A multilevel analysis of women's status and self-rated health in the United States.
OBJECTIVE
We investigated associations between various dimensions of women's status and self-rated health. We hypothesized that women living in states with lower levels of women's status would be at greater risk of reporting poor health than women living in states with higher levels of women's status, even when controlling for individual and state characteristics.


METHODS
We used individual self-rated health and sociodemographic characteristics for 87 848 female respondents to the Behavioral Risk Factor Surveillance System (BRFSS) 2000. Women's status indices and indicators were obtained from the Status of Women in the States 2000. State median income and income inequality were included as state-level contextual variables. We examined data using a multilevel logistic regression method.


RESULTS
Women living in states scoring in the lowest quintile on women's political and economic indices (political participation, employment and earnings, and economic autonomy) were more likely to report poor health, odds ratio (OR) 1.14 (95% confidence interval [CI] 1.01, 1.28), OR 1.29 (CI 1.08,1.55); OR 1.30 (CI 1.09, 1.56), respectively, after controlling for individual characteristics and other state-level variables than were women living in the highest-performing 20% of states.


CONCLUSIONS
The status of women at the state level has an independent association with the risk of reporting poor health over and above women's individual characteristics. This finding suggests a contextual effect of women's societal status on health status.
Jun
Hee-Jin
HJ
Channing Laboratory of Brigham and Women's Hospital, Harvard Medical School, USA.
Subramanian
S V
SV
Gortmaker
Steven
S
Kawachi
Ichiro
I
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D012107:Research Design; D012650:Self Disclosure; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health