老年人自评健康对短期死亡风险预测作用中的性别差异。
Gender differences in the predictive role of self-rated health on short-term risk of mortality among older adults.
作者信息
Assari Shervin
机构信息
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
出版信息
SAGE Open Med. 2016 Sep 9;4:2050312116666975. doi: 10.1177/2050312116666975. eCollection 2016.
OBJECTIVES
Despite the well-established association between self-rated health and mortality, research findings have been inconsistent regarding how men and women differ on this link. Using a national sample in the United States, this study compared American male and female older adults for the predictive role of baseline self-rated health on the short-term risk of mortality.
METHODS
This longitudinal study followed 1500 older adults (573 men (38.2%) and 927 women (61.8%)) aged 66 years or older for 3 years from 2001 to 2004. The main predictor of interest was self-rated health, which was measured using a single item in 2001. The outcome was the risk of all-cause mortality during the 3-year follow-up period. Demographic factors (race and age), socio-economic factors (education and marital status), and health behaviors (smoking and drinking) were covariates. Gender was the focal moderator. We ran logistic regression models in the pooled sample and also stratified by gender, with self-rated health treated as either nominal variables, poor compared to other levels (i.e. fair, good, or excellent) or excellent compared to other levels (i.e. good, fair, or poor), or an ordinal variable.
RESULTS
In the pooled sample, baseline self-rated health predicted mortality risk, regardless of how the variable was treated. We found a significant interaction between gender and poor self-rated health, indicating a stronger effect of poor self-rated health on mortality risk for men compared to women. Gender did not interact with excellent self-rated health on mortality.
CONCLUSION
Perceived poor self-rated health better reflects risk of mortality over a short period of time for older men compared to older women. Clinicians may need to take poor self-rated health of older men very seriously. Future research should test whether the differential predictive validity of self-rated health based on gender is due to a different meaning of poor self-rated health for older men and women and whether poor self-rated health reflects different health statuses based on gender.
目的
尽管自评健康状况与死亡率之间的关联已得到充分证实，但关于男性和女性在这一联系上的差异，研究结果并不一致。本研究利用美国的全国性样本，比较了美国老年男性和女性中基线自评健康状况对短期死亡风险的预测作用。
方法
这项纵向研究在2001年至2004年期间，对1500名66岁及以上的老年人（573名男性（38.2%）和927名女性（61.8%））进行了为期3年的跟踪调查。主要的预测指标是自评健康状况，该指标在2001年通过一个单项进行测量。结果变量是3年随访期内的全因死亡风险。人口统计学因素（种族和年龄）、社会经济因素（教育程度和婚姻状况）以及健康行为（吸烟和饮酒）为协变量。性别是重点调节变量。我们在合并样本中以及按性别分层后运行了逻辑回归模型，将自评健康状况视为名义变量（与其他水平（即一般、良好或优秀）相比差，或与其他水平（即良好、一般或差）相比优秀）或有序变量。
结果
在合并样本中，无论如何处理该变量，基线自评健康状况都能预测死亡风险。我们发现性别与自评健康状况差之间存在显著交互作用，表明自评健康状况差对男性死亡风险的影响比对女性更强。性别与自评健康状况优秀在死亡率方面没有交互作用。
结论
与老年女性相比，老年男性中自评健康状况差更能反映短期内的死亡风险。临床医生可能需要非常重视老年男性自评健康状况差的情况。未来的研究应测试基于性别的自评健康状况的差异预测效度是否源于老年男性和女性对自评健康状况差的不同理解，以及自评健康状况差是否基于性别反映不同的健康状况。
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