The Perceived Health Status from Young Adults to Elderly: Results of the MEHM Questionnaire within the CUORE Project Survey 2008–2012
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Extraction and Pre-Processing
- Q1 (MEHM Item 1, general health status). The question “How is your health in general?” had five possible answer categories: very good; good; fair; bad; and very bad. In order to comply with the requirement of homogeneity of data processing, the order of the 5 answers was inverted to obtain a score of increasing rather than decreasing satisfaction, i.e., very bad perception of health status; bad perception of health status; neither good nor bad; good; very good;
- Q2 (MEHM Item 2, chronic morbidity). The question “Do you have any long-standing illness or health problem?” had two possible answers: yes (long-standing compromised health status) or no (uncompromised health status); with respect to the meaning of “long-standing”, it was explained that it should be understood as a period of not less than 6 months;
- Q3 (MEHM Item 3, activity limitations). The question “For at least the past 6 months, to what extent have you been limited because of a health problem in activities people usually do? Would you say you have been …” had three possible answers: severely limited; limited but not severely; not limited at all. The answers were organized on the basis of an increasing satisfaction score.
- The season, referring to the month in which the questionnaire was administered and codified from 1 January to 12 December;
- The marital status of the participant collected through a face-to-face questionnaire, classified as single, never married; married or cohabiting; separated or divorced; widow/widower;
- The participant’s level of education collected through a face-to-face questionnaire, classified as bachelor’s degree, master’s degree or PhD; high school diploma; lower secondary school licence; primary school licence; level of education lower than primary school.
2.2. Data Processing and Statistical Analysis
3. Results
3.1. Analysis of Age and Gender Groups
- women showed a worse perception of their health status than men at any age (negative perception of general health status (Q1) ranging from 19 to 62% for women and 9 to 46% for men) and there was a greater slope from younger to older age (43% and 37% for women and 37% for men, respectively); as a result, half of the women interviewed (50%) reported a negative perceived health status at the age of 65–69, i.e., ten years earlier than men (Figure 1);
- a relevant prevalence of chronic morbidity (Q2: 24 and 16% in women and men respectively) and activity limitations (Q3: 17 and 15% in women and men respectively) was found even among young adults (35–39 years old), which is quite remarkable in the general population;
- for both genders, 8 multiple comparisons were required to detect statistically significant differences of all MEHM items by age groups. Specifically, a first significant difference was found between the 35–39 group and the 50–54 group, and a second one between the 50–54 and the 65–69 groups; a third one was finally found between the 65–69 group and the oldest group, but only for general health status and activity limitations (Figure 1);
- differences were almost linearly distributed with respect to age groups in both women and men.
3.2. Global Analysis on Environmental and Demographic Factors
4. Discussion
Strengths and Limitations
- -
- unbalanced number of urban and rural samples;
- -
- easonality; in each region, the data collection took place in the same season, but the latitude of the various regions is different, which can potentially influence the association of MEHM with seasonality; however, the distributions of questionnaires in hot and cold seasons was quite balanced for both women and men (51% vs. 49%), moreover the geographical areas were fairly homogeneously represented for the hot season, and also for the cold season if we consider that in Italy the cold season is quite similar in the central and southern regions;
- -
- different living conditions, experience, expectations in the oldest and youngest groups—including the effect of the age cohort—which may have affected comparisons;
- -
- the subgroups provided by urban/rural, married/single, high/low level of education do not always have a similar distribution in terms of age and gender, as these characteristics could not be known in advance;
- -
- the cross-sectional design of the study does not allow to assess the causality of the associations between factors;
- -
- the lack of information on the accessibility of health care facilities may have influenced the perceived health status, even though this aspect could be partly included in the level of education;
- -
- potential bias may have derived from the design of the study, which required participants to “come to the examination room”. Non-respondents may have had various reasons for refusing, among which mobility limitations due to health condition, feeling of a healthy or “already under control” status, opposite feeling of being “too sick or too fearful to attend a screening”, or simply lack of availability for the screening for practical/working reasons; furthermore the perceived relevance or sensitivity of the topic may affect participation.
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Women | Men | |||||||
---|---|---|---|---|---|---|---|---|
Age Group (Years) | N | Median | 25° Perc | 75° Perc | N | Median | 25° Perc | 75° Perc |
35–39 | 242 | 37 | 36 | 39 | 267 | 37 | 36 | 38 |
40–44 | 320 | 42 | 41 | 43 | 279 | 42 | 41 | 43 |
45–49 | 288 | 47 | 46 | 48 | 269 | 47 | 46 | 48 |
50–54 | 293 | 52 | 51 | 53 | 273 | 52 | 51 | 54 |
55–59 | 281 | 57 | 56 | 58 | 272 | 57 | 56 | 58 |
60–64 | 284 | 62 | 61 | 63 | 309 | 62 | 61 | 63 |
65–69 | 265 | 67 | 66 | 68 | 285 | 67 | 66 | 68 |
70–74 | 233 | 72 | 71 | 73 | 235 | 72 | 71 | 73 |
75–79 | 181 | 77 | 76 | 78 | 222 | 77 | 76 | 78 |
Tot (35–79) | 2387 | 55 | 45 | 66 | 2411 | 57 | 46 | 67 |
Geographical Area of ITALY | Factor | WOMEN | MEN | Factor | WOMEN | MEN |
---|---|---|---|---|---|---|
URBAN | RURAL | |||||
northern | 866 | 870 | 218 | 218 | ||
central | 310 | 327 | 118 | 116 | ||
southern | 875 | 880 | 0 | 0 | ||
total | 2051 (86%) | 2077 (86%) | 336 (14%) | 334 (14%) | ||
HOT | COLD | |||||
northern | 423 | 430 | 661 | 658 | ||
central | 428 | 443 | 0 | 0 | ||
southern | 373 | 355 | 502 | 525 | ||
total | 1224 (51%) | 1228 (51%) | 1163 (49%) | 1183 (49%) | ||
HIGH ED | LOW ED | |||||
northern | 528 | 568 | 556 | 520 | ||
central | 226 | 220 | 202 | 223 | ||
southern | 420 | 463 | 455 | 417 | ||
total | 1174 (49%) | 1251 (52%) | 1213 (51%) | 1160 (48%) | ||
MARRIED | SINGLE | |||||
northern | 751 | 879 | 333 | 209 | ||
central | 304 | 351 | 124 | 92 | ||
southern | 682 | 779 | 193 | 101 | ||
total | 1737 (73%) | 2009 (83%) | 650 (27%) | 402 (17%) |
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Intercept | Age 40–44 | Age 45–49 | Age 50–54 | Age 55–59 | Age 60–64 | Age 65–69 | Age 70–74 | Age 75–79 | Q2 | Q3 | Education | Marital Status | Season | Context | |||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
General health status (Q1) a | W | OR | 0.14 *** | 1.12 | 1.21 | 2.03 *** | 2.52 *** | 2.24 *** | 3.06 *** | 4.46 *** | 4.42 *** | 2.29 *** | 1.14 | 1.15 | 1.13 | ||
W | 95% CI | 0.09; 0.22 | 0.74; 1.72 | 0.79; 1.87 | 1.35; 3.08 | 1.68; 3.81 | 1.49; 3.39 | 2.03; 4.65 | 2.91; 6.93 | 2.81; 7.06 | 1.89; 2.77 | 0.92; 1.39 | 0.96; 1.39 | 0.87; 1.47 | |||
M | OR | 0.07 *** | 1.11 | 1.68 | 2.23 ** | 3.27 *** | 3.73 *** | 4.51 *** | 6.70 *** | 6.84 *** | 1.76 *** | 1.20 | 1.00 | 1.16 | |||
M | 95% CI | 0.04; 0.11 | 0.62; 2.00 | 0.98; 2.93 | 1.33; 3.82 | 1.99; 5.52 | 2.31; 6.22 | 2.78; 7.55 | 4.11; 11.28 | 4.17; 11.59 | 1.43; 2.17 | 0.92; 1.57 | 0.82; 1.22 | 0.87; 1.56 | |||
Chronic morbidity (Q2) a | W | OR | 0.22 *** | 0.87 | 1.12 | 1.72 ** | 1.93 *** | 2.16 *** | 2.39 *** | 2.91 *** | 2.85 *** | 1.25 * | 1.13 | 1.37 * | 1.10 | ||
W | 95% CI | 0.15; 0.32 | 0.58; 1.30 | 0.75; 1.67 | 1.18; 2.53 | 1.32; 2.85 | 1.48; 3.19 | 1.62; 3.55 | 1.94; 4.39 | 1.85; 4.42 | 1.03; 1.51 | 0.92; 1.37 | 1.15; 1.64 | 0.86; 1.42 | |||
M | OR | 0.14 *** | 1.06 | 1.69 * | 2.36 *** | 2.85 *** | 2.89 *** | 4.39 *** | 4.76 *** | 5.36 *** | 0.93 | 1.36 * | 1.16 | 1.23 | |||
M | 95% CI | 0.09; 0.21 | 0.67; 1.67 | 1.10; 2.60 | 1.56; 3.59 | 1.90; 4.34 | 1.94; 4.35 | 2.94; 6.67 | 3.13; 7.31 | 3.50; 8.32 | 0.77; 1.12 | 1.07; 1.73 | 0.97; 1.38 | 0.95; 1.61 | |||
Activity limitations (Q3) a | W | OR | 0.11 *** | 0.97 | 1.48 | 1.74 * | 2.35 *** | 2.46 *** | 3.14 *** | 4.40 *** | 6.43 *** | 1.55 *** | 1.24 * | 1.55 *** | 1.21 | ||
W | 95% CI | 0.07; 0.17 | 0.62; 1.53 | 0.96; 2.30 | 1.14; 2.68 | 1.55; 3.62 | 1.62; 3.79 | 2.06; 4.85 | 2.85; 6.89 | 4.04; 10.39 | 1.27; 1.88 | 1.01; 1.52 | 1.29; 1.87 | 0.92; 1.58 | |||
M | OR | 0.11 *** | 0.93 | 1.35 | 1.79 ** | 1.89 ** | 2.19 *** | 2.96 *** | 4.08 *** | 4.38 *** | 1.41 *** | 1.06 | 1.32 ** | 1.20 | |||
M | 95% CI | 0.07; 0.18 | 0.58; 1.50 | 0.86; 2.14 | 1.17; 2.79 | 1.23; 2.93 | 1.45; 3.36 | 1.95; 4.55 | 2.67; 6.34 | 2.84; 6.86 | 1.16; 1.71 | 0.82; 1.37 | 1.09; 1.60 | 0.91; 1.58 | |||
General health status (Q1) b | W | OR | 0.12 *** | 2.69 *** | 5.17 *** | 2.72 *** | 1.13 | 0.94 | 1.07 | ||||||||
W | 95% CI | 0.08; 0.17 | 2.17; 3.33 | 4.15; 6.44 | 2.22; 3.33 | 0.90; 1.41 | 0.77; 1.15 | 0.80; 1.44 | |||||||||
M | OR | 0.08 *** | 3.42 *** | 4.24 *** | 2.32 *** | 1.01 | 0.89 | 1.01 | |||||||||
M | 95% CI | 0.05; 0.11 | 2.70; 4.32 | 3.36; 5.37 | 1.87; 2.90 | 0.75; 1.34 | 0.72; 1.11 | 0.74; 1.39 | |||||||||
General health status (Q1) c | W | OR | 0.09 *** | 1.19 | 1.06 | 1.71 * | 1.94 ** | 1.60 * | 2.08 ** | 2.75 *** | 2.31 ** | 2.58 *** | 4.77 *** | 2.26 *** | 1.05 | 0.93 | 1.07 |
W | 95% CI | 0.05; 0.14 | 0.75; 1.90 | 0.66; 1.71 | 1.09; 2.71 | 1.24; 3.07 | 1.02; 2.52 | 1.31; 3.32 | 1.71; 4.48 | 1.39; 3.88 | 2.07; 3.21 | 3.82; 5.98 | 1.82; 2.80 | 0.83; 1.31 | 0.76; 1.14 | 0.80; 1.44 | |
M | OR | 0.04 *** | 1.14 | 1.49 | 1.74 | 2.54 *** | 2.86 *** | 2.88 *** | 4.07 *** | 3.94 *** | 3.07 *** | 3.99 *** | 1.44 *** | 1.12 | 0.88 | 1.03 | |
M | 95% CI | 0.02; 0.07 | 0.61; 2.13 | 0.83; 2.70 | 1.00; 3.09 | 1.49; 4.47 | 1.70; 4.95 | 1.71; 5.00 | 2.38; 7.13 | 2.30; 6.94 | 2.42; 3.89 | 3.15; 5.06 | 1.84; 2.32 | 0.83; 1.51 | 0.70; 1.10 | 0.75; 1.46 |
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Giacomozzi, C.; Palmieri, L.; Gargiulo, L.; Lo Noce, C.; Iannucci, L.; Di Lonardo, A.; Vannucchi, S.; Onder, G.; Colivicchi, F.; Giampaoli, S.; et al. The Perceived Health Status from Young Adults to Elderly: Results of the MEHM Questionnaire within the CUORE Project Survey 2008–2012. Int. J. Environ. Res. Public Health 2020, 17, 6160. https://doi.org/10.3390/ijerph17176160
Giacomozzi C, Palmieri L, Gargiulo L, Lo Noce C, Iannucci L, Di Lonardo A, Vannucchi S, Onder G, Colivicchi F, Giampaoli S, et al. The Perceived Health Status from Young Adults to Elderly: Results of the MEHM Questionnaire within the CUORE Project Survey 2008–2012. International Journal of Environmental Research and Public Health. 2020; 17(17):6160. https://doi.org/10.3390/ijerph17176160
Chicago/Turabian StyleGiacomozzi, Claudia, Luigi Palmieri, Lidia Gargiulo, Cinzia Lo Noce, Laura Iannucci, Anna Di Lonardo, Serena Vannucchi, Graziano Onder, Furio Colivicchi, Simona Giampaoli, and et al. 2020. "The Perceived Health Status from Young Adults to Elderly: Results of the MEHM Questionnaire within the CUORE Project Survey 2008–2012" International Journal of Environmental Research and Public Health 17, no. 17: 6160. https://doi.org/10.3390/ijerph17176160