Table Of ContentSOCIAL AND PSYCHOSOCIAL
DETERMINANTS OF
SELF-RATED HEALTH IN
CENTRAL AND EASTERN EUROPE
SOCIAL AND PSYCHOSOCIAL
DETERMINANTS OF
SELF-RATED HEALTH IN
CENTRAL AND EASTERN EUROPE
by
Hynek Pikhart
University College London
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
ISBN 978-1-4613-5264-8 ISBN 978-1-4615-0839-7 (eBook)
DOI 10.1007/978-1-4615-0839-7
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Copyright © 2002 Springer Science+Business Media New York
Originally published by Kluwer Academic Publishers in 2002
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To Katka with love
Contents
ListofTables XI
ListofFigures xv
ListofAbbreviations XVII
Acknowledgment XIX
.......................................................... I
INTRODUCTION I
1. EAST-WESTDIFFERENCE I
2. MAIN INTERESTAND HYPOTHESES 3
3. STUDY DESIGN AND DATA 4
4. CONTRIBUTORS TO THE PROJECT 5
5. STRUCTURE 6
2 7
BACKGROUND 7
I. HEALTH STATUS IN COUNTRIES OF CENTRALAND
EASTERN EUROPE 7
2. SELF-RATED HEALTH 8
2.1 Self-rated health as a predictorofmortality 8
2.2 Self-rated health in Central and Eastern Europe 12
3. SOCIOECONOMIC FACTORS 14
3.1 Socioeconomic factors at individual level 14
3.2 Socioeconomic factors in Central and Eastern Europe 16
3.3 Socioeconomic factors at aggregated level 17
4. PSYCHOSOCIAL FACTORS 18
4.1 Work related factors 19
4.2 Perceived control over own life and health 28
4.3 Social support and social networks 31
VIII Contents
3 35
POPULATIONS AND METHODS 35
1. POPULATIONS 35
1.1 National samples 37
1.2 Community samples 38
2. DESCRIPTION OF THE DATA 44
2.1 Socioeconomic status 45
2.2 Psychosocial factors not related to work 46
2.3 Work-related psychosocial factors 48
2.4 Life-style risk factors 49
3. STATISTICAL POWEROF THE STUDY 50
4. STATISTICALANALYSIS 52
4.1 Strategyofanalysis 52
4.2 Restrictions ofanalysis 53
4.3 Missing values 54
4.4 Software 54
4 55
RESULTS 55
1. DESCRIPTIVE CHARACTERISTICS OF STUDY SUBJECTS
AND POPULATIONS 56
1.1 Countries 56
1.2 Study subjects 57
1.3 National samples 58
1.4 Community samples 61
2. SOCIOECONOMIC CHARACTERISTICS AND MARITAL
STATUS 64
2.1 The role ofsocioeconomicvariables in national samples 64
2.2 The role ofsocioeconomic variables in five community samples
80
3. PERCEIVED CONTROL AND OTHERPSYCHO-SOCIAL
FACTORS NOT RELATED TO WORK 90
3.1 The role ofperceived control and other psychosocial factors not
related to work in seven national samples 90
3.2 The role ofperceived control in five community samples 103
4. MEASURES OF SOCIOECONOMIC INEQUALITY ATTHE
POPULATION LEVEL 110
5. WORK RELATED PSYCHOSOCIAL FACTORS 117
5.1 Work-related psychosocial factors in national samples 118
5.2 Work-related psychosocial factors in community samples 120
6. ANALYSES USING OTHER ENDPOINTS 139
6.1 Physical functioning 139
Contents IX
6.2 Otherdefinition ofself-rated health 141
6.3 Self-reported history ofcardiovasculardisease 143
5 147
DISCUSSION 147
1. METHODOLOGICAL ISSUES 148
1.1 Representativeness ofthe sample 148
1.2 Limitations ofthe cross-sectional characterofthe study 150
1.3 Random error 151
1.4 Misclassification 151
1.5 Confounding 153
1.6 Relevance ofstatistical techniques used in the analysis 153
2. CONSISTENCY OF THE RESULTS WITH OTHER STUDIES
157
2.1 Prevalence ofself-rated health 157
2.2 Life-style risk factors 157
2.3 Socioeconomic factors on individual level 159
2.4 Psychosocial factors not related to work 165
2.5 Inequalities measured at the aggregated level 167
2.6 Psychosocial factors related to work 171
3. DOES THIS RESEARCH HELP TO UNDERSTAND THE
HEALTH CRISIS IN CCEE? 173
6 " 177
CONCLUSIONS 177
References I79
Appendix I . ....... ... ............. .. ..... ................. 19I
CHEWE QUESTIONNAIRE 191
Appendix 2 ....... ........... ...... ........................ 201
PHYSICAL FUNCTIONING 201
Appendix3 .... ............ ..................... .. ...... ... 203
CODING OF WORK CHARACTERISTICS 203
Index 207
XII Contents
Table 26. OR (95% CI) ofpoor health by socioeconomic factors by
population (sex-age adjusted) .... ............. ............ .. 83
Table 27. OR(95% CI) ofpoor SRH by socioeconomic factors by population
(fully adjusted) 84
Table 28. Relationship between socioeconomic factors and poor SRH in
working subjects 85
Table 29. OR(95% CI) ofpoor SRH by potential risk factors in Hungary 86
Table 30. OR(95% CI)ofpoor SRH by socioeconomic variables ..... 87
Table 31. Correlation matrix ofvariables used in the analysis in Hungary 88
Table 32. ORand 95% CI ofpoorhealth for socioeconomic variables and
classical risk factors in subsample ofHungarians with known BMI . 89
Table 33. Age-adjusted means ofcontrol scoresby sex and country .... 91
Table 34. Correlation matrix ofsocioeconomic factors and perceived control
in national samples 92
Table 35. OR(95%CI) ofpoor health by perceived control, socioeconomic
factors and marital status. . ......... ............ ......... ... 95
Table 36. OR(95% CI)ofpoor self-rated health by differentcategories of
household items owned by individuals in Hungary and Poland ..... 96
Table 37. An association between poor SRH and social and psychosocial
factors in Russia 98
Table 38. An association between poor SRH and social and psychosocial
factors inBaltic states 100
Table 39. An association between poor SRHand social and psychosocial
variables inthe Czech Republic, Hungary and Poland ... ........ 101
Table40. Ageadjusted mean control scores by sex and population .... 104
Table41. Correlation matrixofsocioeconomic factors and perceived control
in pooled data in 5community samples 105
Table42. OR (95% CI) ofpoor SRH by control in the pooled data .. .. 106
Table 43. OR(95% CI) ofpoor SRH by potential risk factors in Hungary
.... ....... ...... .. ..... ... ......... ............ .. .... 107
Table 44. Correlation between perceived control, general social position, and
all othervariables used in analysis in Hungary. .... ......... ... 108
Table 45. OR(95% CI) ofpoor SRH and social, psychosocial and classical
factors in subsample ofHungarians with known body-mass index . 108
Table 46. Descriptive table ofinequality measures at population level for
seven countries 111
Table47. TheeffectofGini coefficientofincome inequality on poor self
rated health (ORand 95% CI) .... ............ ........ ...... 113
Table 48. The effect ofinequality index on poorself-rated health (OR and
95% CI) 114
Contents XIII
Table 49. OR (95% CI) for the effectofsocioeconomic factors, measures of
inequality and control 114
Table 50. Crude OR (95% CI) ofpoor SRH comparingthe best and the worst
population in ecological analysis 117
Table 51.Age standardized mean control at work and numberofmen and
women in each country .... .......... .......... ........... 118
Table 52. OR and 95% CI ofpoorself-rated health for control at work by
level ofadjustment in pooled data 119
Table 53. OR and 95% CI ofpoor SRH for control at work, general control
and socioeconomic variables in pooled data. .. ..... ... .. ...... 120
Table 54. Prevalence ofSRH and socioeconomic characteristics, and age
distribution in working populations in 5 community samples 122
Table 55. Frequency distribution ofreward and effort scores 124
Table 56. OR(95% CI) for an association between poorhealth and effort
reward model. ........ ......... ............. .......... .. 125
Table 57. An association between self-rated health and effort-reward model
in the pooled data (OR and 95% CI) 129
Table 58. An association between poorself-rated health, effort-reward and
socioeconomic variables in pooled data (OR and 95% CI) 130
Table 59. Frequency distribution ofwork psychosocial characteristics in
community samples. . ........ .. ............ ......... ..... 131
Table 60. The effect ofworking factors on poor SRH (age-sex adjusted) 132
Table 61. The effect ofworking factors on poor self-rated health (adjusted for
each other) ..... ......... ............ .......... ... .... .. 133
Table 62. The effectofworking factors on poor SRH in pooled sample 135
Table 63. Correlation between work psychosocial factors; perceived control,
deprivation and education in pooled data (working population only) 136
Table 64. Poorhealth and home and work psychosocial factors in pooled
data 137
Table 65. ORofpoor SRH by psychosocial work characteristics (per I SD
increase) at different levels ofeducation, material deprivation and marital
status 138
Table 66. OR (95% CI) for poorhealth and social and psychosocial predictors
(pooled data; working population) 139
Table 67. An association between physical functioning and social,
psychosocial and health behavioural factors in Russia ... ... ..... 140
Table 68. OR and 95% CI ofpoor SRH compared to health ofothers ofthe
sameage by psychosocial and socioeconomic variables 142
Table 69. OR(95% CI) for poor SRH compared to health ofothers ofthe
sameage in working population (N=1935) ......... ........... 143
Table 70. OR (95% CI) ofself-reported history ofheart problems by
psychosocial and socioeconomic variables. ......... .... ...... 144
XIV Contents
Table 71. OR(95% CI) ofself-reported historyofheart problems in working
population 145
Table 72. OR(95% CI) ofpoororaverage self-rated health by sex, age, social
and psychosocial variables in seven national samples 155
Table 73. OR(95% CI) for the effect ofsex, age, socioconomic factors and
perceivedcontrol when SRH used as 5-pointscale categorical variable
...... ....... ....... ....... .. ............ ......... .... 156
Table 74. The effectofmean country deprivation level on poorhealth (OR
and 95%CI forthe worst relative to the bestpopulation) ..... .... 168
