A cross-sectional study of self-rated health among older adults: a comparison of China and the United States

Abstract

ObjectivesWe used nationally representative samples of China and the US older population to investigate (1) whether factors influencing self-rated health among older Chinese were similar to those among older Americans; and (2) whether there was a significant cross-national difference in self-rated health between China and the USA after controlling those available influencing factors.DesignA cross-sectional study. Data came from the 2014 Health and Retirement Study and China Health and Retirement Longitudinal Study conducted from 2014 to 2015.ParticipantsOur final sample size totaled 8905 older adults in the USA and 4442 older adults in China.OutcomeThe response variable was self-rated health. Ordered logistic regression models were conducted to investigate factors influencing self-rated health among older adults.ResultsMore than three-fourths (78%) of older adults in China reported fair or poor health status, while almost 74% of older adults in the USA reported excellent, very good or good health status. In the overall ordered logistic regression model, when controlling statistically for sociodemographics, family structure, functional limitations, cognition, chronic conditions, mental health and health-related behaviours, the Chinese survey respondents were much more likely to rate their health as being poorer than the US respondents. The odds of having better versus poorer health was almost five times greater in American older adults than those in China (OR=4.88, 95% CI 4.06 to 5.86). Older adults in China living alone rated their health better than those living with spouse/partner; however, no significant difference was found between these two living arrangements in older Americans. In contrast, older adults in the USA living with others rated their health worse compared with those living with spouse/partner. In addition, older adults who had more activities of daily living limitations, poorer self-reported memory, worse mental health and chronic health conditions had lower self-rated health in both countries.ConclusionsWe found a striking difference in self-rated health between China and the USA even after controlling for measures of disease, functional status and other influencing factors. Relative to their American counterparts, Chinese elders were much more likely to report worse health.

Income-related Inequality in Health Outcomes among Older People in China: Measurement and Decomposition Analysis

“…Without this awareness and affordability, they regard themselves as healthy instead. In addition, SRH is related to many other factors, such as chronic disease, outdoor activities, and depression, not just ADL ability [34]. In other words, even if some older people with more education have bad or fair SRH, they may have other problems but still have good functional ability, according to these six items.…”

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal

“…Positive self-perceived health was also associated with high cognitive status, functional independence and less depressive symptoms in a study conducted by Krug et al ( 90) in a regional sample of older Brazilians. Maintained functional capacity was the variable with the greatest explanatory potential for self-rated health, according to microdata from the National Health Survey (2013), conducted by Figueiredo et al In a comparative study conducted by Xu et al (2) with data from HRS and CHARLS, the authors found that 78% of older adults in China reported fair or poor health status, whereas almost 74% of older adults in the USA reported it as excellent, very good or good. However, older individuals who reported more limitations in activities of daily living, worse self-reported memory, worse mental health, and chronic health conditions had worse self-rated health in both countries.…”

“…It should be noted that healthcare policies must be devised to play an important role in reducing social inequalities in healthcare in Brazil and in Portugal, with planning that guarantees care for vulnerable populations, including that of older adults. This can be accomplished: (1) through greater investments in the area of primary care; (2) through the reorganization of mental healthcare services for easier access by older adults; (3) by expanding the dissemination of good healthcare practices, with home visits by healthcare professionals particularly in the most vulnerable communities; and (4) by ensuring that everyone has access to free services, based on principles of equity and solidarity.…”

“…In a comparative study conducted by Xu et al ( 2 ) with data from HRS and CHARLS, the authors found that 78% of older adults in China reported fair or poor health status, whereas almost 74% of older adults in the USA reported it as excellent, very good or good. However, older individuals who reported more limitations in activities of daily living, worse self-reported memory, worse mental health, and chronic health conditions had worse self-rated health in both countries.…”

“…Self-rated health represents a summary statement about the ways in which various aspects of health, both subjective and objective, are combined according to the subject's own perception ( 1 ). This variable is widely used in large population surveys on health and well-being, consolidating itself as a multidimensional indicator of health and a good predictor of adverse events in older adults ( 2 ). Answers to this assessment are influenced by social, cultural and personality aspects ( 3 ).…”