Department of Social Work, Ben-Gurion University of the Negev, Beersheva, Israel.
Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India.
PLoS One. 2023 Apr 17;18(4):e0284321. doi: 10.1371/journal.pone.0284321. eCollection 2023.
The self-rated health (SRH) is a widely adopted indicator of overall health. The sponge hypothesis suggests that predictive power of SRH is stronger among women compared to men. To gain a better understanding of how gender influences SRH, this study examined whether and what determinants of gender disparity exist current self-rated health (SRHcurrent) and change in SRH (SRHchange) among older adults in Indian setting.
We used cross-sectional data from the 75th National Sample Survey Organizations (NSSO), collected from July 2017 to June 2018. The analytical sample constitutes 42,759 older individuals aged 60 years or older with 21,902 older men and 20,857 older women (eliminating two non-binary individuals). Outcome measures include two variables of poor/worse SRH status (SRHcurrent and SRHchange). We have calculated absolute gaps in the prevalence of poor SRHcurrent and worse SRHchange by background characteristics. We carried out binary logistic regression models to examine the predictors of poor SRHcurrent and worse SRHchange among older adults.
The overall absolute gender gap in poor SRHcurrent was 3.27% and it was 0.58% in worse SRHchange. Older women had significantly higher odds of poor SRHcurrent [AOR = 1.09; CI = 0.99, 1.19] and worse SRHchange [AOR = 1.09; CI = 1.02, 1.16] compared to older men. Older adults belonging to middle-aged, oldest-old, economically dependent, not working, physically immobile, suffering from chronic diseases, belonging to Muslim religion, and Eastern region have found to have higher odds of poor SRHcurrent and worse SRHchange. Educational attainments showed lower odds of have poor SRHcurrent and worse SRHchange compared to those with no education. Respondents belonging to richest income quintile and those who were not covered by any health insurance, belonging to Schedule caste, OBC, Western and Southern regions are found to have lower odds of poor SRHcurrent and worse SRHchange. Compared to those in the urban residence, respondents from rural residence [AOR = 1.09; CI = 1.02, 1.16] had higher odds of worse SRHchange.
Supporting the sponge hypothesis, a clear gender gap was observed in poor current SRH and worse change in SRH among older adults in India with a female disadvantage. We further found lower socioeconomic and health conditions and lack of resources as determinants of poor current SRH and its worse change, which is crucial to address the challenge of the older people's health and their perception of well-being.
自评健康（SRH）是广泛采用的整体健康指标。海绵假说表明，与男性相比，女性的 SRH 预测能力更强。为了更好地了解性别如何影响 SRH，本研究检验了在印度老年人中，当前自评健康（SRHcurrent）和 SRH 变化（SRHchange）的性别差异是否存在以及存在哪些决定因素。
我们使用了 2017 年 7 月至 2018 年 6 月期间，由第 75 届国家抽样调查组织（NSSO）收集的横断面数据。分析样本由 42759 名 60 岁或以上的老年人组成，其中 21902 名男性和 20857 名女性（剔除 2 名非二元个体）。结局指标包括两个较差/更差 SRH 状况的变量（SRHcurrent 和 SRHchange）。我们根据背景特征计算了较差 SRHcurrent 和更差 SRHchange 的患病率的绝对差距。我们进行了二元逻辑回归模型，以检验老年人较差 SRHcurrent 和更差 SRHchange 的预测因素。
总体上，女性在较差的 SRHcurrent 方面的绝对性别差距为 3.27%，在更差的 SRHchange 方面为 0.58%。与老年男性相比，老年女性较差的 SRHcurrent（OR = 1.09；95%CI = 0.99，1.19）和更差的 SRHchange（OR = 1.09；95%CI = 1.02，1.16）的可能性更高。属于中年、最年长、经济依赖、不工作、身体不活动、患有慢性疾病、属于穆斯林宗教和东部地区的老年人，较差的 SRHcurrent 和更差的 SRHchange 的可能性更高。与没有受过教育的人相比，教育程度较低的人较差的 SRHcurrent 和更差的 SRHchange 的可能性较低。属于最富裕收入五分位数和没有任何医疗保险的受访者、属于在册种姓、在册种姓、西部和南部地区的受访者，较差的 SRHcurrent 和更差的 SRHchange 的可能性较低。与城市居民相比，农村居民（OR = 1.09；95%CI = 1.02，1.16）的更差的 SRHchange 的可能性更高。
支持海绵假说，在印度老年人中，当前较差的 SRH 和更差的 SRH 变化都存在明显的性别差距，女性处于不利地位。我们还发现，较低的社会经济和健康状况以及缺乏资源是较差的当前 SRH 及其更差变化的决定因素，这对于解决老年人的健康挑战和他们的幸福感至关重要。
