Gender and the structure of self-rated health across the adult life span

Abstract

Despite the widespread use of self-rated health (SRH) in population health studies, the meaning of this holistic health judgment remains an open question. Gender differences in health, an issue of utmost importance in population research and policy, are often measured with SRH; the comparisons could be biased if men and women differ in how they form their health judgment. The aim of this study is to examine whether men and women differ in how health inputs predict their health rating across the adult life span. We use the 2002–2015 National Health Interview Survey data from US-born respondents aged 25–84. Ordered logistic models of SRH as a function of 24 health measures including medical conditions and symptoms, mental health, functioning, health care utilization, and health behaviors, all interacted with gender, test how the measures influence health ratings and the extent to which these influences differ by gender. Using a Bayesian approach, we then compare how closely a select health measure (K6 score) corresponds to SRH levels among men and women. We find little systematic gender difference in the structure of SRH: men and women use wide-ranging health-related frames of reference in a similar way when making health judgments, with some exceptions: mid-life and older men weigh physical functioning deficits and negative health behaviors more heavily than women. Women report worse SRH than men on average but this only holds through mid-adulthood and is reversed at older ages; moreover, the gross female disadvantage disappears when differences in socio-economic and health covariates are considered. Our findings suggest that the meaning of SRH is similar for women and men. Both groups use a broad range of health-related information in forming their health judgment. This conclusion strengthens the validity of SRH in measuring gender differences in health.

Health Measurement and Health Inequality Over the Life Course: A Comparison of Self-rated Health, SF-12, and Grip Strength

“…In a Swedish study, men but not women considered risky health behaviors in their self-reports of general health even if the negative health effects of these behaviors had not transpired yet (Peersman et al 2012 ). In a study from the United States, no gender differences in the effect of health behaviors on self-rated health were found (Zajacova et al 2017 ). In the absence of similar studies for the German context, it is unclear whether health behaviors are more important for women’s than for men’s self-reports of health.…”

“…At younger ages, education gaps were large in women’s self-rated measures but absent in women’s objective measures. A possible explanation is that self-rated measures of health may capture risky health behaviors that did not yet turn into actual health problems detectable with objective health measures (Peersman et al 2012 ; Zajacova et al 2017 ). In a Swedish study, men but not women considered risky health behaviors in their self-reports of general health even if the negative health effects of these behaviors had not transpired yet (Peersman et al 2012 ).…”

“…This evidence, however, is not consistent. One recent study found no gender differences in terms of criteria that individuals use to report on their self-rated health status Zajacova et al 2017 ). Other studies found that women take milder symptoms and health complaints into account, whereas men focus on more severe or even life-threatening conditions as well as on health behaviors (Benyamini et al 2003 ; Grol-Prokopczyk et al 2011 ; Peersman et al 2012 ).…”

Funktionale und subjektive Gesundheit bei Frauen und Männern im Verlauf der zweiten Lebenshälfte

“…Ergebnisse des Deutschen Alterssurveys (DEAS) zeigen, dass Frauen und Männer ihre Gesundheit subjektiv gleich bewerten, trotz der genannten Unterschiede in der funktionalen Gesundheit . Dies könnte an sozialen Vergleichsprozessen und der dabei von Frauen und Männern genutzten Referenzgruppen liegen: Wenn sich Frauen mit anderen Frauen ihres Alters vergleichen, ist ein gewisses Maß an funktionalen Einschränkungen "normal" -was so zu einem besseren selbsteingeschätztem Gesundheitszustand führt als wenn sie sich mit gleichaltrigen Männern vergleichen würden (Zajacova, Huzurbazar, & Todd 2017).…”

Impact of Experienced HIV Stigma on Health is Mediated by Internalized Stigma and Depression: Results From the People Living With HIV Stigma Index in Ontario

“…This makes the use of a subjective global health question an extremely e cient way to glean information about an individual's health in a clinical or research setting. The predictive ability is generally high across genders, ethnic groups, socioeconomic statuses, and education levels which makes it an ideal outcome measure for the diverse HIV population (26)(27)(28)(29)(30)(31)(32).…”