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      Social Determinants of Self-reported Health Among Population in Republic of Macedonia – Results from a Case-control Study



      Materia Socio-Medica

      AVICENA, d.o.o., Sarajevo

      self-rated health, social determinants, Macedonia

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          Studying self-reported health is considered an indicator for morbidity and mortality that may be used in primary health care to detect poor health in certain population groups that predicts health care utilization.


          The goal of the survey is to assess the socioeconomic self-rated health gradient and to describe contribution of behavioral risk factors to this gradient among population in Republic of Macedonia.

          Material and methods:

          Data is collected through a “nested case-control study”, conducted in the period March – December, 2013. “Cases” are households with TB patient(s) registered in the period July, 2012 – June, 2013 and “controls” are households randomly chosen in cases’ immediate vicinity.


          The total study population is 562 households with total of 2720 respondents. Self-rated health was reported as excellent or good by only half of the respondents, with slightly less positive answers among cases compared to controls and evident differences in responses for poor or extreme difficulties in everyday life. Positive association was found between poor rated health and long-standing diseases and education was associated with poor self-rated health. Adding questions on mobility, self-care, pain, cognition, interpersonal activities and affect has only reaffirmed the findings, with statistically significant differences among study groups along all six dimensions.


          The ease of use of simple questions to ask for self-rated health makes it an extremely beneficial tool in health care planning.

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          Most cited references 21

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          Self-rated health and mortality: a review of twenty-seven community studies.

          We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.
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            Which is the correct statistical test to use?

            This paper explains how to select the correct statistical test for a research project, clinical trial, or other investigation. The first step is to decide in what scale of measurement your data are as this will affect your decision-nominal, ordinal, or interval. The next stage is to consider the purpose of the analysis-for example, are you comparing independent or paired groups? Several statistical tests are discussed with an explanation of when it is appropriate to use each one; relevant examples of each are provided. If an incorrect test is used, then invalid results and misleading conclusions may be drawn from the study.
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              Socioeconomic factors, material inequalities, and perceived control in self-rated health: cross-sectional data from seven post-communist countries.

               M Marmot,  H Pikhart,  M Bobak (2000)
              This study examined the association between perceived control and several socioeconomic variables and self-rated health in seven post-communist countries (Russia, Estonia, Lithuania, Latvia, Hungary, Poland, Czech Republic). Questionnaire interviews were used to collect data on self-rated health in the last 12 months, education, marital status, perceived control based on nine questions, and material deprivation based on availability of food, clothing and heating. For each population, two ecological measures of material inequalities were available: an inequality score estimated from the survey data as the distance between the 90th and 10th percentiles of material deprivation, and Gini coefficient from published sources. Data on 5330 men and women aged 20-60 were analysed. Prevalence of poor health (worse than average) varied between 8% in Czechs and 19% in Hungarians. The age-sex-adjusted odds ratio for university vs primary education was 0.36 (0.26-0.49); odds ratios per 1 standard deviation increase in perceived control and in material deprivation were 0.58 (95% CI 0.48-0.69) and 1.51 (1.40-1.63), respectively. The odds ratio for an increase in inequality equivalent to the difference between the most and the least unequal populations was 1.49 (0.88-2.52) using the material inequality score and 1.41 (0.91-2.20) using the Gini coefficient. No indication of an effect of either inequality measure was seen after adjustment for individuals' deprivation or perceived control. The results suggest that, as in western populations, education and material deprivation are strongly related to self-rated health. Perceived control appeared statistically to mediate some of the effects of material deprivation. The non-significant effects of both ecological measures of inequality were eliminated by controlling for individuals' characteristics.

                Author and article information

                Mater Sociomed
                Mater Sociomed
                Materia Socio-Medica
                AVICENA, d.o.o., Sarajevo (Bosnia and Herzegovina )
                August 2014
                26 August 2014
                : 26
                : 4
                : 264-267
                [1 ]Department of Social Medicine, Faculty of Medicine, University of Ss Cyril and Methodius, Skopje, Republic of Macedonia
                Author notes
                Corresponding author: Dance Gudeva Nikovska, MD, MPH, Department of Social Medicine, Faculty of Medicine, University of Ss Cyril and Methodius, Skopje, Republic of Macedonia, Phone/Fax: +389 23 177983 e-mail: dgnikovska@ 123456gmail.com
                Copyright: © AVICENA

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Original Paper

                self-rated health, social determinants, macedonia


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