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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
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Medicina 2017, 53(2), 114-121; (registering DOI)

Ethnic variation in self-rated health–mortality association: Results from a 17-year follow-up study in Estonia

1,2,3,* and 3,4
Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
Institute of Social Studies, University of Tartu, Tartu, Estonia
Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
Author to whom correspondence should be addressed.
Received: 15 September 2016 / Revised: 1 March 2017 / Accepted: 13 April 2017 / Published: 2 May 2017
PDF [487 KB, uploaded 26 February 2018]


Background and aim: Previous research has highlighted the role of self-rated health (SRH) as an important predictor of mortality. With substantial ethnic differences in SRH and mortality reported in Estonia, this study aims to examine the ethnic variation in SRH–mortality association in this setting.Materials and methods: The baseline data come from the nationally representative 1996 Estonian Health Interview Survey. Individual records of 3983 respondents in the 25–79 age group were linked with mortality data with 17 years follow-up time. The association between SRH and all-cause mortality was analyzed using the Cox regression for two ethnic groups and separately for men and women.Results: Among ethnic Estonians, both men and women with bad or very bad SRH had about 60% higher mortality compared to those with good or very good SRH even after adjustment for age, socioeconomic and health-related variables. In contrast, SRH did not predict mortality among non-Estonian men and women. A strong and universal inverse association with mortality was found for personal income. Education (among men) and occupation (among women) predicted mortality only among non-Estonians, whereas ever smoking was associated with mortality in Estonian men and women. Overweight women had lower mortality risk compared to women in normal weight category.Conclusions: We found considerable ethnic variation in SRH–mortality association and in socioeconomic predictors of mortality. Further research, preferably focusing on causespecific mortality and reporting heterogeneity of SRH could potentially shed further light on ethnic differences in SRH–mortality association in Estonia and more generally on socioeconomic inequalities in mortality in Eastern Europe.
Keywords: Self-rated health; Mortality; Health inequality; Ethnicity; Estonia Self-rated health; Mortality; Health inequality; Ethnicity; Estonia
This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License (CC BY-NC-ND) (CC BY-NC-ND).

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Reile, R.; Leinsalu, M. Ethnic variation in self-rated health–mortality association: Results from a 17-year follow-up study in Estonia. Medicina 2017, 53, 114-121.

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