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# Internet Use and Self-Rated Health Among Older People: A National Survey

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, PhD , 1 , , PhD 2

(Reviewer), (Reviewer)

Gunther Eysenbach

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### Abstract

##### Background

Older people are among the segments of the population for which the digital divide is most persistent and are considered to be at risk of losing out on the potential benefits that the information society can provide to their quality of life. Little attention has been paid, however, to relationships between Internet use and actual indicators of health among older people.

##### Objective

The aim of this study was to examine the association between Internet use and self-rated health among older people and determine whether this association holds independently of socioeconomic position.

##### Methods

Data were from a survey about the digital divide and quality of life among older people in Spain that was conducted in 2008. The final sample consisted of 709 individuals and was representative of the Spanish adult population in terms of Internet use and sex across two age groups (55-64 and 65-74 years). Multivariate logistic regression analyses were performed to assess the relationship between Internet use and self-rated health.

##### Results

Results initially showed a significant relationship between Internet use and poor self-rated health (Model 1, OR = 0.32, 95% CI 0.16-0.67, P = .002), suggesting that Internet users have better self-rated health than nonusers. This effect remained significant when other sociodemographic variables were entered into the equation (Model 2, OR = 0.39, 95% CI 0.18-0.83, P = .01; Model 3, OR = 0.41, 95% CI 0.19-0.87, P = .02). However, the significant relationship between Internet use and self-rated health disappeared once social class was considered (Model 4, OR = 0.61, 95% CI 0.27-1.37, P = .23).

##### Conclusions

This study suggests that the use of the Internet is not a significant determinant of health among older people once the socioeconomic position of individuals is taken into account.

### Most cited references56

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### Social Implications of the Internet

(2001)
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### Using the Internet for Surveys and Health Research

(2002)
This paper concerns the use of the Internet in the research process, from identifying research issues through qualitative research, through using the Web for surveys and clinical trials, to pre-publishing and publishing research results. Material published on the Internet may be a valuable resource for researchers desiring to understand people and the social and cultural contexts within which they live outside of experimental settings, with due emphasis on the interpretations, experiences, and views of real world' people. Reviews of information posted by consumers on the Internet may help to identify health beliefs, common topics, motives, information, and emotional needs of patients, and point to areas where research is needed. The Internet can further be used for survey research. Internet-based surveys may be conducted by means of interactive interviews or by questionnaires designed for self-completion. Electronic one-to-one interviews can be conducted via e-mail or using chat rooms. Questionnaires can be administered by e-mail (e.g. using mailing lists), by posting to newsgroups, and on the Web using fill-in forms. In "open" web-based surveys, selection bias occurs due to the non-representative nature of the Internet population, and (more importantly) through self-selection of participants, i.e. the non-representative nature of respondents, also called the volunteer effect'. A synopsis of important techniques and tips for implementing Web-based surveys is given. Ethical issues involved in any type of online research are discussed. Internet addresses for finding methods and protocols are provided. The Web is also being used to assist in the identification and conduction of clinical trials. For example, the web can be used by researchers doing a systematic review who are looking for unpublished trials. Finally, the web is used for two distinct types of electronic publication. Type 1 publication is unrefereed publication of protocols or work in progress (a `post-publication' peer review process may take place), whereas Type 2 publication is peer-reviewed and will ordinarily take place in online journals.
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### Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health.

(1997)
Previous studies of variation in the magnitude of socioeconomic inequalities in health between countries have methodological drawbacks. We tried to overcome these difficulties in a large study that compared inequalities in morbidity and mortality between different countries in western Europe. Data on four indicators of self-reported morbidity by level of education, occupational class, and/or level of income were obtained for 11 countries, and years ranging from 1985 to 1992. Data on total mortality by level of education and/or occupational class were obtained for nine countries for about 1980 to about 1990. We calculated odds ratios or rate ratios to compare a broad lower with a broad upper socioeconomic group. We also calculated an absolute measure for inequalities in mortality, a risk difference, which takes into account differences between countries in average rates of illhealth. Inequalities in health were found in all countries. Odds ratios for morbidity ranged between about 1.5 and 2.5, and rate ratios for mortality between about 1.3 and 1.7. For men's perceived general health, for instance, inequalities by level of education in Norway were larger than in Switzerland or Spain (odds ratios [95% CI]: 2.57 [2.07-3.18], 1.60 [1.30-1.96], 1.65 [1.44-1.88], respectively). For mortality by occupational class, in men aged 30-44, the rate ratio was highest in Finland (1.76 [1.69-1.83]), although there was no large difference in the size of the inequality in those countries with data. For men aged 45-59, for whom France did have data, this country had the largest inequality (1.71 [1.66-1.77]). In the age-group 45-64, the absolute risk difference ranked Finland second after France (9.8% [9.1-10.4], 11.5% [10.7-12.4]), with Sweden and Norway coming out more favourably than on the basis of rate ratios. In a scatter-plot of average rank scores for morbidity versus mortality. Sweden and Norway had larger relative inequalities in health than most other countries for both measures; France fared badly for mortality but was average for morbidity. Our results challenge conventional views on the between-country pattern of inequalities in health in western European countries.
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### Author and article information

###### Journal
J Med Internet Res
JMIR
Journal of Medical Internet Research
Gunther Eysenbach (Centre for Global eHealth Innovation, Toronto, Canada )
1438-8871
Oct-Dec 2009
2 December 2009
: 11
: 4
###### Affiliations
2University of Oviedo OviedoSpain
1University of Valencia ValenciaSpain
###### Article
v11i4e49
10.2196/jmir.1311
2802559
19955041
© Enrique Gracia, Juan Herrero. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.12.2009.

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

###### Categories
Original Paper

Medicine