title: Sex/gender and socioeconomic differences in the predictive ability of self-rated health for mortality.
abstract: BACKGROUND
  Studies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups.
  
  
  RESULTS
  The analyses in the study were based on the Aichi Gerontological Evaluation Study's (AGES) 2003 Cohort Study in Chita Peninsula, Japan, which followed the four-year survival status of 14,668 community-dwelling people who were at least 65 years old at the start of the study. We first examined sex/gender and education-level differences in association with fair/poor SRH. We then estimated the sex/gender- and education-specific hazard ratios (HRs) of mortality associated with lower SRH using Cox models. Control variables, including health behaviors (smoking and drinking), symptoms of depression, and chronic co-morbid conditions, were added to sequential regression models. The results showed men and women reported a similar prevalence of lower SRH. However, lower SRH was a stronger predictor of mortality in men (HR = 2.44 [95% confidence interval (CI): 2.14-2.80]) than in women (HR = 1.88 [95% CI: 1.44-2.47]; p for sex/gender interaction = 0.018). The sex/gender difference in the predictive ability of SRH was progressively attenuated with the additional introduction of other co-morbid conditions. The predictive ability among individuals with high school education (HR = 2.39 [95% CI: 1.74-3.30]) was similar to that among individuals with less than a high school education (HR = 2.14 [95% CI: 1.83-2.50]; p for education interaction = 0.549).
  
  
  CONCLUSIONS
  The sex/gender difference in the predictive ability of SRH for mortality among this elderly Japanese population may be explained by male/female differences in what goes into an individual's assessment of their SRH, with males apparently weighting depressive symptoms more than females.
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, United States of America. anishi@hsph.harvard.edu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Kokoro
authors.initials: K
authors.lastname: Shirai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hirai
authors.forename: Seungwon
authors.initials: S
authors.lastname: Jeong
authors.forename: Katsunori
authors.initials: K
authors.lastname: Kondo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D007564:Japan; D008297:Male; D011237:Predictive Value of Tests; D012649:Self Concept; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis