The impact of the implementation of hierarchical medical system on population health: evidence from China.

Introduction: The implementation of a hierarchical medical system holds significant practical importance in advancing the Healthy China strategy and elevating the overall health status of the population of China. Methods: This article empirically examines the influence of the implementation of a hierarchical medical system on the health of the population using the latest 2020 China Family Panel Studies database. Furthermore, it investigates the variability of this impact across distinct health insurance participation statuses and literacy groups. Results: The findings of the study demonstrate that the implementation of the hierarchical medical system substantially enhances the health of the population, not only in terms of self-assessed health but also through a notable positive effect on alleviating chronic diseases. These results maintain their validity even after conducting robustness tests utilizing a replacement estimation model. Heterogeneity analysis reveals that the impact of the hierarchical medical system on the population's health status exhibits significant variation concerning health insurance participation and literacy. Specifically, regarding health insurance participation, the hierarchical medical system effectively improves both self-assessed health and chronic disease status among the insured population. However, for those not enrolled in health insurance, the hierarchical medical system only demonstrates improvement in chronic disease status, with insignificant results observed in enhancing self-assessed health status. Moreover, propensity score matching (PSM) was also used to address endogeneity problems resulting from sample selectivity bias. The findings demonstrate that endogeneity issues can be suitably addressed by the PSM model. Additionally, they point out that an overestimation of the impact of the hierarchical medical system on the population's self-assessed health state would result from failing to take sample selectivity bias into account. On the other hand, it will lead to the underestimation of the effect of the hierarchical medical system on the status of chronic diseases. Discussion: Moving forward, steadfast efforts should be directed toward further enhancing the implementation of the hierarchical medical system. This includes the comprehensive promotion and using the pivotal role of the hierarchical medical system in improving the health of the population.

Clear as a bell? Policy stringency and elderly health during Covid-19.

This paper investigates how restriction policies have impacted elderly self-assessed health (SAH) in Europe during the pandemic, and how the Covid-19 infection interacts with policy stringency to modulate the SAH deterioration. Using the Survey of Health, Aging and Retirement in Europe (SHARE) between October 2019 and August 2021, including 9,034 adults aged 50 years and above, alongside with a stringency index from the Oxford's Coronavirus Government Response Tracker (OxCGRT), we design both an adjusted probit model and a recursive bivariate probit model to test for endogeneity of Covid-19 infection. Estimations results show a bell curve between stringency and SAH degradation: a deleterious effect of restrictions at low levels of stringency up to a tipping point after which more stringent policies become protective. Covid-19 infection moderates this association. Depending on individuals' initial health, the effect of restrictions is uneven: highly stringent policies become damaging for individuals most likely to enter a vulnerabilization path, for whom the bell curve is thus inverted. Overall, this study shows clear patterns of association between policy stringency and perceived health among older Europeans, and highlights the potential trade-off between targeting as many people as possible, those in poor health or those on the edge of vulnerability.

Provincial distribution differences and influencing factors of self-assessed health among elderly population in China / 环境与职业医学

Background Regional differences in economic development, natural environment, health care level, and social structure may lead to differences in the provincial distribution of the health status of the elderly population. Objective To explore the provincial distribution characteristics, regional differences, and influencing factors of the self-assessed health of the elderly population, with the aim of providing a policy basis for improving the health of the elderly population and promoting healthy aging according to local conditions. Methods Using 31 provinces (municipalities and autonomous regions) in China as the basicstudy unit and based on the method of Wagstaff, the self-rated health data of the elderly population (aged 60 years and above) in each province from the 2010 and 2020 national censuses and the 2015 1% National Population Sample Survey were converted into ill-health scores as a measure of self-assessed health, and higher scores represented worse health status perception. Global Moran's I was used to evaluate spatial autocorrelation, range [−1, 1], with a value of 1 as a perfect clustered pattern. Local Moran's I was used to evaluate the tendency of local autocorrelation, and high-high aggregation/low-low aggregation indicated that both target province and its neighboring provinces showed higher/lower ill-health scores. Spatial econometric models were selected by Lagrange multiplier test and Hausman test to explore influencing factors of the self-assessed health of the elderly population. Results In 2010, 2015, and 2020, the national ill-health scores of the elderly population were 1.831, 1.873, and 1.547, respectively, and the corresponding Global Moran's I statistics were 0.347, 0.482, and 0.511, respectively (P<0.01), indicating that the ill-health scores of the elderly population showed a significant spatial positive autocorrelation, and the degree of spatial aggregation was increasing gradually. From 2010 to 2020, the high-high aggregation of ill-health scores among the elderly population was concentrated in the inland northwest, while the low-low aggregation was concentrated in the southeast coast, gradually showing a "southeast-central-northwest" stepped incremental pattern of differentiation. The Lagrange multiplier test and Hausman test suggested that the fixed-effects spatial lagged model was a better choice, and the regression model showed a spatial autocorrelation in the ill-health scores of the elderly population, with an autocorrelation coefficient of 0.3969 (P<0.001); the ill-health scores of the elderly population were negatively correlated with the natural logarithms of gross regional product per capita, and the number of beds in health care facilities per 1000 population, with regression coefficients of −0.8297 and −0.0454 (P<0.05) respectively, and positively correlated with the annual average concentration of PM2.5, illiteracy rate, and the number of health technicians per 1000 population, with regression coefficients of 0.0033, 0.0297, and 0.0765 (P<0.05), respectively. Conclusion From 2010 to 2020, the overall self-assessed health level of China's elderly population showed an upward trend and a spatial positive autocorrelation, with better self-assessed health in the southeast coast and poorer ratings in the northwestern inland. Additionally, there was a gradual decline in self-assessed health of the elderly population from the southeast to the central regions and further to the northwest in terms of spatial distribution. Economic development level, environmental pollution, health resource allocation, and education level are important factors influencing the self-assessed health of the elderly population.

Health inequality and health insurance coverage: The United States and China compared.

We study inequality in the distribution of self-assessed health (SAH) in the United States and China, two large countries that have expanded their insurance provisions in recent decades, but that lack universal coverage and differ in other social determinants of health. Using comparable health survey data from China and the United States, we compare health inequality trends throughout the period covering the public health insurance coverage expansions in the two countries. We find that whether SAH inequality is greater in the US or in China depends on the concept of status and the inequality-sensitivity parameter used; however, the regional pattern of SAH inequality is clearly associated with health-insurance coverage expansions in the US but not significant in China.

Adaptation in life satisfaction and self-assessed health to disability - Evidence from the UK.

Experiencing deteriorating health has implications for your quality of life. The theory of adaptation suggests that with time spend living in a health state individuals can adapt, resulting in observed quality of life levels to revert or stagnate despite persistently decreased health. Adaptation has implications for the use of subjective quality of life indicators when quantifying the impact of health changes or the benefits from new medical technologies. As both the impact from ill health and the benefit from new interventions might be disease- or subgroup-specific adaptation further raises ethical concerns but empirical evidence on its existence, magnitude, and heterogeneity remains inconclusive. This paper uses a general population sample of 9,543 individuals that participate in the UK Understanding Society survey and experience the onset of a long-standing illness or disability to provide evidence on these questions. Using ordered-response fixed effects models we explore longitudinal changes in self-assessed health and life satisfaction around the onset of disability. Our results indicate that disability onset is associated with large decreases in subjective health and well-being. Over time this initial decrease in subjective quality of life indicators attenuates, especially in life satisfaction and to a lesser extent for self-assessed health. While the relative difference in adaptation across these two measures remains persistent, we find that across demographic and severity groups the initial impact of disability onset and adaptation differs considerably in its magnitude. These results have important implications for studies aiming to quantify the impact of health conditions on quality of life outcomes, especially when using observational datasets.

Food insecurity and health outcome nexus: empirical evidence from the informal sector enterprises in Bangladesh.

BACKGROUND: Food insecurity indicates the difficulty of constantly obtaining adequate food because of limited economic resources. Food insecurity challenges the desired health outcomes. Although extensive literature has examined the associations between food security and health, low-wage informal sector workers have been less frequently addressed in this topic. The present study has focused on food insecurity among the workers working in the informal sector enterprises who experienced entrenched disadvantage during COVID-19 and examines the relationship between food insecurity and health status as measured by self-reported physical and mental health conditions. METHODS: This study has utilized cross-sectional data collected from workers working in informal manufacturing and business enterprises in Dhaka city of Bangladesh. The Food Insecurity Experience Scale (FIES) with eight items is used to screen for food insecurity, and the Short Form 12v2 (SF12v2) scale with 12 questions, and validated for use with Bengali respondents, is used to measure the health status of the informal workers. A health production function has been constructed where the health status (both physical and mental) of workers is associated with food insecurity and other socio-economic and health care factors. Empirical analyses of the study have included descriptive statistics, mean score comparisons, and multivariate regression analyses to identify the predictive factors of the physical and mental health status of the workers. RESULTS: A moderate to severe food insecurity is found to be responsible for the poor health status (both physical and mental) of the selected working group population. Moreover, age over 40 years, having a large family, dissatisfaction with the work place, and the prevalence of occupational health risks are linked to lower physical health, while dissatisfaction with the work place and the incidence of severe diseases contribute to poor mental health status along with food insecurity. CONCLUSIONS: Extending social and economic protection towards health coverage and basic consumption is suggested as an immediate action to save lives and ensure productivity of the informal workers. Besides, an increase in income and ensuring decent working conditions are also recommended for the health, safety and satisfaction of workers working in informal sector enterprises.

Unmet healthcare needs among the population aged 50+ and their association with health outcomes during the COVID-19 pandemic.

The COVID-19 pandemic led to unprecedented levels of subjective unmet healthcare needs (SUN). This study investigates the association between SUN in 2020 and three health outcomes in 2021-mortality, cancer, and self-assessed health (SAH), among adults aged 50 years and older, using data from the regular administration of the Survey of Health, Ageing and Retirement in Europe and from the two special waves administered in 2020 and 2021 regarding COVID-19. Three types of SUN were surveyed: care foregone due to fear of contracting COVID-19, pre-scheduled care postponed, and inability to get medical appointments or treatments demanded. We resort on the relative risk and the logistic specification to investigate the association between SUN and health outcomes. To avoid simultaneity, 1-year lagged SUN variables are used. We found a negative association between SUN and mortality. This result differs from the (scarce) previous evidence, suggesting that health systems prioritised life-threatening conditions, in the pandemic context. In line with previous studies, we obtained a positive association between SUN and worse health, in the case of cancer, though it is statistically significant only for the global measure of SUN (any reason). The higher chances of reporting cancer among those exposed to SUN might mean delayed cancer diagnosis, confirming that healthcare foregone was truly needed for a timely diagnosis. The association between SUN and poor or fair SAH is positive but not statistically significant, for the period analysed.

Synthetic indicators to analyze work-related physical and psychosocial risk factors: evidence from the European Working Conditions Survey.

In modern workplaces, alongside physical, chemical, and biological hazards, other risks are linked to the organisation of work and to the nature of the work itself. This paper investigates the association between workers' well-being and both psychosocial and physical risk factors at work proposing a synthetic measure suitable to generate insights on well-being at work and on individual risk factors. Exploiting data from the European Working Conditions Survey, we select as response variable the "self-assessed health". As this proxy of well-being is measured on a Likert scale, Ordered Probit analyses are run, and respondents' profiles are illustrated. Then, a Principal Component Analysis is carried out to build two synthetic measures summarising the selected risk determinants. The resulting first principal components are subsequently used as synthetic indicators in further, simplified, Ordered Probit models to explain the impact of different sets of risks on perceived health. Such a methodology allows for a straightforward interpretation of the results since many different risk drivers are replaced by two continuous synthetic indicators. Our findings, in line with existing research, confirm that both types of risk factors do exert a substantial impact on workers' health, although the psychosocial determinants seem to be more prominent.

Is inconsistent reporting of self-assessed health persistent and systematic? Evidence from the UKHLS.

In this paper, we investigate whether individuals provide consistent responses to self-assessed health (SAH) questions in the UK Household Longitudinal Study (UKHLS), and the potential implications for empirical research in case of inconsistent reporting behaviour. We capitalise on an opportunity in the UKHLS, asking respondents the same SAH question twice: with a self-completion and an open interview mode, within the same household interview over four waves. We estimate multivariate models to explore which individual characteristics are systematically relevant for the likelihood and frequency of inconsistent reporting. About 11-24% of those reported a particular SAH category in the self-completion reported inconsistently in the open interview. The probability of inconsistency is systematically associated with individual's demographics, education, income, employment status, cognitive and non-cognitive skills. The same characteristics also predict the frequency of inconsistent reporting across four UKHLS waves. Analysis of the implications of reporting inconsistencies shows no impact of SAH measurement on the association between income and health. A set of dimensions of people's physiological and biological health, captured using biomarkers, is associated equally with both SAH measures, suggesting that the interview mode does not play a role in the relationship between SAH and more objective health measures.

Socioeconomic inequalities in self-rated health in Japan, 32 European countries and the United States: an international comparative study.

AIMS: Japan is known as a country with low self-rated health despite high life expectancy. We compared socioeconomic inequalities in self-rated health in Japan with those in 32 European countries and the US using nationally representative samples. METHODS: We analysed individual data from the Comprehensive Survey of Living Conditions (Japan), the European Union Statistics on Income and Living Conditions, and the Behavioral Risk Factor Surveillance System (US) in 2016. We used ordered logistic regression models with four ordinal categories of self-rated health as an outcome, and educational level or occupational class as independent variables, controlling for age. RESULTS: In Japan, about half the population perceived their health as 'fair', which was much higher than in Europe (≈20-40%). The odds ratios of lower self-rated health among less educated men compared with more educated were 1.72 (95% confidence interval (CI) 1.61-1.85) in Japan, and ranged from 1.67 to 4.74 in Europe (pooled; 2.10 (95% CI 2.01-2.20)), and 6.65 (95% CI 6.22-7.12) in the US. The odds ratios of lower self-rated health among less educated women were 1.79 (95% CI 1.65-1.95) in Japan, and ranged from 1.89 to 5.30 in Europe (pooled; 2.43 (95% CI 2.33-2.54)), and 8.82 (95% CI 8.29-9.38) in the US. Socioeconomic inequalities were large when self-rated health was low for European countries, but Japan and the US did not follow the pattern. CONCLUSIONS: Japan has similar socioeconomic gradient patterns to European countries for self-rated health, and our findings revealed smaller socioeconomic inequalities in self-rated health in Japan compared with those in western countries.

Have Health Inequalities Increased during the COVID-19 Pandemic? Evidence from Recent Years for Older European Union Citizens.

Reducing inequality is one of the current challenges that most societies are facing. Our aim was to analyze the evolution of inequalities in self-assessed health among older Europeans in a time period spanning the 2008 economic crisis and the COVID-19 health crisis. We used data from Waves 2, 4 and 8 of the Survey of Health, Ageing and Retirement in Europe. We used inequality indices that accept ordinal variables. Our empirical results suggest that average inequality declines over time. Gender significantly influences the results. Some of the countries with the highest level of inequality are Denmark and Sweden, and some with the lowest are Estonia and the Netherlands. Our results may be of interest for the development of public policies to reduce inequalities. Special attention should be paid to vulnerable groups, such as the elderly.

The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas.

Previous studies have found that the expansion of primary health care in Brazil following the country-wide family health strategy (ESF), one of the largest primary care programs in the world, has improved health outcomes. However, these studies have relied either on aggregate data or on limited individual data, with no fine-grained information available concerning household participation in the ESF or local supply of ESF services, which represent crucial aspects for analytical and policy purposes. This study analyzes the relationship between the ESF and health outcomes for the adult population in metropolitan areas in Brazil. We investigate this relationship through two linked dimensions of the ESF: the program's local supply of health teams and ESF household registration. In contrast with previous studies focusing on comparisons between certain definitions of "treated" versus "nontreated" populations, our results indicate that the local density of health teams is important to the observed effects of the ESF on adult health. We also find evidence consistent with the presence of positive primary health care spillovers to people not registered with the ESF. However, current ESF coverage levels in metropolitan areas have limited ability to address prevailing health inequalities. Our analysis suggests that the local intensity of ESF coverage should be a key consideration for evaluations and policy efforts related to future ESF expansion.

Working Hours, Sleep Disturbance and Self-Assessed Health in Men and Women: A Multilevel Analysis of 30 Countries in Europe.

Objectives: This study examined the gender and cross-country differences in the relationship between working hours and self-assessed health among working men and women in Europe, and further explored the moderating role of sleep disturbance in the relationship. Methods: We used cross-sectional data from the 6th European Working Condition Survey on 14,603 men and 15,486 women across 30 countries in Europe. A multivariate logistic regression was applied to evaluate the relationship between working hours, sleep disturbance, and self- assessed health. In addition, we employed a two-stage multilevel logistic regression to assess the cross-country variations in the relationship between working hours and self-assessed health. Results: The study showed a slightly U-shaped relationship between working hours and less-than-good self-assessed health among working adults in Europe (<31 h: aOR = 1.11; 95% CI: 1.00-1.25, 41-50 h: aOR = 0.98; 95% CI: 0.84-1.15, and 50+ h: aOR = 1.31; 95% CI: 1.07-1.59). However, working men had higher odds of reporting less-than-good self-assessed health as compared to women when they devote longer hours to paid work. The results further showed that there are cross-country variations in the association between working hours and less-than-good self-assessed health for both men and women, and that men had slightly lower variations as compared to women. Contrary to expectation, sleep disturbance did not moderate the relationship between working hours and less-than-good self-assessed health for both men and women in Europe. Conclusions: Although there are gender differences and cross-country variations in the association between working hours and less-than-good self-assessed health, sleep disturbance did not moderate the associations. These findings underscore the importance for strict work time regulation and generous work-family policies that may promote good working conditions and health.

An objective metric of individual health and aging for population surveys.

BACKGROUND: We have previously developed and validated a biomarker-based metric of overall health status using Mahalanobis distance (DM) to measure how far from the norm of a reference population (RP) an individual's biomarker profile is. DM is not particularly sensitive to the choice of biomarkers; however, this makes comparison across studies difficult. Here we aimed to identify and validate a standard, optimized version of DM that would be highly stable across populations, while using fewer and more commonly measured biomarkers. METHODS: Using three datasets (the Baltimore Longitudinal Study of Aging, Invecchiare in Chianti and the National Health and Nutrition Examination Survey), we selected the most stable sets of biomarkers in all three populations, notably when interchanging RPs across populations. We performed regression models, using a fourth dataset (the Women's Health and Aging Study), to compare the new DM sets to other well-known metrics [allostatic load (AL) and self-assessed health (SAH)] in their association with diverse health outcomes: mortality, frailty, cardiovascular disease (CVD), diabetes, and comorbidity number. RESULTS: A nine- (DM9) and a seventeen-biomarker set (DM17) were identified as highly stable regardless of the chosen RP (e.g.: mean correlation among versions generated by interchanging RPs across dataset of r = 0.94 for both DM9 and DM17). In general, DM17 and DM9 were both competitive compared with AL and SAH in predicting aging correlates, with some exceptions for DM9. For example, DM9, DM17, AL, and SAH all predicted mortality to a similar extent (ranges of hazard ratios of 1.15-1.30, 1.21-1.36, 1.17-1.38, and 1.17-1.49, respectively). On the other hand, DM9 predicted CVD less well than DM17 (ranges of odds ratios of 0.97-1.08, 1.07-1.85, respectively). CONCLUSIONS: The metrics we propose here are easy to measure with data that are already available in a wide array of panel, cohort, and clinical studies. The standardized versions here lose a small amount of predictive power compared to more complete versions, but are nonetheless competitive with existing metrics of overall health. DM17 performs slightly better than DM9 and should be preferred in most cases, but DM9 may still be used when a more limited number of biomarkers is available.

Three-year prediction of depression and anxiety with a single self-rated health item.

BACKGROUND: Self-rated health (SRH) is a single question with which general health status is assessed. AIMS: To study whether SRH (i) is associated with depression and anxiety symptoms, concurrently and after three years, (ii) predicts the course over time for meeting a cutoff for depression and anxiety, and (iii) predicts development of depression and anxiety after three years. METHOD: Population-based questionnaire data from northern Sweden were used. In total, 2336 individuals participated at baseline and three-year follow-up. The Hospital Anxiety and Depression Scale was used to quantify symptoms of depression and anxiety. Categorical and continuous data were used for analyses to complement each other. RESULTS: Regarding prevalence, the analyses showed three- to four-fold increased odds for depression and anxiety at three-year follow-up, and two- to three-fold odds for their development at three-year follow-up. SRH at baseline was also found to be a significant, but weak, predictor of depression and anxiety severity and worsening at follow-up as well as being a predictor over time for meeting a cutoff for depression and anxiety. CONCLUSIONS: Assessment of SRH may be used in general practice to identify individuals who qualify for further evaluation of depression and anxiety.

Does Internet Use Impact the Health Status of Middle-Aged and Older Populations? Evidence from China Health and Retirement Longitudinal Study (CHARLS).

In the context of both rapid technological development and increasing aging, the relationship between technological development and the health of the middle-aged and older population is gradually receiving academic attention. This study empirically examined the health consequences of the Internet for the middle-aged and older population in China using data from the 2018 China Health and Retirement Longitudinal Study. The results indicated that Internet use was effective in improving the self-assessed health and chronic disease status of the middle-aged and older population. However, the effect of Internet use on the improvement of chronic disease conditions in this population was more pronounced than self-assessed health. In the heterogeneity analysis, the effect of Internet use on the health of female and middle-aged adults was more significant than that of male and older adults aged >60 years. This paper also used a propensity score matching model to eliminate the endogeneity problem caused by sample selectivity bias. The results revealed that the propensity score matching model analysis was more robust. Moreover, if sample selectivity bias was not eliminated, the effect of Internet use on the improvement of self-assessed health in the middle-aged and older population would be underestimated, whereas the effect of Internet use on the chronic disease status of the middle-aged and older adults would be overestimated.

The health impact of free access to antiretroviral therapy in South Africa.

Since 2004 the South African government has rolled out free antiretroviral therapy (ART) at public health care facilities nationwide. No prior studies have estimated the impact of the ART rollout on health and survival using a longitudinal household survey with national coverage. We match household member deaths and self-assessed health from a large national longitudinal survey to community-level ART availability in clinics to estimate the reduction in mortality and morbidity attributable to ART availability between 2006 and 2016, using a difference-in-difference model. Our analysis focuses on black Africans aged 25-49 because this demographic group represents more than two-thirds of all South African HIV cases. We find that the rollout of free ART has reduced annual mortality by 27% and decreased the likelihood of reporting poor health by 36% for black Africans aged 25-49. These estimates amount to annual reductions in this demographic category of 31% in annual mortality and 47% in individuals reporting poor health. Our findings confirm that making ART treatment freely available nationwide has had a dramatic impact in terms of both prolonged survival and improved health, with most of these gains concentrated in the high HIV prevalence group of black Africans aged 25-49.

Tooth loss and associated self-rated health and psychological and subjective wellbeing among community-dwelling older adults: A cross-sectional study in India.

BACKGROUND: Losing teeth has been considered as part of normal aging. However, in developing countries, tooth loss among older adults is shown to be more negatively associated with self-image and quality of life compared to their western counterparts. This study examines the association of tooth loss with self-rated health and psychological and subjective wellbeing among older adults in India. METHODS: Data were derived from the "Building Knowledge Base on Population Ageing in India" (BKPAI) survey which was carried out in 2011. The final sample size for the analysis was 9231 older adults. Descriptive statistics and bivariate analysis along with binary logistic regression analysis were conducted to fulfil the objective of the study. RESULTS: A proportion of 12.3% of older adults reported complete tooth loss. It was found that older adults who reported tooth loss were 2.38 times significantly more likely to have poor self-rated health (SRH) [2.38; CI: 1.99,2.83] than older adults who did not report tooth loss. The odds of low psychological health were high among older adults who suffered from tooth loss than their counterparts [OR: 1.59; CI: 1.33,1.91]. Older adults who reported tooth loss had 65% significantly higher odds of low subjective well-being than older adults who did not report tooth loss [OR: 1.65; CI: 1.38,1.97]. CONCLUSION: Complete loss of teeth is associated with older individuals' poor SRH as well as low psychological and subjective well-being, but such a consequence is avoidable by practising the efforts to maintain good oral health.

Health and life satisfaction factors of Portuguese older adults.

Portugal has some peculiar features concerning older age. Despite long life expectancy, the share of healthy life years in older ages is small. The decreasing relationship between age and life satisfaction in Portugal has recently been pointed out. The absence of knowledge about self-assessed health and life satisfaction of the population of older Portuguese motivates this analysis. This work aims to find the drivers of self-assessed health and life satisfaction and their relationship for older Portuguese (older than 70). Two ordered logistic regressions are estimated using data from the National Health Survey of 2019. Endogeneity of self-assessed health is tested in the regression of life satisfaction. The main descriptive result shows that older people in Portugal tend to report a low health status but a high level of life satisfaction. We also found that despite the general decrease across age and after controlling for determinants, life satisfaction seems to display a U-shape, and the likelihood of being life satisfied increases with age from the age group of 70-74 on. The main determinants of self-assessed health and life satisfaction include the existence of chronic diseases, physical limitations in daily life, and depression indicators. But the findings also show that social interactions and income play a part in the way people report health and life satisfaction. Some policy measures could be taken to jointly improve the health and life satisfaction.

Trends and socioeconomic inequalities in self-rated health in Japan, 1986-2016.

INTRODUCTION: Despite having very high life expectancy, Japan has relatively poor self-rated health, compared to other high-income countries. We studied trends and socioeconomic inequalities in self-rated health in Japan using nationally representative data. METHODS: The Comprehensive Survey of Living Conditions was analyzed, every 3 years (n ≈ 0.6-0.8 million/year) from 1986 to 2016. Whereas previous studies dichotomized self-rated health as an outcome, we used four categories: very good, good, fair, and bad/very bad. Proportional odds ordinal logistic regression models are used, with ordinal scale self-rated health as an outcome, and age category, survey year and occupational class or educational level as independent variables. RESULTS: In 2016, the age-adjusted percentages for self-rated health categorized as very good, good, fair, and bad/very bad, were 24.0, 17.1, 48.7, and 10.2% among working-age men, and 21.6, 17.5, 49.4, and 11.5% among working-age women, respectively. With 1986 as the reference year, the odds ratios (ORs) of less good self-rated health were lowest in 1995 (0.69; 95% Confidence Interval [95% CI]: 0.66-0.71 of working-age men), and highest in 2010 (1.23 [95% CI: 1.19-1.27]). The ORs of male, lower non-manual workers (compared to upper non-manual) increased from 1.12 (95% CI: 1.07-1.17) in 2010 to 1.20 (95% CI: 1.15-1.26) in 2016. Between 2010 and 2016, the ORs of working-age men with middle and low levels of education (compared to a high level of education) increased from 1.22 (95% CI: 1.18-1.27) to 1.34 (95% CI: 1.29-1.38), and from 1.47 (95% CI: 1.39-1.56) to 1.75 (95% CI: 1.63-1.88), respectively. The ORs of working-age women with middle and low levels of education also increased from 1.22 (95% CI: 1.17-1.28) to 1.32 (95% CI: 1.26-1.37), and from 1.74 (95% CI: 1.61-1.88) to 2.03 (95% CI: 1.87-2.21) during the same period. CONCLUSION: Japan has the unique feature that approximately 50% of the survey respondents rated their self-rated health as fair, but with important variations over time and between socioeconomic groups. In-depth studies of the role of socioeconomic conditions may shed light on the reasons for the high prevalence of poor self-rated health in Japan.