Cardiovascular risk factor burden has a stronger association with self-rated poor health in adults in the US than in Sweden,especially for the lower educated

Abstract

Background: There is an ongoing debate about the importance of biomedical and sociodemographic risk factors in the prediction of self-rated health. Objectives: To compare the association of sociodemographic and cardiovascular risk factors and self-rated health in Sweden and the US. Design: Data from two population-based cross-sectional health surveys, one in Sweden and one in the US. Subjects: The surveys included questionnaire and measured data from 5,461 adults in Sweden and 7,643 in the US. Participants were between 35 and 65 years of age. Results: The odds ratios for poor self-rated health for the included cardiovascular risk factors were greater in the US. Low education was significantly more prevalent among those with self-rated poor health in the US, but not in Sweden. Using Swedes with high education as reference group (OR=1), adults in the US with low education and 2+ risk factors had a greater than threefold risk (OR=6.3) of self-rated poor health compared with Swedish low-educated adults with the same risk factor burden (OR=1.9). The better-educated US adults with 2+ risk factors were significantly more likely to report poor health (OR=3.4) compared with their Swedish counterparts (OR=2.4). Conclusions: The interaction between risk factors, education, and self-rated health suggests a frightening picture, especially for the US. Public health interventions for reducing cardiovascular risk factors need to include both population and individual measures. Taking people's overall evaluation of their health into account when assessing total health risk is important.

Keywords

Cardiovascular disease epidemiology health surveys risk factors self-rated health

Get full access to this article

View all access options for this article.

References

Lundberg O. , Manderbacka K. Assessing reliability of a measure of self-rated health. Scand J Soc Med 1996 ;24:218—24.

Martikainen P. , Aromaa A. , Heliovaara M. , Klaukka T. , Knekt P. , Maatela J. , et al. Reliability of perceived health by sex and age. Soc Sci Med 1999;48:1117—22.

Idler EL , Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies . J Health Soc Behav 1997;38:21—37.

Benyamini Y. , Idler EL Community studies reporting association between self-rated health and mortality — Additional studies, 1995 to 1998. Research on Aging 1999;21:392—401.

Fylkesnes K. , Førde OH

The Tromsø Study: predictors of self-evaluated health — has society adopted the expanded health concept?

Soc Sci Med 1991;32:141—6.

Manderbacka K. , Lundberg O. , Martikainen P. Do risk factors and health behaviours contribute to self-ratings of health? Soc Sci Med 1999 ;48:1713—20.

Kaplan GA , Goldberg DE , Everson SA , Cohen RD , Salonen R. , Tuomilehto J. , et al. Perceived health status and morbidity and mortality: Evidence from the Kuopio ischaemic heart disease risk factor study. Int J Epidemiol 1996;25:259—65.

Fylkesnes K. , Førde OH Determinants and dimensions involved in self-evaluation of health. Soc Sci Med 1992;35:271—9.

Burström B. , Fredlund P. Self rated health: Is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes? J Epidemiol Community Health 2001 ;55:836—40.

10.

Benyamini Y. , Leventhal EA , Leventhal H. Gender differences in processing information for making self-assessments of health. Psychosom Med 2000;62:354—364.

11.

Idler EL , Hudson SV , Leventhal H. The meanings of self-ratings of health. Research on Aging 1999;21:458—76.

12.

Mansson NO , Merlo J. The relation between self-rated health, socioeconomic status, body mass index and disability pension among middle-aged men. Eur J Epidemiol 2001;17:65—9.

13.

Weinehall L. , Johnson O. , Jansson JH , Boman K. , Huhtasaari F. , Hallmans G. , et al. Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case-control study from northern Sweden. J Intern Med 1998;243:99—107.

14.

Emmelin M. , Weinehall L. , Stegmayr B. , Dahlgren L. , Stenlund H. , Wall S. Self-rated ill-health strengthens the effect of biomedical risk factors in predicting stroke, especially for men — an incident case referent study. J Hypertens 2003;21:887—96.

15.

Jylha M. , Guralnik JM , Ferrucci L. , Jokela J. , Heikkinen E. Is self-rated health comparable across cultures and genders? J Gerontol B Psychol Sci Soc Sci 1998;53:144—52.

16.

Carlson P. Self-perceived health in East and West Europe: Another European health divide. Soc Sci Med 1998;46:1355—66.

17.

Brännström I. Community participation and social patterning in cardiovascular disease intervention. Umeå: Univ., 1993.

18.

Weinehall L. Partnership for health: On the role of primary health care in a community intervention programme. Umeå : Univ. , 1997.

19.

Weinehall L. , Hallgren CG , Westman G. , Janlert U. , Wall S. Reduction of selection bias in primary prevention of cardiovascular disease through involvement of primary health care. Scand J Prim Health Care 1998;16:171—6.

20.

Pearson TA , Lewis C. Rural epidemiology: Insights from a rural population laboratory. Am J Epidemiol 1998;148: 949—57.

21.

Nafziger AN , Weinehall L. , Lewis C. , Jenkins PL , Erb TA , Pearson TA , et al. Design issues in the combination of international data from two rural community cardiovascular intervention programs. Scand J Public Health 2001;29(Suppl. 56):33—9.

22.

Bowlin SJ , Morrill BD , Nafziger AN , Jenkins PL , Lewis C. , Pearson TA Validity of cardiovascular disease risk factors assessed by telephone survey: The Behavioral Risk Factor Survey. J Clin Epidemiol 1993;46:561—71.

23.

Bray G. An approach to the classification and evaluation of obesity. In: Björntorp P , Brodoff B , editors. Obesity. Philadelphia : J.B. Lippincott, 1992.

24.

Fayers PM , Sprangers MA Understanding self-rated health . Lancet 2002;359:187—8.

25.

Eriksson I. , Unden AL , Elofsson S. Self-rated health. Comparisons between three different measures. Results from a population study. Int J Epidemiol 2001;30:326—33.

26.

Orfila F. , Ferrer M. , Lamarca R. , Alonso J. Evolution of self-rated health status in the elderly: Cross-sectional vs. longitudinal estimates. J Clin Epidemiol 2000;53:563—70.

27.

Boström G. , Persson G. Chapter 2. The development and distribution of public health. Scand J Public Health 2001 ;29(Suppl. 58):17—36.

28.

Blakely TA , Kennedy BP , Kawachi I. Socioeconomic Inequality in voting participation and self-rated health. Am J Public Health 2001;91:99—104.

29.

Subramanian SV , Kawachi I. , Kennedy BP Does the state you live in make a difference? Multilevel analysis of self-rated health in the US. Soc Sci Med 2001;53:9—19.

30.

Estes RJ Trends in world social development, 1970—95: Development prospects for a new century. J Developing Societies 1998 ;14:11—39.

31.

Barsky AJ The paradox of health. N Engl J Med 1988;318:414—18.

32.

Bailis DS , Segall A. , Chipperfield JG Two views of self-rated general health status . Soc Sci Med 2003;56:203—17.

33.

James V , Gabe J , editor. Health and the sociology of emotions. Oxford: Blackwell, 1996 .

34.

Idler EL , Angel RJ Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study . Am J Public Health 1990;80:446—52.

35.

Mackenbach JP , van den Bos J. , Joung IM , van de Mheen H. , Stronks K. The determinants of excellent health: Different from the determinants of ill-health? Int J Epidemiol 1994;23:1273—81.

36.

Kelleher CC , Friel S. , Nic Gabhainn S. , Tay JB Sociodemographic predictors of self-rated health in the Republic of Ireland: Findings from the National Survey on Lifestyle, Attitudes and Nutrition, SLAN. Soc Sci Med 2003;57: 477—86.

37.

Blaxter M. Health & Lifestyles. London: Routledge, 1989.

38.

Moum T. Self-assessed health among Norwegian adults. Soc Sci Med 1992;35:935—47.

39.

Pearson TA Education and income: double-edged swords in the epidemiologic transition of cardiovascular disease. Ethn Dis 2003;13(Suppl. 2):158—63.