The relationship between self-rated health and subsequent health outcomes over the decades among older Individuals in the United States

• Main Author: Wong, Shawn Jun Kit
• Other Authors: Premchand Dommaraju
• Format: Thesis-Master by Research
• Language: English
• Published: Nanyang Technological University 2024
• Subjects: Social sciences::Sociology
• Online Access: https://hdl.handle.net/10356/173234
• Institution: Nanyang Technological University

Objectives: Existing research has established significant associations between Self-Rated Health (SRH) and subsequent health outcomes such as mortality and morbidity. However, limited research has examined associational changes between Self-Rated Health and these health outcomes. Drawing from the framework of health evaluation, associational changes may arise from both reductions and improvements in accuracy of health evaluations. The study therefore seeks to investigate associational changes between Self-Rated Health and subsequent health outcomes in the American context. Another study objective highlights the role of culture in the health evaluation framework. As culture influences the components deemed relevant to Self-rated Health as well as how it is reported, a study examining association differences between Self-Rated health and morbidity in a cross-national context is merited. Method: Fourteen waves (1992-2018) from the Health and Retirement Study were used to investigate associational changes via discrete-time survival analysis. Participants were sorted into three groups (1992, 2000, 2010), according to the year of entry into the study. This was to facilitate a decade-by-decade comparison of associational change. For the cross-national study culture, six waves (2008-2018) from the Korean Longitudinal Study of Aging were additionally used alongside the corresponding six waves from the Health and Retirement Study. Similarly, discrete-time survival analyses were used to investigate associational differences. Results: No associational changes between SRH and mortality over the decades were noted. Similar findings were observed between SRH and the global measure of morbidity onset. However, associational weakening occurred between SRH and onset of diabetes and cancer, while associational strengthening was found between SRH and onset of high blood pressure. For the cross-national study, differences in the associational strength between SRH and morbidity onset were noted between the Korean and American participants. Each level of decreasing SRH was associated with greater increased risk to morbidity onset in the Korean sample than the American sample. The differences included the global measure of morbidity as well as individual chronic illnesses like cancer, heart disease, stroke and arthritis. Discussion: The absence of associational change between SRH and mortality as well as the global measure of morbidity onset could be attributed to the competing effects of factors improving accuracy of health evaluations with those weakening accuracy of health evaluations. Association change observed for SRH and onset of high blood pressure, diabetes and cancer may be explained by medical screening. The findings highlight the utility of medical screening for chronic diseases, irrespective of one’s perceived health status. For the cross-national study, the findings provide support to cultural differences in health evaluation. American respondents are more likely to provide more optimistic ratings of their health relative to their objective health. Keywords: Self-Rated Health, Mortality, Morbidity, Associational change, Culture