Objective To systematically review the evidence of the factors associated with self-rated health (SRH) and estimating the population attributable risk proportion (PARP) of interests in the elderly. Methods MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched (from January 1960 to April 2011) for relevant literature. The combined effect on each factor associated with poor SRH was expressed as RR or OR (95%CI). The contribution of each factor to poor SRH in the elderly population was estimated with PARP. Meta-analysis was performed using RevMan 5.1 software. Results Twelve studies involving a total of 35 349 participants aged 60 or above were eligible in this systematic review. Ten studies were conducted in China and the rest two studies were from the USA and Brazil. Of them, only one was prospective cohort study and 11 studies were cross-sectional. The results of meta-analysis showed that the main factors associated with poor SRH in the elderly were dependency, diabetes and coronary heart disease with the corresponding OR and 95%CI as 12.10 (6.31, 23.20), 6.49 (3.21, 13.09) and 5.60 (1.07, 29.42), respectively. However, the top three factors contributing to poor SRH in the elderly population were coronary heart disease, having illness half one year ago and chronic disorders with the corresponding PARP as 53.91%, 52.56%, and 50.09%, respectively. It was not possible to perform sub-group analysis because of the limited quantity of studies on each factor associated with poor SRH. Conclusion Based on the current available evidence, it appears that chronic disorders are closely related to poor SRH and contribute most in the elderly population. However, due to the limitation of the included predominantly cross sectional studies which are not enough for causal argument, it is insufficient to determine the association of many factors with poor SRH. Further high-quality prospective cohort studies are needed.
ObjectiveTo investigate the factors that influence Chinese residents, self-rated health and the effects of the multilevel health insurance system and neighborhood social capital on self-rated health. MethodsBased on the 2018 China labor-force dynamics survey data, and Stata 15.0 software was used to conduct χ2 test, univariate analysis and multiple logistic regression model were used to analyze the influencing factors of self-rated health of Chinese residents. An interaction model was used to analyze the interactive effects of the multilevel health insurance system and the social capital of the neighborhood on self-rated health. ResultsA total of 10 201 people were investigated in this study, and 39.20% of them were self-rated unhealthy. After adjusting for confounders, the results of the multivariate logistic regression model showed that having social health insurance (OR=0.8, 95%CI 0.7 to 1.0) and having neighborhood social capital (OR=0.7, 95%CI 0.6 to 0.8) were more inclined to self-rated health. In addition, the results showed that being male, having a college degree or higher, having a job, and drinking alcohol increased the risk of self-rated unhealthy (P<0.05); whereas being 45-59 years of age, 60 years of age or older, in the central and western regions, exercising regularly, and having a disease or injury within two weeks decreased the risk of self-rated unhealthy (P<0.05). There was a positive multiplicative interaction effect between health insurance and neighborhood social capital on residents’ self-rated health (univariate: OR=1.5, 95%CI 1.1 to 3.7, P<0.05; multivariate: OR=1.7, 95%CI 1.2 to 2.4, P<0.05), and negative additive interactions (RERI=−0.8, 95%CI −1.4 to −0.1; AP=−0.3, 95%CI −0.6 to −0.1; SI=0.6, 95%CI 0.5 to 0.8). ConclusionAttention should be paid to the self-rated health status of key populations through means such as health promotion and education, and healthy behavior lifestyles should be promoted. The health insurance system should be further improved, and attention should be paid to the role of social capital in the neighborhood, encouraging residents to actively build a good social neighborhood, and realizing the coordinated development of the multilevel health insurance system and the social capital in the neighborhood.