Social and psychosocial determinants of self-rated health in seven countries of Central and Eastern Europe
Life expectancy in countries of Central and Eastern Europe (CCEE) is substantially shorter than in Western Europe, and similar divide exists in self-rated health. The project described in this thesis was set up to study the effects of socio-economic factors (such as material deprivation, education and inequalities) and psychosocial factors (perceived control, psychosocial work environment) on self-rated health (a predictor of mortality in prospective studies). Cross-sectional surveys were conducted in seven CCEE: Russia, Lithuania, Latvia, Estonia, Poland, Czech Republic and Hungary. Data were collected by interviews in randomly selected national samples in all seven countries (total 7,599 subjects), and by questionnaires in random community samples in 4 countries (total 6,642 subjects). The data included socio-economic and psychosocial factors, self-rated health (SRH) and behavioural risk factors. Overall, 17% of men and 23% of women rated their health as worse than average. In the national samples, perceived control, material deprivation and education were strongly related to poor SRH. In the pooled data, adjusted odds ratio (OR) of poor health for 1 standard deviation (SD) increase in perceived control was 0.59 (95% Cl 0.54-0.63). The OR for 1 SD increase in the material deprivation score was 1.35 (95% Cl 1.26-1.46). The ORs for vocational, secondary and university education, compared with primary education, were 0.75,0.58 and 0.53, respectively. We also examined the ecological effects of income inequality; the OR for the most versus the least unequal populations (using the Gini coefficient of income inequality) was 1.88 (95% Cl 1.55-2.28). In multivariate analyses, however, the effect of inequality was eliminated by adjustment for material deprivation and perceived control. In the community samples, the results were similar. Among psychosocial factors at work, the effort-reward imbalance appeared to be the strongest predictor of self-rated health; work variety was also a predictor of self-rated health. Job strain was not associated with SRH. Our results suggest that (a) the prevalence of poor SRH in CCEE is high, and (b) socioeconomic and psychosocial factors are strongly related to self-rated health in these populations. The gradients were present in all populations, and were of the same direction and similar magnitude as in the West. Prospective studies are needed to address the problems of temporality and reporting bias, which are the major problems of these results.