Self-Rated Health Trajectories in the African American Health Cohort

Abstract

BackgroundSelf-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans.Materials/MethodsData on 998 African American men and women aged 50–64 years old were taken from a probability-based community sample that was first assessed in 2000–2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later. Using an innovative approach for including decedents in the analysis, semi-parametric group-based mixture models were used to identify person-centered group trajectories of self-rated health over time. Multivariable multinomial logistic regression analysis was then used to differentiate the characteristics of AAH participants classified into the different group trajectories.ResultsFour self-rated health group trajectories were identified: persistently good health, good but declining health, persistently fair health, and fair but declining health. The main characteristics that differentiated the self-rated health trajectory groups from each other were age, education, smoking, morbidity (angina, congestive heart failure, diabetes, and kidney disease), having been hospitalized in the year prior to baseline, depressive symptoms, mobility limitations, and initial self-rated health.ConclusionsThis is the first study to examine self-rated health trajectories separately among African Americans. Four qualitatively distinct self-rated health group trajectories were identified that call into question the accuracy of prior reports that a single, average self-rated health trajectory for African Americans adequately captures their within-group heterogeneity.

Variability in self-rated health trajectories from adolescence to young adulthood by demographic factors

“…Studies among adults indicate individuals with higher income, higher education, or who self-identify as White fare better in SRH. 5–7 These disparities may originate in adolescent development, but research has yet to explore this.…”

Falls efficacy and self-rated health in older African American adults

“…SRH is a very efficient clinical measure of overall health (“Would you say your health is excellent, very good, good, fair, or poor?”) (Idler & Benyamini, 1997; Mossey & Shapiro, 1982). It also reflects the continuum of a person's perceived health by eliciting thoughts on previous, current, and future health (Ayyagari et al, 2012; Idler & Benyamini, 1997). Therefore, for individuals who have a rich history filled with unique experiences and circumstances, such as older African American adults, SRH may be a more appropriate indicator of holistic health than reports of the number/presence of health conditions or objective appraisals of physical health.…”

Loneliness and Self-rated Health among Church-Attending African Americans

“…19–21 These health disparities are also reflected in self-rated health, with African Americans over the age of 50 rating themselves as having poorer health on average than their White counterparts. 22 Studies have indicated that a variety of characteristics, such as depressive symptoms, smoking, and less education, were associated with poorer self-rated health 23 and self-rated health trajectories 24 among African Americans. However, to our knowledge, no previous studies have examined the association of loneliness and self-rated health among African Americans of any age group.…”