SOCIOECONOMIC-FACTORS, PERCEIVED CONTROL AND SELF-REPORTED HEALTH IN RUSSIA - A CROSS-SECTIONAL SURVEY

Russia has the lowest life expectancy among industrialised countries, but little is known about other health outcomes and determinants of he alth in the Russian population. Here we report a cross-sectional study in a national sample of the Russian population of social and psychoso cial determinants of two self-reported health indicators: self rated h ealth (shown to predict mortality in prospective studies) and physical functioning (validated against more objective health measures). A mul ti-stage sample of the Russian population aged 18 years and more was i nterviewed (n = 1599, response rate 66%). The questionnaire included p olitical attitudes, social and economic circumstances, psychosocial fa ctors, smoking, alcohol consumption, self-rated health and physical fu nctioning (from the SF36 instrument). Scores of perceived control over life and over one's health were calculated from 6 and 3 questions, re spectively. Data were analysed in logistic regression for two dichotom ised outcomes: poor self-rated health (worse than average) and low phy sical functioning (less than 60% of maximum). Overall, 25% of subjects rated their health as worse than average; this is substantially more than in western countries. Perceived control over life was strongly re lated to both outcomes; age- and sex-adjusted OR for 1 standard deviat ion increase in control were 0.60 (95% CI 0.52-0.69) for Door self-rat ed health and 0.67 (0.57-0.81) for low physical functioning. Adjustmen t ibr a battery of other factors reduced these estimates only slightly . Associations between control over one's health and both outcomes wer e also significant, but weaker and attenuated in multivariate models. Material deprivation was also strongly related to both outcomes. Educa tion was inversely related to self-rated health, and unmarried men rep orted poor physical functioning substantially more often. Subjects; no t approving the economic changes reported poorer health but this assoc iation was removed by adjustment for socioeconomic factors and control . Subjects who could not rely on informal social structures when in pr oblems reported worse health; this effect largely persisted in multiva riate analyses. These results are consistent with the hypothesis that poor health status in Russia is related to dysfunction of social struc tures, socioeconomic deprivation, and lack of perceived control. The a bsence of informal social networks, vital for maintaining general welf are, seems to affect adversely self-rated health. Deprivation and low perceived control may be important mediators between the broad social environment and health in populations undergoing transition and can pr ovide a useful framework for many biological and behavioural factors. Prospective studies are needed to address the issue of temporality and reporting bias, the major problems in interpreting these findings. (C ) 1998 Elsevier Science Ltd. All rights reserved.