Abstract [en]

Aims: Self-rated health comprehensively accounts for many health domains. Using self-ratings and a knowledge of associations with health domains might help personnel in the health care sector to understand reports of ill health. The aim of this paper was to investigate associations between age-comparative self-rated health and disease, risk factors, emotions and psychosocial factors in a general population. Methods: We based our study on population-based cross-sectional surveys performed in 1999, 2004 and 2009 in northern Sweden. Participants were 25-74 years of age and 5314 of the 7500 people invited completed the survey. Comparative self-rated health was measured on a three-grade ordinal scale by the question How would you assess your general health condition compared to persons of your own age?' with the alternatives better', worse' or similar'. The independent variables were sex, age, blood pressure, cholesterol, body mass index, self-reported myocardial infarction, stroke, diabetes, physical activity, smoking, risk of unemployment, satisfaction with economic situation, anxiety and depressive emotions, education and Karasek scale of working conditions. Odds ratios using ordinal regression were calculated. Results: Age, sex, stroke, myocardial infarction, diabetes, body mass index, physical activity, economic satisfaction, anxiety and depressive emotions were associated with comparative self-rated health. The risk of unemployment, a tense work situation and educational level were also associated with comparative self-rated health, although they were considerably weaker when adjusted for the the other variables. Anxiety, depressive emotions, low economic satisfaction and a tense work situation were common in the population. Conclusions:Emotions and economic satisfaction were associated with comparative self-rated health as well as some medical variables. Utilization of the knowledge of these associations in health care should be further investigated.

Place, publisher, year, edition, pages
London: Sage Publications, 2016. Vol. 44, no 3, 233-239 p.
Keyword [en]
cardiovascular disease, comparative self-rated health, diabetes, emotions, ordinal regression analysis, population based study, psychosocial factors, risk factors
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-109147DOI: 10.1177/1403494815618554ISI: 000373591600003PubMedID: 26644159OAI: oai:DiVA.org:umu-109147DiVA: diva2:855297
Note

Originally published in manuscript form.

Available from: 2015-09-21 Created: 2015-09-21 Last updated: 2017-05-23Bibliographically approved
In thesis
1. Self-rated health: from epidemiology to patient encounter
Open this publication in new window or tab >>Self-rated health: from epidemiology to patient encounter
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In epidemiology self-rated health is often measured as people’s subjective answer to a question “How is your health in general?” or “How is your general health compared to persons of your own age?”. The answers have a strong association with significant medical outcomes such as death, diabetes, coronary heart disease, functional ability and depression, medical diagnoses and how these are perceived. The overarching aim of this thesis was to investigate if and how a use of the epidemiologists’ tool of self-rated health might aid GPs in practising medicine with a holistic perspective, contextually sensitive and taking into account the patients’ medical and personal histories.

Methods: In Paper I, I used semantics to elucidate the meaning of self-rated health. Data came from the Northern Sweden Monica Project 1990–1999. In Paper II, with data from the MONICA Project in 1999–2009, I used ordinal regression to investigate associations between self-rated health, medical factors, psychosocial factors and emotions. In Paper III, I used data from the Västerbotten Intervention Programme 1990–2004 in Cox regression analyses to investigate the relationship between self-rated health and standard risk factors for the outcome myocardial infarction. Paper IV is a qualitative study from seven primary care health centres. Actual consultations were audio-recorded and analysed with systematic text condensation, measuring apportionment of speaking time and by taking into account GPs’ assessments of using a question about comparative self-rated health in a consultation.

Results: In Paper I, I found “health” in questionnaires being understood not through definitions of health but through associations of the word “health” with “sense relations”, that are important connotations of the word “health”. Age-comparative self-rated health was semantically clearer as it pointed towards comparison with a reference group. In Paper II, emotions of anxiety or depression and discontent with personal economy were associated with lower self-rated health and were common in the population. Paper III established self-rated health as an independent risk factor for myocardial infarction when adjusted for standard risk factors. In the qualitative Paper IV, self-rated health affected consultations, increased patients’ speaking time in relation to doctors’ when discussing self-rated health and elicited reactions, sometimes with strong language. Reflections ensued that could give vivid descriptions of function, life circumstances and resources or obstacles in handling symptoms and illnesses.

Conclusion: Comparative self-rated health constitutes a feasible tool in general practice, particularly in taking account of patients’ medical and personal histories. It is holistic, sensitive to psychosocial factors. It is useful to solicit information on risk and the patient’s feelings related to an illness/disease, and to encourage the patient’s active reflection on functional abilities, life situation, health and health strategies. However, self-ratings are not to be seen as a standard procedure in all consultations.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2015. 73 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1756
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:umu:diva-109404 (URN)978-91-7601-337-3 (ISBN)
Public defence
2015-10-30, Aulan, Sunderby sjukhus, Luleå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-10-02 Created: 2015-09-26 Last updated: 2015-10-01Bibliographically approved

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Waller, GöranJanlert, UrbanHamberg, KatarinaForssén, Annika

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