Self-reported health status and health determinants in low income midlife women aged 40 to 64

Abstract

The purpose of this descriptive longitudinal study was to describe (a) self-reported health status, (b) the relationship between self-reported health status and individual, environmental, and system health determinants, and (c) changes over time in self-reported health status and health determinants in midlife low income women.

Two main concepts from the Dynamic Model of Midlife Women's Self-Reported Health Status and Health Determinants used in this study were self-reported health status and health determinants (individual, environmental, and system) within the context of women's midlife transition. The sample was drawn from an urban Medicaid Managed Care health insurance program in Nebraska, and was comprised of 417 women aged 40 to 64 who began Medicaid coverage and completed an initial health assessment interview between July 2000 and December 2004 and completed a reassessment 11 to 23 months later. Self-reported health status was measured by the Health Status Questionnaire 12 Version 2.0. Health determinants included individual determinants (demographic, biologic, and behavioral factors), environmental determinants (social and physical resources), and system determinants.

Results indicate no statistically significant changes in self-reported health status occurred for the group comparing the two time periods. Using a scoring schema to begin to compare Total Health Status (THS) to the literature, 55% of these women had fair/poor self-reported health status compared to 15% of Nebraska adults and 39% of US women on Medicaid. Self-reported health status measures were statistically significantly higher at yearly reassessment for women with interrupted Medicaid health insurance coverage compared to women without a break in Medicaid coverage between assessments. About one-third of the variance in break in Medicaid coverage is predicted by (a) race/ethnicity, (b) disability, (c) number of medical conditions, (d) mammogram, and (e) self-reported health status. The majority (40%) of self-reported total health status variation is explained by individual health determinants. Significant changes in health determinants between initial assessment and reassessment include an increase in both prescription drug use and having a regular source of care. Almost all reassessment self-reported health status variation is explained by initial self-reported health status.