Self-rated health: assessment, social variance and association with mortality

Abstract

„Milline on Teie tervis üldiselt?” on küsitlusuuringutes sagedasti kõlav küsimus. See lihtne enesehinnangule tuginev terviseseisundi mõõdik on laialdaselt kasutusel ning tõendus varasematest uuringutest kinnitab instrumendi valiidsust rahvastiku terviseseisundi hindamisel ning edasiste tervisetulemite prognoosimisel. Rainer Reile doktoritöö analüüsis subjektiivse tervise hindamismehhanisme, tervise enesehinnangu aluseks olevaid tegureid ja nende sotsiaalset variatiivsust, ning seost edasise suremusega. Töös leiti, et tervise enesehinnangu mõjurid varieeruvad sõltuvalt tervise enesehinnangu tasemest: kui negatiivne hinnang seondus põhiliselt füüsilise ja vaimse tervise aspektidega, siis positiivne hinnang seondus ka demograafiliste, sotsiaalmajanduslike ja heaolu teguritega. Negatiivse tervise enesehinnangu korral prognoosisid edasist suremust haigustega seotud piirangud, positiivse tervise enesehinnangu korral sõltus suremusrisk demograafilistest, sotsiaalmajanduslikest ja tervisekäitumisega seotud teguritest. Halva tervise enesehinnanguga vastajatel oli ligi 40% suurem suremusrisk ligi 18-aastase jälgimisaja jooksul. Leid, et erinevalt eestlastest ei prognoosi tervise enesehinnang prognoosib edasise suremusriski mitte-eestlastel, viitab võimalikule sotsiaalsele variatiivsusele tervise hindamisel. Töö näitas, et tervise enesehinnang on tundlik mõõdik tervise hindamiseks makromajanduslike muutuste taustal – 2008. aastal alanud majanduskriis peatas eelneva tervise enesehinnangu olulise paranemise trendi kriisist tugevalt mõjutatud Eestis ja Leedus. Makromajanduslikud muutused avaldasid mõju ka tervise enesehinnangu sotsiaalsele varieeruvusele – kui majanduskasvuga seoses ebavõrdsus kasvas, siis majanduskriisi tingimustes ebavõrdsus pigem kahanes. Doktoritöö näitab, et tervise enesehinnang varieerub lisaks tervisega otseselt seotud teguritele ka demograafiliste, sotsiaalmajanduslike ning psühholoogiliste tegurite lõikes. Need tegurid mõjutavad nii terviseseisundit kui ka selle tõlgendamist ja hindamist tervise enesehinnangu kontekstis. Seega saab tervist subjektiivsete tervisemõõdikute kontekstis käsitleda eelkõige ettevaatlikku tõlgendust vajava sotsiaalse nähtusenaThe single question on individual’s self-rated health (SRH) –“How would you rate your health in general?”– has become a popular tool in survey research as its validity for assessing population health status and predicting mortality and morbidity outcomes has been consistently demonstrated. Rainer Reile’s dissertation analyzed the mechanisms underlying the subjective health evaluations, their social variations and associations between SRH and mortality. The findings support the existing evidence that SRH is a valid and responsive indicator of individual health that rests on a wide range of determinants that differ for negative and positive health assessments. The former is characterized mostly by the physical and psychological aspects whereas a wide range of demographic, socioeconomic and wellbeing-related factors contribute to the latter. Moreover, similar patterning of predictors of positive and negative health was also found for factors underpinning the mortality risk in an analysis stratified by SRH. Those with poor SRH had approximately 40% higher mortality during the 18-year follow-up period. SRH was found to predict subsequent mortality only among Estonians with social variations in health assessments being one of the plausible explanations. The dissertation studied SRH in the context of macroeconomic changes demonstrating the health effects of late-2000s economic recession that halted the previous trend of health improvement in Estonia and Lithuania. The reduction in existing health disparities during the recession indicates that rapid economic fluctuations may affect different socioeconomic groups disproportionately. SRH is influenced by a wide range of factors, not necessarily limited to those directly related to physical aspects of health. The social determinants affect health outcomes but are also the source of social variation in health assessments as they influence how health is conceptualized and evaluated. In this, health can be interpreted essentially as a social phenomenon that in the context of subjective health measures requires careful interpretation