Determinants of self-rated health among elderly persons in São Paulo, Brazil

To investigate the influence that demographic determinants, socioeconomic determinants, chronic diseases, and functional capacity have on self-rated health among elderly persons (60 years and older) living in the city of São Paulo, São Paulo, Brazil, and to investigate the existence of differences between men and women in terms of their self-rated health. The study was carried out using data collected in the city of São Paulo as part of a project called Health, Well-being, and Aging in Latin America and the Caribbean (the "SABE project"). We analyzed data on 2,135 elderly individuals (58.6% women; mean age, 69.4 years; median age, 68.0 years). The dependent variable was self-rated health (good or poor). The following independent variables were considered: (1) demographic ones (age, sex, marital status, and living arrangements (whether the elderly person lived alone or with others)), (2) socioeconomic ones (schooling and income), (3) the number of chronic diseases (hypertension, arthritis or rheumatism, cardiovascular disease, diabetes, asthma, bronchitis or emphysema, embolism or stroke, and cancer), and (4) functional capacity. To estimate the association between self-rated health and the independent variables and to study gender differences, a multiple binary logistic regression analysis was performed. The presence of chronic diseases in association with gender was the strongest determinant of self-rated health among the elderly in São Paulo. Among men with four or more chronic diseases, they were 10.53 times as likely to characterize their health as poor; among women with four or more chronic diseases, the ratio was 8.31. Functional capacity, schooling, and income were also strongly associated with self-rated health, and the influence of age was significant. The elderly women were more likely to report good self-rated health than were men when the women or men either had no chronic diseases or had two or more. Our results indicate the need for simultaneous, comprehensive actions in the health sector, social services, and the economic sector to address the main determinants of self-rated health in order to promote well-being and quality of life among the elderly.