Variations In Social Determinants Of Self-Rated Health And Self-Reported Illness 3045-3055
Dr. Paul A. Bourne, 1Socio-Medical Research Institute (Formerly of Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica)
Background There are extensive empirical studies which have examined the social and/or medical determinants of the health status, but none have evaluated whether those determinants vary by the definitions of health.Aims: This research seeks to elucidate the social determinants of health, based on the definition of health and the dichotomization of health, in order to establish whether variations exist in the social determinants, based on the definition and the measurement of health, as well as the correlation between the determinants.Design and setting: By using a representative probability sampling dataset, 2007 Jamaica Survey of Living Conditions, of some 6,782 respondents, and logistic regression analyses, the determinants of health were examined in these subjects.Methods and measure: Self-rated health was a five-point ordinal scale (very poor; poor; moderate; good; very good health) measure. It was dichotomized as good-to-very good health status, and moderate-to-very good health, and not reporting an illness, to measure health to explore the effect and the determinants of each definition of health.Results: When health was measured and the cut-off was good-to-very good, eight variables emerged as statistically significant factors of the self-rated health status of Jamaicans (Model, χ2 = 1187.67, P < 0.0001; -2 Log likelihood = 3374.2, R2 = 0.367). By using a cut-off of moderate-to-very good health, six variables emerged as statistically significant factors of the self-rated health status of Jamaicans. The health status was dichotomized as moderate-to-very good self-rated health and very poor-to-poor health (Model, χ2 = 498.41, P < 0.0001; -2 Log likelihood = 1491.30, R2 = 0.295). However, when self-reported illness was used to measure health, six factors emerged from a listing of social variables as explanations of self-rated health (using not reporting an illness) (Model, χ2 = 2012.57, P < 0.0001; -2 Log likelihood = 1726.05, R2 = 0.641).Conclusion: With the importance of correct information in policy making, health assessment and health modifications, the current findings provide pertinent materials that can be used by researchers and other health professionals to make correct conclusions, the choice of the dichotomization of health and the fact that the social determinants of health vary across the different subgroups of measure and the definitions of health.
Key words: Social determinants, self-rated health status, self-reported illness, dichotomization of self-rated health status