Positive self-perceived health markers in the older adult population in Brazil

A quantitative and descriptive study using data from the Brazilian National Health Survey conducted in 2013. This survey constituted a weighted sample of 11.8 million older people living in Brazil. The outcome variable analyzed is self-perceived health, and was categorized as positive and negative. The independent variables contemplate three dimensions: sociodemographic, lifestyle and health aspects. The analyzes were presented as Odds Ratio obtained by applying the binary logistic regression model.

Results:

The results show, for both men and women, that having declared themselves white, not having chronic illnesses or functional disabilities, having a healthier lifestyle (never having smoked and having participated in religious social interaction activities more frequently) and higher levels of education contribute to the chances of a better perception of health being greater. Older people with complete high school and incomplete higher education were three times more likely to have a positive perception of health than those without complete elementary school.

Conclusion:

This study identified the social determinants of health of older persons and the relationship with a positive perception of health. Identifying and analyzing these associations are important points for the elaboration of specific public policies, aiming at equity and health promotion.

Keywords
Aging; Population health; Self concept; Aged Social determinants of health; Brazil

Sociodemographic variables		Sex/self-perceived health
		Male			Female
		Positiva %	Negativa %	Total %	Positiva %	Negativa %	Total %
Region
	North	5	10	6	4	6	5
	Northeast	20	33	23	19	38	23
	Southeast	15	14	15	16	15	16
	South	7	7	7	6	7	6
	Center-West	53	35	50	55	34	50
Age group
	60 to 64 years old	32	27	31	37	30	35
	65 to 69 years old	31	32	31	29	30	29
	70 to 74 years old	17	11	16	13	15	13
	75 to 79 years old	11	18	12	13	13	13
	Over 80 years old	9	13	10	8	11	9
Ethnicity/color
	White	58	30	53	59	39	55
	Black	40	70	45	39	59	44
	Asian/Indigenous	2	0	2	1	2	2
Education
	Up to incomplete elementary school	60	88	65	58	86	64
	Complete elementary school and incomplete high school	9	6	8	8	4	7
	Complete high school and incomplete higher education	13	5	12	18	7	15
	Complete higher education	18	1	15	16	3	13
Total		100	100	100	100	100	100

Variáveis de estilo de vida		Sexo/Autopercepção da saúde
		Masculino			Feminino
		Positiva %	Negativa %	Total %	Positiva %	Negativa %	Total %
Bebidas alcóolicas
	Não consome	53	78	58	81	94	84
	Menos de 1 vez por mês	12	10	12	9	2	7
	Uma ou mais vezes por mês	35	12	31	10	4	9
Tabagismo
	Nunca fumou	41	32	40	70	64	68
	Fumante	15	23	17	11	12	11
	Ex-fumante	44	44	44	19	24	21
Atividades religiosas
	Não frequenta	37	38	37	20	30	22
	Raramente frequenta	22	24	22	16	17	16
	Frequentemente	42	38	41	65	52	62
Total		100	100	100	100	100	100

Quantidade de doenças crônicas não transmissíveis e Capacidade Funcional		Sexo/Autopercepção da saúde
		Masculino			Feminino
		Positiva %	Negativa %	Total %	Positiva %	Negativa %	Total %
Doenças crônicas não transmissíveis
	Nenhuma	39	12	34	32	4	26
	Uma	32	32	32	30	14	27
	Duas a três	25	37	27	31	46	35
	Quatro ou mais	4	18	7	6	36	13
Capacidade funcional
	Dependente AIVD	1	13	3	4	15	7
	Dependente AVD e AIVD	0	1	0	0	3	1
	Independente	99	86	97	96	81	93
Total		100	100	100	100	100	92,5

Variables		Final model – male and female older adults
		Final model – Male		Final model - Female
		OR	95% CI	OR	95% CI
Age		1,00^NS	(0,97;1,03)	1,01^NS	(0,99;1,04)
Ethnicity/color (White ref.)
	Black	0,37^* ***** p value <0.001; NS: not significant.	(0,23;0,60)	0,64^* * p value <0.05;	(0,45;0,92)
	Asian/Indigenous	5,16^* * p value <0.05;	(1,19;22,37)	0,33^NS	(0,10;1,03)
Region of residence (Southeast ref.)
	North	3,63^ p value <0.01;	(0,17;0,76)	0,40^* ***** p value <0.001; NS: not significant.	(0,22;0,70)
	Northeast	3,91^* ***** p value <0.001; NS: not significant.	(0,24;6,43)	0,36^* ***** p value <0.001; NS: not significant.	(0,23;0,54)
	South	0,60^NS	(0,32;1,14)	0,64^NS	(0,38;1,07)
	Center-West	0,63^NS	(0,34;1,18)	0,62^* * p value <0.05;	(0,39;0,98)
Education (Up to incomplete elementary school ref.)
	Complete elementary school and incomplete high school	2,15^NS	(0,97;4,76)	2,59^* ***** p value <0.001; NS: not significant.	(1,59;4,20)
	Complete high school and incomplete higher education	3,30^* ***** p value <0.001; NS: not significant.	(1,69;6,42)	3,181^ p value <0.01;	(1,50;6,72)
	Complete higher education	28,15^* ***** p value <0.001; NS: not significant.	(9,81;80,80)	6,06^* ***** p value <0.001; NS: not significant.	(3,01;12,20)
Alcohol beverage consumption (Do not consume ref.)
	Less than once a month	1,35^NS	(0,75;2,42)	3,14^* ***** p value <0.001; NS: not significant.	(1,68;5,87)
	Once or more times a week	3,35^* ***** p value <0.001; NS: not significant.	(2,04;5,50)	1,87^NS	(0,87;4,04)
Smoking (Never smoked)
	Smoker	0,48^* * p value <0.05;	(0,27;0,86)	-	-
	Former smoker	0,85^NS	(0,50;1,45)	-	-
Religious activities (Usual ref.)
	Do not attend	0,52^* * p value <0.05;	(0,32;0,85)	0,40^* ***** p value <0.001; NS: not significant.	(0,27;0,58)
	Rarely	0,73^NS	(0,40;1,33)	0,570^ p value <0.01;	(0,38;0,86)
Chronic non-communicable diseases (No disease ref.)
	One disease	0,23^* ***** p value <0.001; NS: not significant.	(0,13;0,40)	0,32^* ***** p value <0.001; NS: not significant.	(0,19;0,52)
	Two to three diseases	0,11^* ***** p value <0.001; NS: not significant.	(0,06;0,20)	0,08^* ***** p value <0.001; NS: not significant.	(0,54;0,13)
	Four diseases and over	0,02^* ***** p value <0.001; NS: not significant.	(0,01;0,05)	0,02^* ***** p value <0.001; NS: not significant.	(0,10;0,35)
Functional capacity (Independent ref.)
	ADL and IADL dependent	0,07^* ***** p value <0.001; NS: not significant.	(0,02;0,19)	0,37^* * p value <0.05;	(0,18;0,74)
	IADL dependent	0,09^NS	(0,01;1,14)	0,10^* ***** p value <0.001; NS: not significant.	(0,03;0,36)

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Marília Miranda Forte Gomes, E-mail: mariliamfg@gmail.com