Determinants of and inequalities in self-perceived health in Ukraine.
Ukraine is the second most populous of the former Soviet Republics and since transition its economy has fared even more poorly than Russia. Although the impact of the collapse of the former Soviet Union on health in Russia has been investigated, little is known of its impact in other post-Soviet republics. We report a cross-sectional study undertaken in Ukraine in March 2000. A multi-stage random sampling technique was used and 1600 interviews completed (72% response rate) with a representative national sample of Ukrainian adults. We investigated socioeconomic and psychosocial determinants of self-perceived health, which has been shown to be a valid and reliable measure of overall health and predictive of mortality. Odds ratios for less than good physical health were calculated using logistic regression. The self-rated health of Ukrainians was poor, 25% of men and 43% of women rated their health as poor or very poor. This is worse than levels recorded in Russia and considerably worse than levels seen in western Europe. Marked gender, geographical and socioeconomic inequalities in health were recorded. Women are at increased risk of poor self-rated health compared with men (OR 3.58, 2.50-5.14) as are women living in villages compared with those in cities (OR 3.24, 1.30-8.07). Socioeconomic factors including poor material situation (OR 1.64, 1.01-2.67), and psychosocial factors including low control over life (OR 1.89, 1.15-3.11) were identified as independent health determinants. Control over life was found to account for the negative impact of low social position on health. Good family relations protected against poor health. The findings suggest that a decrease in control, arising from an increasingly uncertain political and economic environment, a reduction in material wealth and the stress of change may all have contributed to the decline in life expectancy seen with transition.
Gilmore
Anna B C
AB
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK. anna.gilmore@lshtm.ac.uk
McKee
Martin
M
Rose
Richard
R
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006305:Health Status Indicators; D019456:Health Transition; D006801:Humans; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D011203:Poverty; D011209:Power, Psychological; D012307:Risk Factors; D012649:Self Concept; D012737:Sex Factors; D012959:Socioeconomic Factors; D014455:Ukraine / Q000453:epidemiology