Gender differences in the relationship between self-rated health and mortality among older adults in Taiwan

Background: Although the relationship between self-rated health and mortality has been well established, the mechanisms of this association remain unclear. Growing evidence of the influence of neighborhood socioeconomic (SES) on individual health lead us to posit that these characteristics may mediate the association between self-rated health and mortality among older adults in Taiwan. We also posit that this pathway may differ among men and women, and subsequently assess gender differences in the interrelationships between neighborhood SES, perceived health, and mortality. Methods: This investigation is based on secondary analysis of existing data from the Taiwan Longitudinal Study on Aging, a population-based sample of older adults aged 65-74 surveyed over 14 years (N=1,720). Baseline self-rated health was dichotomized as poor versus good health. Baseline neighborhood SES indicators included the average area-level income disparity, ethnic stratification, and proportion of households with a motor vehicle. Multilevel logistic regressions are used to estimate all models. Results: Preliminary results show that self-assessed poor health strongly predicts subsequent mortality, particularly for men (OR= 2.71; p<0.001) versus women (OR= 2.19; p<0.001). Multilevel modeling indicated that neighborhood SES significantly predicts mortality of women, but not men, and this effect is independent of the self-rated health and mortality relationship. Conclusions: These findings underscore the importance of assessing neighborhood characteristics as predictors of health and mortality among older adults, and the differences between males and females in the influence of these predictors. Further analyses will examine the influence of individual SES and behavioral covariates on these relationships.