Re: Self-rated health and mortality in older men and women: A time-dependent covariate analysis

Gender differences in the relationship between self-rated health (SRH)
and 6-year mortality risks among the elderly in Japan

Kazushi Okamotoa, , , Yumiko Momoseb, Ayumi Fujinob and Yukari Osawab
aDepartment of Public Health, Aichi Prefectural College of Nursing and
Health, Togoku, Kamishidami, Moriyama-ku, Nagoya 463-8502, Japan
bDepartment of Gerontological Nursing, Aichi Prefectural College of
Nursing and Health, Togoku, Kamishidami, Moriyama-ku, Nagoya 463-8502,
Japan
Received 24 April 2007; revised 10 August 2007; accepted 22 August
2007. Available online 23 October 2007.

Abstract
The purpose of this study was to investigate the relationship between
SRH and mortality among 784 non-institutionalized community-living
elderly in Japan from 1995 to 2001. The data were collected by face-to-
face interviews. The direct effect was estimated by the ratio of
regression coefficient of two adjacent models (full model entered all
covariates to total effect of SRH), and composed of the direct and
indirect effect. Cox analysis stratified by gender was employed to
examine the relationship between SRH and mortality. At follow-up in
2001, 148 (18.9%) died, and 636 (81.1%) were alive. Mortality rates
were significantly increased with worsening SRH responses for men, but
not for women. Men had a significant dose-response association between
SRH and mortality, in comparison with fair or poor SRH, the odds ratio
for good SRH were multiplied by 0.63 and 0.48, respectively. The
magnitude of the direct effect of SRH on mortality was much larger in
men (95.7%) than in women (52.5%). These findings suggest that SRH may
be more strongly and directly associated with mortality in men,
compared to women. Further researches are needed to explore the
relationship between the changes in SRH and mortality among elderly
people.

Corresponding author. Tel.: +81 52 736 1401; fax: +81 52 736 1415.

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