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Sex/Gender and Socioeconomic Differences in the Predictive Ability of Self-Rated Health for Mortality

Author

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  • Akihiro Nishi
  • Ichiro Kawachi
  • Kokoro Shirai
  • Hiroshi Hirai
  • Seungwon Jeong
  • Katsunori Kondo

Abstract

Background: Studies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups. Methodology/Principal Findings: The analyses in the study were based on the Aichi Gerontological Evaluation Study's (AGES) 2003 Cohort Study in Chita Peninsula, Japan, which followed the four-year survival status of 14,668 community-dwelling people who were at least 65 years old at the start of the study. We first examined sex/gender and education-level differences in association with fair/poor SRH. We then estimated the sex/gender- and education-specific hazard ratios (HRs) of mortality associated with lower SRH using Cox models. Control variables, including health behaviors (smoking and drinking), symptoms of depression, and chronic co-morbid conditions, were added to sequential regression models. The results showed men and women reported a similar prevalence of lower SRH. However, lower SRH was a stronger predictor of mortality in men (HR = 2.44 [95% confidence interval (CI): 2.14–2.80]) than in women (HR = 1.88 [95% CI: 1.44–2.47]; p for sex/gender interaction = 0.018). The sex/gender difference in the predictive ability of SRH was progressively attenuated with the additional introduction of other co-morbid conditions. The predictive ability among individuals with high school education (HR = 2.39 [95% CI: 1.74–3.30]) was similar to that among individuals with less than a high school education (HR = 2.14 [95% CI: 1.83–2.50]; p for education interaction = 0.549). Conclusions: The sex/gender difference in the predictive ability of SRH for mortality among this elderly Japanese population may be explained by male/female differences in what goes into an individual's assessment of their SRH, with males apparently weighting depressive symptoms more than females.

Suggested Citation

  • Akihiro Nishi & Ichiro Kawachi & Kokoro Shirai & Hiroshi Hirai & Seungwon Jeong & Katsunori Kondo, 2012. "Sex/Gender and Socioeconomic Differences in the Predictive Ability of Self-Rated Health for Mortality," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-7, January.
    • Handle: RePEc:plo:pone00:0030179
    DOI: 10.1371/journal.pone.0030179
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    References listed on IDEAS

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    2. Daniel Kahneman & Amos Tversky, 2013. "Prospect Theory: An Analysis of Decision Under Risk," World Scientific Book Chapters, in: Leonard C MacLean & William T Ziemba (ed.), HANDBOOK OF THE FUNDAMENTALS OF FINANCIAL DECISION MAKING Part I, chapter 6, pages 99-127, World Scientific Publishing Co. Pte. Ltd..
    3. McFadden, E. & Luben, R. & Bingham, S. & Wareham, N. & Kinmonth, A.-L. & Khaw, K.-T., 2009. "Does the association between self-rated health and mortality vary by social class?," Social Science & Medicine, Elsevier, vol. 68(2), pages 275-280, January.
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    1. Yosuke Kasai & Etsuji Suzuki & Toshihide Iwase & Hiroyuki Doi & Soshi Takao, 2013. "Type D Personality Is Associated with Psychological Distress and Poor Self-Rated Health among the Elderly: A Population-Based Study in Japan," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-7, October.
    2. Zajacova, Anna & Huzurbazar, Snehalata & Todd, Megan, 2017. "Gender and the structure of self-rated health across the adult life span," Social Science & Medicine, Elsevier, vol. 187(C), pages 58-66.
    3. Hiyoshi, Ayako & Fukuda, Yoshiharu & Shipley, Martin J. & Brunner, Eric J., 2014. "Health inequalities in Japan: The role of material, psychosocial, social relational and behavioural factors," Social Science & Medicine, Elsevier, vol. 104(C), pages 201-209.
    4. Asami Ota & Naoki Kondo & Nobuko Murayama & Naohito Tanabe & Yugo Shobugawa & Katsunori Kondo & Japan Gerontological Evaluation Study (JAGES) group, 2016. "Serum Albumin Levels and Economic Status in Japanese Older Adults," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-15, June.
    5. Jane K L Teh & Nai Peng Tey & Sor Tho Ng, 2014. "Ethnic and Gender Differentials in Non-Communicable Diseases and Self-Rated Health in Malaysia," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-8, March.
    6. Kino, Shiho & Jang, Soong-nang & Takahashi, Shuko & Ebner, Daniel K. & Kawachi, Ichiro, 2020. "Socioeconomic disparities in self-rated health in two East Asian countries: Comparative study between Japan and Korea," Social Science & Medicine, Elsevier, vol. 253(C).

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