title: Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders.
abstract: OBJECTIVE
  We aimed to examine whether pain-inducing musculoskeletal disorders might explain the gender difference in the strength of the self-rated health (SRH)-mortality association.
  
  
  METHODS
  We pooled data from two National Health and Nutrition Examination Surveys (conducted in 1998 and 2001), which were linked to national mortality data of Korea using 13-digit unique personal identification numbers. There were 9,912 study participants, and 456 deaths were recorded (average length of follow-up = 5.7 years). Using a checklist of chronic conditions, the prevalences of major pain-causing musculoskeletal disorders (arthritis, sciatica, and herniated intervertebral disc) were obtained.
  
  
  RESULTS
  The relative risk (RR) of mortality for the poor and very poor categories of SRH tended to be greater in men than in women. Compared with those without musculoskeletal disorders, the RR for those with musculoskeletal disorders was similar in men but lower in women. Women had a greater prevalence of musculoskeletal disorders than men, and women with musculoskeletal disorders reported poorer health than did men with these disorders. In individuals without major musculoskeletal disorders, the strength of the SRH-mortality association was reduced in men but increased in women. Similar patterns in RRs for SRH by gender were observed when sociodemographic characteristics (education and marital status), number of severe chronic illnesses, and health behaviors (cigarette smoking, alcohol consumption, and regular physical exercise) were additionally adjusted for.
  
  
  CONCLUSIONS
  Nonfatal musculoskeletal disorders may explain gender differences in the SRH-mortality association. Larger prospective studies in different cultural settings may help advance our understanding of the role of pain and pain-inducing musculoskeletal disorders in explaining gender differences in the SRH-mortality association.
authors.affiliation: Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea. youngk@amc.seoul.kr
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Khang
authors.forename: Hye Ryun
authors.initials: HR
authors.lastname: Kim
mesh_terms: D000368:Aged; D002423:Cause of Death; D059026:Diagnostic Self Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000401:mortality; D009749:Nutrition Surveys; D010146:Pain / Q000209:etiology / Q000401:mortality; D056910:Republic of Korea; D012737:Sex Factors; D012959:Socioeconomic Factors