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Michael Marmot - One of the best experts on this subject based on the ideXlab platform.
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levels and distribution of self rated Health in the kazakh population results from the kazakhstan household Health survey 2012
BMC Public Health, 2014Co-Authors: Michael Marmot, Adil Supiyev, Talgat Nurgozhin, Zhaxybay Zhumadilov, Almaz Sharman, Martin BobakAbstract:The high and fluctuating mortality and rising Health inequalities in post-Soviet countries have attracted considerable attention. However, there are very few individual-level data on distribution of Health outcomes in Central Asian countries of the former Soviet Union. We analysed socioeconomic predictors of two Self-Rated Health outcomes in a national survey in Kazakhstan. We used data from the 2012 Kazakhstan Household Health Survey on 12,560 respondents aged 15+. Self-Rated Health, self-reported worsening of Health, and a range of socio-demographic variables were collected in an interview. The Self-Rated Health outcomes were dichotomized and logistic regression was used to estimate their associations with education, income, ownership of a car, second house and computer, marital status, ethnicity and urban/rural residence. The prevalence of poor/very poor Self-Rated Health was 5.3%, and 11.0% of participants reported worse Health compared to 1 year ago. After controlling for age, sex and region, all socio-demographic factors were related to Self-Rated Health. After adjusting for all variables, education and car ownership showed the most consistent effects; the odds ratio of poor Health and worsening of Health were 0.43 (95% confidence interval 0.32-0.58) and 0.54 (0.44-0.68) for university vs. primary education, respectively, and 0.64 (0.51-0.82) and 0.68 (0.58-0.80) for car ownership, respectively. Unmarried persons, ethnic Russians and urban residents also had increased prevalence of poor Health in multivariable models. Despite the limitations of using subjective Health measures, these data suggest strong associations between two measures of Self-Rated Health and a number of socioeconomic characteristics. Future studies and Health policy initiatives in Kazakhstan and other Central Asian countries should take social determinants of Health into account.
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psychosocial work characteristics and self rated Health in four post communist countries
Journal of Epidemiology and Community Health, 2001Co-Authors: Hynek Pikhart, Martin Bobak, Johannes Siegrist, Andrzej Pajak, S Rywik, J Kyshegyi, A Gostautas, Z Skodova, Michael MarmotAbstract:STUDY OBJECTIVES—To examine whether psychosocial factors at work are related to self rated Health in post-communist countries. DESIGN AND SETTINGS—Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated Health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor Health ("poor Health") were estimated for a 1 SD increase in the scores of work related factors. MAIN RESULTS—The overall prevalence of poor Health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor Health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor Health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. CONCLUSIONS—The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated Health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations. Keywords: self rated Health; psychosocial work characteristics; effort-reward imbalance
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socioeconomic factors material inequalities and perceived control in self rated Health cross sectional data from seven post communist countries
Social Science & Medicine, 2000Co-Authors: Martin Bobak, Hynek Pikhart, Richard Rose, Clyde Hertzman, Michael MarmotAbstract:This study examined the association between perceived control and several socioeconomic variables and Self-Rated Health in seven post-communist countries (Russia, Estonia, Lithuania, Latvia, Hungary, Poland, Czech Republic). Questionnaire interviews were used to collect data on Self-Rated Health in the last 12 months, education, marital status, perceived control based on nine questions, and material deprivation based on availability of food, clothing and heating. For each population, two ecological measures of material inequalities were available: an inequality score estimated from the survey data as the distance between the 90th and 10th percentiles of material deprivation, and Gini coefficient from published sources. Data on 5330 men and women aged 20-60 were analysed. Prevalence of poor Health (worse than average) varied between 8% in Czechs and 19% in Hungarians. The age-sex-adjusted odds ratio for university vs primary education was 0.36 (0.26-0.49); odds ratios per 1 standard deviation increase in perceived control and in material deprivation were 0.58 (95% CI 0.48-0.69) and 1.51 (1.40-1.63), respectively. The odds ratio for an increase in inequality equivalent to the difference between the most and the least unequal populations was 1.49 (0.88-2.52) using the material inequality score and 1.41 (0.91-2.20) using the Gini coefficient. No indication of an effect of either inequality measure was seen after adjustment for individuals' deprivation or perceived control. The results suggest that, as in western populations, education and material deprivation are strongly related to Self-Rated Health. Perceived control appeared statistically to mediate some of the effects of material deprivation. The non-significant effects of both ecological measures of inequality were eliminated by controlling for individuals' characteristics.
Ichiro Kawachi - One of the best experts on this subject based on the ideXlab platform.
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participation in community group activities among older adults is diversity of group membership associated with better self rated Health
Journal of Epidemiology, 2018Co-Authors: Katsunori Kondo, Ichiro Kawachi, Masayoshi Zaitsu, Toyo Ashida, Naoki KondoAbstract:BACKGROUND: Participation in community activities (eg, sports and hobby groups or volunteer organizations) is believed to be associated with better Health status in the older population. We sought to (1) determine whether a greater diversity of group membership is associated with better Self-Rated Health and (2) identify the key dimension of the membership diversity (eg, gender, residential area, or age). METHODS: We performed a cross-sectional study of 129,740 participants aged 65 years and older who were enrolled in the Japan Gerontological Evaluation Study in 2013. We assessed the diversity of group membership using (1) a continuous variable (range 0-4) accounting for the total degree of each diversity dimension or (2) dummy variables for each dimension. We estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for better Self-Rated Health according to the diversity of group membership, using Poisson regression and robust variance with multiple imputation, adjusted for other covariates. RESULTS: The participants involved in social groups with greater diversity had better Self-Rated Health: the PR per one point unit increase in diversity was 1.03 (95% CI, 1.02-1.04). Participation in gender-diverse groups was associated with the best profile of Health (PR 1.07; 95% CI, 1.04-1.09). CONCLUSIONS: Among the older population in Japan, higher group diversity is associated with better Self-Rated Health. Gender is the key dimension of diversity that is associated with better Self-Rated Health.
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trajectories of self rated Health in the last 15 years of life by cause of death
European Journal of Epidemiology, 2016Co-Authors: Ichiro Kawachi, Marja Jylha, Sari Stenholm, Mika Kivimaki, Hugo Westerlund, Jaana Pentti, Marcel GoldbergAbstract:Poor Self-Rated Health is associated with increased risk of mortality, but no previous study has examined how long-term trajectories of Self-Rated Health differ among people at risk of subsequent death compared to those who survive. Data were drawn from French occupational cohort (the GAZEL study, 1989-2010). This nested case-control study included 915 deceased men and women and 2578 controls matched for sex, baseline age, occupational grade and marital status. Self-Rated Health was measured annually and dichotomized into good versus poor Health. Trajectories of poor Self-Rated Health up to 15 years were compared among people who subsequently died to those who survived. Participants contributed to an average 10.3 repeated assessments of Self-Rated Health. Repeated-measures log-binomial regression analysis with generalized estimating equations showed an increased prevalence of poor Self-Rated Health in cases 13-15 years prior to death from ischemic and other cardiovascular disease [multivariable-adjusted risk ratio 2.06, 95 % confidence interval (CI) 1.55-2.75], non-smoking-related cancers (1.57, 95 % CI 1.30-1.89), and suicide (1.78, 95 % CI 1.00-3.16). Prior to death from ischemic and other cardiovascular disease, increased rates of poor Self-Rated Health were evident even among persons who were free of cardiovascular diseases (2.05, 95 % CI 1.50-2.78). In conclusion, perceptions of Health diverged between the surviving controls and the deceased already 15 years prior to death. For cardiovascular mortality, decline in Self-Rated Health started before diagnosis of the disease leading to death. The findings suggest that declining Self-Rated Health might capture pathological changes before and beyond the disease diagnosis.
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does social participation improve self rated Health in the older population a quasi experimental intervention study
Social Science & Medicine, 2013Co-Authors: Yukinobu Ichida, Hiroshi Hirai, Katsunori Kondo, Ichiro Kawachi, Tokunori Takeda, Hideki EndoAbstract:Social participation has been linked to Healthy aging and the maintenance of functional independence in older individuals. However, causality remains tenuous because of the strong possibility of reverse causation (Healthy individuals selectively participate in social activities). We describe a quasi-experimental intervention in one municipality of Japan designed to boost social participation as a way of preventing long-term disability in senior citizens through the creation of ‘salons’ (or community centers). In this quasi-experimental intervention study, we compared 158 participants with 1391 non-participants in salon programs, and examined the effect of participation in the salon programs on Self-Rated Health. We conducted surveys of community residents both before (in 2006) and after (in 2008) the opening of the salons. Even with a pre/post survey design, our study could be subject to reverse causation and confounding bias. We therefore utilized an instrumental variable estimation strategy, using the inverse of the distance between each resident's dwelling and the nearest salon as the instrument. After controlling for Self-Rated Health, age, sex, equivalized income in 2006, and reverse causation, we observed significant correlations between participation in the salon programs and Self-Rated Health in 2008. Our analyses suggest that participation in the newly-opened community salon was associated with a significant improvement in Self-Rated Health over time. The odds ratio of participation in the salon programs for reporting excellent or good Self-Rated Health in 2008 was 2.52 (95% CI 2.27–2.79). Our study provides novel empirical support for the notion that investing in community infrastructure to boost the social participation of communities may help promote Healthy aging.
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social trust and self rated Health in us communities a multilevel analysis
Journal of Urban Health-bulletin of The New York Academy of Medicine, 2002Co-Authors: S V Subramanian, Ichiro KawachiAbstract:This study assessed the contextual and individual effects of social trust on Health. Methods consisted of a multilevel regression analysis of Self-Rated poor Health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for Self-Rated Health. Higher levels of cominunity social trust were associated with a lover probability of reporting poor Health. Individual demographic and socioeconomic preditors did not explain the association of community social trust with Self-Rated Health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the Health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on Self-Rated Health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population Health achievements and Health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population Health should routinely consider the cross-level nature of community or neighborbood effects.
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metropolitan area income inequality and self rated Health a multi level study
Social Science & Medicine, 2002Co-Authors: Tony Blakely, Kimberly Lochner, Ichiro KawachiAbstract:We examined the association of income inequality measured at the metropolitan area (MA) and county levels with individual Self-Rated Health. Individual-level data were drawn from 259,762 respondents to the March Current Population Survey in 1996 and 1998. Income inequality and average income were calculated from 1990 census data, the former using Gini coefficients. Multi-level logistic regression models were used. Controlling for sex, age, race, and individual-level household income, respondents living in high, medium-high, and medium-low income inequality MAs had odds ratios of fair/poor Self-Rated Health of 1.20 (95% confidence interval 1.04-1.38), 1.07 (0.95-1.21), and 1.02 (0.91-1.15), respectively, compared to people living in the MAs with the lowest income inequality. However, we found only a small association of MA-level income inequality with fair/poor Health when controlling further for average MA household income: odds ratios were 1.10 (0.95-1.28), 1.01 (0.89-1.14), and 1.00 (0.89-1.12), respectively. Likewise, we found only a small association of county-level income inequality with Self-Rated Health--although only 40.7% of the sample had an identified county on CPS data. Regarding the association of state-level income inequality with fair/poor Health, we found the association to be considerably stronger among non-metropolitan (i.e. rural) compared to metropolitan residents.
Hynek Pikhart - One of the best experts on this subject based on the ideXlab platform.
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a multilevel analysis of social capital and self rated Health evidence from the british household panel survey
Social Science & Medicine, 2009Co-Authors: John W Snelgrove, Hynek Pikhart, Mai StaffordAbstract:Social capital is often described as a collective benefit engendered by generalised trust, civic participation, and mutual reciprocity. This feature of communities has been shown to associate with an assortment of Health outcomes at several levels of analysis. The current study assesses the evidence for an association between area-level social capital and individual-level subjective Health. Respondents participating in waves 8 (1998) and 9 (1999) of the British Household Panel Survey were identified and followed-up 5 years later in wave 13 (2003). Area social capital was measured by two aggregated survey items: social trust and civic participation. Multilevel logistic regression models were fitted to examine the association between area social capital indicators and individual poor Self-Rated Health. Evidence for a protective association with current Self-Rated Health was found for area social trust after controlling for individual characteristics, baseline Self-Rated Health and individual social trust. There was no evidence for an association between area civic participation and Self-Rated Health after adjustment. The findings of this study expand the literature on social capital and Health through the use of longitudinal data and multilevel modelling techniques.
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psychosocial work characteristics and self rated Health in four post communist countries
Journal of Epidemiology and Community Health, 2001Co-Authors: Hynek Pikhart, Martin Bobak, Johannes Siegrist, Andrzej Pajak, S Rywik, J Kyshegyi, A Gostautas, Z Skodova, Michael MarmotAbstract:STUDY OBJECTIVES—To examine whether psychosocial factors at work are related to self rated Health in post-communist countries. DESIGN AND SETTINGS—Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated Health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor Health ("poor Health") were estimated for a 1 SD increase in the scores of work related factors. MAIN RESULTS—The overall prevalence of poor Health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor Health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor Health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. CONCLUSIONS—The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated Health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations. Keywords: self rated Health; psychosocial work characteristics; effort-reward imbalance
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socioeconomic factors material inequalities and perceived control in self rated Health cross sectional data from seven post communist countries
Social Science & Medicine, 2000Co-Authors: Martin Bobak, Hynek Pikhart, Richard Rose, Clyde Hertzman, Michael MarmotAbstract:This study examined the association between perceived control and several socioeconomic variables and Self-Rated Health in seven post-communist countries (Russia, Estonia, Lithuania, Latvia, Hungary, Poland, Czech Republic). Questionnaire interviews were used to collect data on Self-Rated Health in the last 12 months, education, marital status, perceived control based on nine questions, and material deprivation based on availability of food, clothing and heating. For each population, two ecological measures of material inequalities were available: an inequality score estimated from the survey data as the distance between the 90th and 10th percentiles of material deprivation, and Gini coefficient from published sources. Data on 5330 men and women aged 20-60 were analysed. Prevalence of poor Health (worse than average) varied between 8% in Czechs and 19% in Hungarians. The age-sex-adjusted odds ratio for university vs primary education was 0.36 (0.26-0.49); odds ratios per 1 standard deviation increase in perceived control and in material deprivation were 0.58 (95% CI 0.48-0.69) and 1.51 (1.40-1.63), respectively. The odds ratio for an increase in inequality equivalent to the difference between the most and the least unequal populations was 1.49 (0.88-2.52) using the material inequality score and 1.41 (0.91-2.20) using the Gini coefficient. No indication of an effect of either inequality measure was seen after adjustment for individuals' deprivation or perceived control. The results suggest that, as in western populations, education and material deprivation are strongly related to Self-Rated Health. Perceived control appeared statistically to mediate some of the effects of material deprivation. The non-significant effects of both ecological measures of inequality were eliminated by controlling for individuals' characteristics.
Johannes Siegrist - One of the best experts on this subject based on the ideXlab platform.
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measuring effort reward imbalance in school settings a novel approach and its association with self rated Health
Journal of Epidemiology, 2010Co-Authors: Li Shang, Tao Wang, Johannes SiegristAbstract:Background: We attempted to apply the model of effort–reward imbalance (ERI) to school settings in order to measure students’ psychosocial stress and analyze its association with Self-Rated Health in adolescents.Methods: A cross-sectional survey was conducted in Kunming, China among 1004 Chinese students (468 boys and 536 girls) in grades 7 through 12, using a 19-item effort–reward imbalance questionnaire.Results: Satisfactory internal consistencies for the scales for effort and reward were obtained; the value for the scale for overcommitment was acceptable. Factor analysis replicated the theoretical structure of the ERI construct in this sample of Chinese students. All 3 scales were associated with an elevated odds ratio for diminished Self-Rated Health, and the effect was strongest for the effort–reward ratio, as predicted by the theory. Sex and grade differences were also observed.Conclusions: The ERI questionnaire is a valid instrument for identifying sources of stressful experience, in terms of effort–reward imbalance, among adolescents in school settings.
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psychosocial work stress is associated with poor self rated Health in danish nurses a test of the effort reward imbalance model
Scandinavian Journal of Caring Sciences, 2006Co-Authors: Simone Weyers, Richard Peter, Henrik Boggild, Hans Jeppe Jeppesen, Johannes SiegristAbstract:Nursing staff are exposed to stressful work load which in turn is associated with poor physical and psychological Health, sickness absence and job exit. The effort-reward imbalance (ERI) model is a validated approach to measure chronic psychosocial work stress by identifying nonreciprocity between occupational efforts spent and rewards received, and has been found to predict poor Health. The aim of this cross-sectional study (n = 367 nurses and nurses aides) was first to test the psychometric properties of the Danish questionnaire measuring ERI, and secondly to analyse whether psychosocial work stress is associated with six indicators of poor Self-Rated Health. Results derived from confirmatory factor analysis indicate satisfying psychometric properties. Elevated risks of poor Self-Rated Health (odds ratios varying from 1.92 to 4.76) are observed in nursing staff characterized by high effort in combination with low reward. Effects are enhanced in those respondents who additionally exhibit a high level of work-related overcommitment. In conclusion, despite methodological limitations, this study contributes to the validation of the ERI questionnaire in Danish language. Furthermore, by documenting associations with poor Self-Rated Health, it supports efforts of theory-guided prevention of work stress in Health care professions.
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psychosocial work characteristics and self rated Health in four post communist countries
Journal of Epidemiology and Community Health, 2001Co-Authors: Hynek Pikhart, Martin Bobak, Johannes Siegrist, Andrzej Pajak, S Rywik, J Kyshegyi, A Gostautas, Z Skodova, Michael MarmotAbstract:STUDY OBJECTIVES—To examine whether psychosocial factors at work are related to self rated Health in post-communist countries. DESIGN AND SETTINGS—Random samples of men and women in five communities in four countries were sent a postal questionnaire (Poland, Czech Republic and Lithuania) or were invited to an interview (Hungary). Working subjects (n=3941) reported their self rated Health in the past 12 months (5 point scale), their socioeconomic circumstances, perceived control over life, and the following aspects of the psychosocial work environment: job control, job demand, job variety, social support, and effort and reward at work (to calculate a ratio of effort/reward imbalance). As the results did not differ by country, pooled analyses were performed. Odds ratios of poor or very poor Health ("poor Health") were estimated for a 1 SD increase in the scores of work related factors. MAIN RESULTS—The overall prevalence of poor Health was 6% in men and 7% in women. After controlling for age, sex and community, all work related factors were associated with poor Health (p<0.05). After further adjustment for perceived control, only two work related factors remained associated with poor Health; the odds ratios (95% confidence intervals) for 1 SD increase in the effort/reward ratio (log transformed) and job variety were 1.51 (1.29, 1.78) and 0.82 (0.73, 1.00), respectively. Further adjustment for all work related factors did not change these estimates. There were no interactions between individual work related factors, but the effects of job control and social support at work differed by marital status, and the odds ratio of job demand increased with increasing education. CONCLUSIONS—The continuous measure of effort/reward imbalance at work was a powerful determinant of self rated Health in these post-communist populations. Although the cross sectional design does not allow firm conclusions as to causality, this study suggests that the effect of the psychosocial work environment is not confined to Western populations. Keywords: self rated Health; psychosocial work characteristics; effort-reward imbalance
S V Subramanian - One of the best experts on this subject based on the ideXlab platform.
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political regimes political ideology and self rated Health in europe a multilevel analysis
PLOS ONE, 2010Co-Authors: Tim Huijts, Jessica M Perkins, S V SubramanianAbstract:Background: Studies on political ideology and Health have found associations between individual ideology and Health as well as between ecological measures of political ideology and Health. Individual ideology and aggregate measures such as political regimes, however, were never examined simultaneously. Methodology/Principal Findings: Using adjusted logistic multilevel models to analyze data on individuals from 29 European countries and Israel, we found that individual ideology and political regime are independently associated with Self-Rated Health. Individuals with rightwing ideologies report better Health than leftwing individuals. Respondents from Eastern Europe and former Soviet republics report poorer Health than individuals from social democratic, liberal, Christian conservative, and former Mediterranean dictatorship countries. In contrast to individual ideology and political regimes, country level aggregations of individual ideology are not related to reporting poor Health. Conclusions/Significance: This study shows that although both individual political ideology and contextual political regime are independently associated with individuals’ Self-Rated Health, individual political ideology appears to be more strongly associated with Self-Rated Health than political regime.
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does gender modify associations between self rated Health and the social and economic characteristics of local environments
Journal of Epidemiology and Community Health, 2006Co-Authors: Anne M Kavanagh, Rebecca Bentley, Gavin Turrell, Dorothy Broom, S V SubramanianAbstract:Objectives: To examine whether area level socioeconomic disadvantage and social capital have different relations with women’s and men’s self rated Health. Methods: The study used data from 15 112 respondents to the 1998 Tasmanian (Australia) Healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated Health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. Results: IRSD was associated with poor self rated Health for women (age adjusted p Conclusions: These finding suggest that women may benefit more than men from higher levels of area social capital.
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racial residential segregation and geographic heterogeneity in black white disparity in poor self rated Health in the us a multilevel statistical analysis
Social Science & Medicine, 2005Co-Authors: S V Subramanian, Dolores Acevedogarcia, Theresa L OsypukAbstract:Existing evidence demonstrating a relationship between racial residential segregation and Health has been based on aggregate analysis. Using a multilevel analytical framework, we assess the extent of geographic variation in black/white disparities in Self-Rated Health across US metropolitan areas, and whether racial residential segregation accounts for such variation. We estimated multilevel regression models of poor Self-Rated Health among 51,316 non-Hispanic white and non-Hispanic black adults nested within 207 metropolitan areas to assess the multilevel relationship between segregation and racial disparities in Health. We found statistically significant variation in the black/white disparity in poor Self-Rated Health across metropolitan areas, after controlling for individual level factors (age, sex, marital status, education and income) and residential segregation. High black isolation was associated with increased odds of reporting poor Health among blacks (p<0.05). While a similar pattern was observed for white/black dissimilarity and white isolation, they were not statistically significant. Our multilevel analysis only partially supports the previously reported aggregate findings linking segregation to Health. Additional multilevel statistical investigations across different Health outcomes are required to draw firmer conclusions regarding the adverse effects of segregation on Health.
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social trust and self rated Health in us communities a multilevel analysis
Journal of Urban Health-bulletin of The New York Academy of Medicine, 2002Co-Authors: S V Subramanian, Ichiro KawachiAbstract:This study assessed the contextual and individual effects of social trust on Health. Methods consisted of a multilevel regression analysis of Self-Rated poor Health among 21,456 individuals nested within 40 US communities included in the 2000 Social Capital Community Benchmark Survey. Controlling for demographic covariates, a strong income and education gradient was observed for Self-Rated Health. Higher levels of cominunity social trust were associated with a lover probability of reporting poor Health. Individual demographic and socioeconomic preditors did not explain the association of community social trust with Self-Rated Health. Controlling for individual trust perception, however, rendered the main effect of community social trust statistically insignificant, but a complex interaction effect was observed, such that the Health-promoting effect of community social trust was significantly greater for high-trust individuals. For low-trust individuals, the effect of community social trust on Self-Rated Health was the opposite. Using the latest data available on community social trust, we conclude that the role of community social trust in explaining average population Health achievements and Health inequalities is complex and is contingent on individual perceptions of social trust. Future multilevel investigations of social capital and population Health should routinely consider the cross-level nature of community or neighborbood effects.
