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Insights from a developing country: self-reported health status of elderly men (60 years and over) in Jamaica.

Older men's health status is of increasing concern given the rates of prostate cancer, genitourinary disorders and risk factors such as smoking in earlier life. There is limited research on the health status of Caribbean men, particularly Jamaicans. This paper documents self-reported health status of older men from a recent pioneer work in Jamaica. Older men (1530) were surveyed in a cross-sectional study. Cluster sampling with probability proportional to population size was utilized. Seventy-four percent reported health status as "good/excellent." There was no statistical association between self-reported health of older men and area of residence or marital status. However, there was a positive correlation between health status and tertiary level education (p < 0.05). Domicile ownership, working status, age, visits to doctor/health centre within the last year and reporting current disease were independent predictors of health status. Cancer was the most frequently reported chronic disease (16.6%), followed by kidney/bladder conditions (12.7%), hypertension (9.2%) and prostate conditions (7.3%). Greater attention to cancer, kidney/bladder issues and prostate conditions is warranted. Programs focused on healthy lifestyles, including behaviour change, and routine screening for chronic diseases are recommended.

Keywords: ageing, older men, health status, Jamaica, developing country

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The perception exists that except for issues related to reproduction health problems, there is little difference in the health of men and women and that the solutions are essentially the same (Kalache & Lunenfeld, 2002). As a result of lobby groups of women from all over the world and the 1995 Beijing Conference, research on women's health needs, rapidly mushroomed. Increasing evidence on important differences between men and women from the cellular to the societal level has been generated (Kimura, 1987). Interestingly, according to Kalache and Lunenfeld (2002), the strong emphasis on women's issues has (though almost by default) revealed areas of men's health that require just as much attention.

The issue of older men's ageing and health has been spearheaded on the international stage by the World Health Organization (WHO). WHO has provided leadership in the area of research and policy on the care of older persons. Older men's health status is of increasing concern given the rates of prostate cancer, genitourinary disorders and the presence of risk factors such as smoking in earlier life. Yet, the literature revealed limited research on the health status of men in the Caribbean and in particular in Jamaica.

Currently the majority of older people live in developing countries (WHO, 2000). As the demographic transition gathers momentum in the poorer regions of the world, an even greater proportion of the world's men will live in countries and regions with the least resources to respond to their needs. Approaches to meeting that challenge can be systematically developed if there is greater understanding of older men and women in poor regions (Lunenfeld & Gooren, 2002). Both from a physiological and from a psychosocial perspective, the determinants of health as individual's age are intrinsically related to gender (Kalache & Kickbusch, 1997).

Worldwide, there has been increasing interest in working with men on sexual and reproductive health concerns. Nevertheless collaboration among those who champion men's health has been limited beyond conventional medical problems such as erectile dysfunction or prostate cancer (Baker, 2001). Baker further suggests that the idea that men have specific health needs, experiences, and concerns related to their gender as well as their biological sex is relatively novel. Additionally he notes that even in those countries where emphasis has been placed on men's health issues, programs have largely remained small scale operations. In the Caribbean, information and understanding of health and ageing issues among older men is relatively limited. Programmes specifically addressing the health of older men are sparse, and if present are rudimentary.

In Jamaica, diseases of the prostate, especially prostate cancer are a significant cause of morbidity and mortality in older men more than other age cohorts. The average age-adjusted incidence (adjusted to the standard U.S. population) of prostate cancer in Kingston, Jamaica was 304/100,000 men, the highest rate in the world. The cancers are more significant clinically with greater morbidity in Jamaica than in the United States (Glover et al., 1998).

Men are poor consumers of health care services, therefore if their needs are to be understood one way is to listen to their self-report on their health status. Self-rated health is a complex variable that captures multiple dimensions of the relation between physical health and other personal and social characteristics. It is very consistent in its capacity to predict mortality (Idler & Benyamini, 1997). It has also been strongly associated with successful aging (Roos & Havens, 1991). Self-rated health is relatively easy to obtain through a single-item question; it has often been included in health surveys as an outcome in many studies (Damian, Pastor-Barriuso, & Valderrama-Gama, 2008). This study focused on self-reported health status of older men age 60 years and over in Jamaica.

METHODS

The study was a quantitative cross-sectional survey among Jamaican men 60 years and older.

The population of men in this age group living in the parish of St. Catherine in the southeastern area of Jamaica was the target.

Sampling Strategy and Sample Size

The sampling frame consisted of almost 18,000 in the targeted group living in the parish of St. Catherine. This parish was chosen as previous data and surveys (Jackson et al., 2003; Statistical Institute of Jamaica, 2003; Wilks et al., 2007) suggest that it has the mix of demographic characteristics (urban, rural and age-composition), which typifies Jamaica's population.

The Statistical Institute of Jamaica (STATIN) maintains a list of enumeration districts (ED) or census tracts. The parish of St. Catherine is divided into a number of constituencies made up of a total of 162 enumeration districts (ED). Consistent with cluster sample methodology (Bennett et al., 1991; NCCPHP, 2012), forty (40) enumeration districts (clusters) were subsequently selected with the probability of selection being proportional to population size. Advised by the Statistical Institute of Jamaica (STATIN) and the utilising the C-Survey computer software (University of California at Los Angeles and University of Indonesia 1997), it was determined that an average of 38.25 (approximately 38) older men in each enumeration district were to be interviewed yielding a sample size of 1530. This total sample (i.e., no of households to be canvassed in the study) was determined based on the reported prevalence of hypertension (a common disease among men) being 15-24% in the Jamaican population (Cooper et al., 1997). The usual confidence level of 95% and a margin of error of 5% were used for the sample size calculation.

STATIN maintains maps of enumeration districts. The maps of the selected EDs showed access routes as well as the site to be selected as the starting point household within each ED. The starting point was determined by randomly selecting a household with a man 60 years and over from the list of persons in the ED. With this information the interviewers travelled in a north-easterly or closest to north-easterly direction beginning with the first selected household, and conducted interviews until the requisite number of interviews for that ED was completed. (North-East was randomly selected by STATIN as the direction of travel from the starting point.)

Where the selected household was found to be subsequently devoid of an older man (due to out-migration or death), an adjacent household was canvassed. Where households had a man 60+ years as a resident and he was not at home a call-back form was left indicating a proposed time that the interviewer would return which would not be longer than two days after the initial visit. After two failed attempts to contact any given household, no further attempts at contact was made and as before an adjacent household selected. In households where there were more than one man 60 years old and over, all were included in the survey. All selected eligible men were interviewed face-to-face in their homes and questionnaires completed by trained field staff. Men, who were reported as suffering from severe psychiatric illness or severe cognitive disorders and without available surrogate to provide information, were not eligible for the study. Older men in institutions in the parish of St. Catherine (who numbered less than 50) were not part of the survey. Only community-dwelling persons in private households were surveyed. There was a 100% response rate as all eligible men contacted at the household level.

A 132-item questionnaire was developed. Provisions were made for accepting multiple responses as necessary. The items included on questionnaire were guided by the objectives of the study and further informed by focus group discussions which were held prior to the development of the questionnaire.

From these discussions themes and issues with regard to the health status and health-seeking behaviour of men sixty years and older in Jamaica were identified. The participants were recruited through the Senior Citizens Clubs and the National Council for Senior Citizens (NCSS). Emergent issues included in the questionnaire were related to perceptions about the state of men's health, health concerns including prevalent chronic diseases, perceptions of, use and experience with the health care system, and plans for retirement.

The questionnaire was pre-tested for clarity and appropriateness among older persons in households in EDs that were not part of the survey and necessary adjustments made. The final instrument was formatted into a booklet for easier handling and consisted of items related to the following four areas; demographic profile, past and current health status and health-seeking behaviour, retirement status and planning, social and functional status. The main dependent variable "self-reported health status" had four possible response options excellent, good, fair and poor. Additionally, men were asked to report on specific conditions with which they had been diagnosed. Regarding factors contributing to men's health, a single multiple-choice question was used. "Other, (specify)" was among the choices. These responses were quantified and included where appropriate in tables and charts. Independent variables were collected as single items.

Data Analysis

Data was cleaned and analysis was carried out with the help of the Statistical Package for Social Sciences software (SPSS for windows version 12.0). The data where appropriate were summarized using measures of central tendency and dispersion; frequencies and relative frequencies. Data were also displayed using charts, tables and graphs. Chi-square tests were used to assess bivariate relationships between categorical variables.

Associations and correlations among key variables such as health status, health-seeking behaviour, life style behaviours such as smoking, and socio-demographic characteristics were examined. Variables that were statistically associated with self-reported health status in bivariate analyses were selected for entry as predictor variables into a logistic regression model using SPSS. Prior to entry, relationships between independent variables were assessed to ensure that no multiple collinearity problems existed. In the regression model, self-reported health status was the dependent or outcome variable. Excellent health status was coded as 1 with other health status coded as 0 (reference category). Logistic regression was used to control for confounding and to identify independent predictors of the outcome/dependent variable (self reported health status). P-values of less than 0.05 were deemed to be statistically significant.

Ethical Considerations

The purpose of the study was explained to all persons interviewed. Participants were informed that the research had no invasive procedures. They were each provided with contact information for the researcher as well as information of the supervisor for further questions.

All respondents were asked to sign a consent form, before beginning to answer the questions. Where respondents were unable to sign, their mark was witnessed by a legal guardian. Questionnaires were collected by the field supervisor from field personnel at the end of each day, and stored in secure cabinets accessible only to the researcher.

All participants were provided with information as to how they could access additional information on care, be it social or physical. Where men were found to be in extremely destitute circumstances or in need of care, information was provided so as to facilitate contact with the relevant service agencies.

RESULTS

Socio-Demographic Characteristics of the Sample

The sample consisted of 1530 men aged 60 years and older. The mean age was 70.4 years (SD = 7.8), with 51% of them between ages 60 and 69 years. In terms of residence, 48.9% (748) and 51.1% (742) of the respondents were from urban and rural areas respectively.

By proportion, married men were 44.2% (677), while 7% (107) were in common-law unions. There was a significant difference in the marital status of the men when disaggregated by age. "Old old men" (75 years and older) had higher rates of widowhood while the "young old" (65-74 years old) had higher rates of common-law relationships or were single ([chi square] = 141.13; p < 0.01). When marital status was examined by rural and urban distribution, there was also a statistically significant difference ([chi square]= 22.5; p < 0.01). More rural than urban men were in common law relationships or were widowed. There was no association between marital status and self-reported heath status.

Although only 42.1% (644) of older men studied, owned the house in which they lived, 87.9% of the time these older men (1345) were heads of said household in which they lived. There was a statistically significant difference ([chi square]= 16.2, p < 0.01) in home ownership when rural and urban men were compared. Rural men (47.1%) were more likely to own their homes than urban men (36.9%). Table 1 provides details of the socio demographic characteristics of the sample.

Only 15 men (1% of the sample) lived alone, approximately 33% (508) lived with one other person, while approximately 64% of the men had at least two or more other persons living in the household. The number of other persons in the household in which the men lived ranged from 0 to l0 with the median number of persons being 2 (inter-quartile range 1-4). There was no statistically significant difference in the median number of persons living in households by urban/rural distribution.

About 77.6% (1187) of the population surveyed were "not working/retired," with most being retired 57.8% (884). There was a statistically significant association between age and employment status ([chi square] = 48.9, p < 0.001), with greater proportions of those not working/retired men being observed at older ages (75+ years).

Older men in the study stopped working for various reasons, chief of which was that they had reached the statutorily designated age of retirement of sixty-five years. Employment was still evident beyond the statutory age of retirement. Nearly one-fifth (18.6%) of the 70-74 age group were still working and 14.8 % and 16.2% reported that they were still working in the 75-79, and 80+ years age group respectively. The majority of men (94.0%) reported that their highest education was at the primary school level or less. While there was no statistically significant association between age category and highest level of education, it was noted that increasingly, proportions of the younger age groups tended to report achieving higher levels of education.

Self-Reported Health Status

With regard to self reported health status, most men perceived themselves as being in good health as illustrated in Figure 1, with 54.8% of respondents indicating that their health was "good" and 19.8% indicating it was "excellent."

In bivariate analysis, there was no statistically significant difference with regards to self reported health status when examined by age-group, urban-rural residence and marital status. No significant relationship was observed between self reported health status and whether men were living alone or with other persons in the household. Neither did the number of persons in the household significantly impact the reported health status. Only "highest level of education" was found to be associated with self-reported health status, with the least optimal category ("fair") being reported by significantly more men whose highest level of education was "basic school" or "no formal education" (p < 0.05).

Eighteen point four percent (18.4%) of men from urban areas reported 'excellent health' in comparison to 21.1% of men from rural zones. There was no statistically significant difference as shown in the distribution of self-reported health status, and residence by age cohort (Table 2).

Reported Factors that Contribute to Men's Health

In describing their views of health, 53.7% of respondents indicated that being physically well with no known form of sickness was what "good health" meant to them. Twenty point seven percent (20.7%) and thirteen point two percent (13.2%) indicated that it meant having a healthy diet and the ability to care for themselves, respectively.

With regard to the question of factors that contributed to one's health, 36% of the men indicated diet as an important factor. Exercise was cited by 28% of interviewees, and sleep and rest by 9% of the sample. Having regular check-ups was identified by only 5% of men as a contributory factor to health status. The individual's age and religious practices were recognized as contributing factors by 4% of men, while getting regular check-ups was recognized as contributory factors by only 5% of the men interviewed. Men who identified physical and mobility factors as indicators of and contributors to good health (66.2%) were more likely to report visits to doctors/health centres within the last year than those who highlighted diet (17.1%) and self care (7.7 %) or religious/psychological factors (9%) ([chi square] = 12.6, p < 0.03).

Disease Conditions Reported (%)

Figure 3 below shows the distribution of diagnosed diseases (self-reported) in men 60 years and over. Men in the study reported being diagnosed with several diseases: kidney/bladder diseases (13.0%), hypertension (10.1%), prostate problems (7.3%), diabetes mellitus (7.1%) and heart disease (5.6%). Cancer (regardless of site) was the leading diagnosis and was reported by 16.7% of the older men surveyed.

Self-Reported Health Status by Diagnosed Health Condition/Disease, and Visits to Health Facility

Persons with diagnosed disease tended to report more favourable health ratings than those who did not. The only exceptions to this pattern were those diagnosed with cancer and kidney/bladder disease where such men gave less favourable self-ratings than those without the disease.

There were statistical significant associations between doctor visits (within the last year) and self-reported health status (p < 0.05) as well as visits to health centre (within the last year) and health status (p < 0.05). Those who did not visit a doctor or health centre reported less favourable health ratings.

Self-Report of Ever Having a Prostate Examination by Men's Age

When asked if they ever had a prostate examination, 34.8% responded "yes." Men in the 75+ age group were more likely to report ever having had a prostate examination ([chi square] = 10.57, p < .05) than younger men. Rates of report of prostate examination ever among men surveyed by age group are shown in Figure 4.

Persons who had never smoked comprised 31.8 % (486) of respondents, while 18.8% (288) and 49.4% (756) were current smokers and past smokers respectively. A statistically significant relationship was found between ever smoked and self-reported health rating ([chi square] = 9.19,p < 0.01). While similar proportions of those who had ever smoked and those who had never smoked rated their health status as excellent, more of those with a positive history of smoking were found in the lower health rating category (28.4% versus 21.6%).

Logistic regression identified independent predictors of excellent health status among the elderly men surveyed. Using geographic residence, marital status, domicile ownership, living arrangements, working status, smoking history, visit to a health centre within 1 year, visit to a doctor within 1 year and report of any current disease as categorical covariates the results in Table 4 were obtained.

Persons who did not own they house in which the lived were 60% less likely to report excellent health status than those who owned their domicile and those who lived by themselves were 60% more likely to report excellent health status than those in other living arrangements. Those who were "not working/not employed" less frequently reported having excellent health status (OR = 0.6); so did those less than 70 years old.

Persons who visited doctors/health centres within the preceding one year period were more likely to describe their health status as excellent vis-a-vis those who had not. Those not reporting any current disease at all were more likely to report their health status as excellent.

Discussion

In many developing countries, older men's health will increasingly be of concern as population ageing occurs. While issues pertaining to the sexual health of older men have been examined, the well-being of older males in Jamaica as well as other developing countries is less well-studied. This study represents an empirical starting point from which policies and programs can be fashioned for older men. Approximately 20% of the sample reported that their health was "excellent" while 55% indicated "good" health. Overall 74.6% of the men surveyed rated their health as "good' or "excellent;" findings which are akin to those from an Indian study where Swain (2007) found that 74.8% of elderly persons surveyed reported their health status as good, very good or excellent.

Reservations exist about the use of self reported health status as it is not deemed to be an objective indicator of health status. However, increasingly researchers contend that self-reported health study is a good proxy indicator of health status (Cummins, 2005; Diener, 2000; Diener, Suh, Lucus, & Smith, 1999). Additionally, Mor, Wilcox, Rakowski, and Hiris (1994) have reported a strong correlation of a self-reported health status with successful ageing. Consequently self reported health status is a metric by which health status may be gauged.

Men who deemed themselves to be relatively disease-free, not surprisingly tended to report excellent health more often than those who did not. Notably, 44.7% of the men diagnosed with hypertension said that their health was excellent; a finding compatible with the 'silent killer' moniker of that disease. Many men with chronic diseases rated their health as excellent and none rated their health as poor regardless of diagnosis. Are the men's ratings of their health status a reflection of denial of their health conditions or are they eternal optimists?

The seeming paradox of excellent self-rated health status amidst self-reported chronic disease may be partially explained by the following. Individuals who live in a health state of less than perfect health often adapt over time to their disease and subsequently assign higher ratings and higher utilities to their health state than an external observer would expect (Murray, 1996). A second factor may also be at work. It is not culturally acceptable for Jamaican to be "whining in self-pity" (Morris, James, & Eldemire-Shearer, 2010). This may in some measure account for why none of the men interviewed indicated their health status as "poor," preferring the use of the term "fair" in such cases.

The adaptation and adjustment to living in a less than perfect state of health may also help explain the age associated trend where men 70 years and over rated their health as excellent more commonly than the younger 60-69 years cohort. This is also consistent with the existing belief in Jamaican society that one should be gracious towards years lived more than "three score and ten." There may also be at work a 'healthy survivor effect' where those who have greater longevity selectively tend to be in better states of health (Murphy et al., 2011).

Older men's perceptions of their health status also reflect their concept of good health. More than half of the men interviewed alluded to good health meaning that an individual had no known sickness; an observation corroborated by the fact that those with no reported diagnosed illness tended to rate their health as excellent in contrast to those with diagnosed disease. This view may contribute to the lower/inadequate utilization of health care services or the presentation of men to health facilities only when they are overtly or extremely sick. Consequently for silent killers such as hypertension and occult cancer (colon and prostate), screening opportunities for early detection are not necessarily highly valued and will be often missed. It helps explain ambivalence regarding the utility of preventive or routine visits to health providers by older men (Morris, 2009).

Men mentioned healthy diets and the ability to take care of one's self as the primary factors that contributed to good health. These answers suggest that men are not aloof when it comes to health matters. This already existing understanding provides a base upon which health promotion programs can build in the quest for improved health literacy. Simultaneously, there needs to be promotion of the importance of screening and preventive visits and the expansion of men's comprehension of silent and occult disease.

With regard to prostate cancer, approximately 65% had never had a prostate test/examination done. Culturally, there is considerable resistance to prostate examinations (digital) as well as colonoscopy procedures. Many Jamaican men perceive prostate examinations as "de-masculinizing" and hence there is significant hesitation to request such examinations or to discuss it with doctors. George and Fleming (2004) in their research study described prostate cancer as a "taboo" subject among men; and further asserted that men thought it inappropriate and not masculine to be open about health. For the older man such matters are private, not to be openly discussed. Moreover, when older men unduly revere doctors, they may fail to take the initiative to raise healthcare issues unless they deem them specifically related to an acute problem for which they are seeking help.

It is noteworthy that cancers were identified as being the disease of most importance to the older men in the study. Jamaica has been cited as having one of the highest incidence rates of prostate cancer in the world (Glover et al., 1998). In our study 16% of men had some type of cancer and 80% of those were diagnosed within the last twelve months. The Jamaica Cancer Society has reported a general increase in clients accessing the services of the society but the increase by gender was not specifically addressed (Ministry of Health, 2004). Is this increase a result of education campaigns? Cancer is dreaded by most persons, and the fears of treatment and long suffering could possibly be some of the reasons for the increased utilization of Jamaica Cancer Society's services.

Genitourinary health issues remain of considerable importance to men. These include benign prostatic hyperplasia, prostate cancer, erectile dysfunction, infertility in the ageing male, urinary incontinence, and testicular cancer. These areas represent the most intimate concerns of men. Many ageing men will experience urinary problems ranging from nocturia, increased frequency of micturition, urgency, hesitancy, poor stream, and post-micturition dribbling to loss of balder control resulting in incontinence, and retention. Population studies have showed the frequency of a moderate-to-severe lower urinary tract symptom to be 8-31% in men in their 50s, increasing to 27-44% of men in their 70s (Lunenfeld & Gooren, 2002). It is therefore not surprising that prostate problems and bladder disease were commonly reported among men surveyed.

Older men may also fear that if something is found to be wrong with the prostate, it will often require surgery and their lives will be of a lesser quality. The latter fact is not unique to Jamaica as Remzi, Walden, and Djavan (2004), who studied the treatment of prostate cancer in an Austrian population, found that older men may be more risk adverse and less willing to sacrifice quality of life for prolongation of life. Yet prostate cancer is one of the curable cancers. Local health promotion messages have been advocating that "a test in time can prevent your death by prostate cancer." Active efforts are needed to make men more knowledgeable and more health conscious with regard to screening for prostate problems. Qualitative research which captures emic views of men is recommended to make messages more relevant and appealing with the potential for increased healthy behaviors among older men. Foster (2004) concurs, underscoring the need for (i) education of men regarding prostate cancer and screening; and (ii) greater sensitization among health providers of the need to routinely raise the matter of prostate health with older men.

The task of getting older men to utilize clinical services will need to grapple with men's perception of good health and the contributory factors. The data indicate that those who placed emphasis on physical factors tended to visit clinical providers more than those who mainly pointed to diet and self care. The recognition of this fact is crucial if one is to design strategies to increase visits to conventional health centres or health providers. Health education and behaviour change programs must also take this fact into account.

The relatively positive self-reported health status does not mean that morbidity among older men (Table 2) is to be ignored. Swain (2007) found that thirty one percent of older persons who perceived their health as excellent or very good were reported to be suffering from a chronic disease. A similar pattern of excellent health status being reported by men with chronic disease was noted in this study. No association between self-reported health status and marital status, or urban/rural residence was found among older Jamaican men. The positive associations with continuation of work and solo living arrangements likely reflect optimal functional capacities which facilitate participation in a competitive labour market as well as the full mastery of all domains of the Instrumental Activities Daily Living. Owning the house in which one lives may contribute to higher levels of health, through a number of pathways. There is increased financial security and income that would be used for rent etcetera can be diverted to healthcare and health promoting activities. Additionally, there is greater mental well-being as the uncertainties of tenancy, risks of eviction and disruption of social networks is lessened. Owning a house also culturally represents a major self-actualization goal that can enhance well-being.

CONCLUSION

While there were generally positive ratings of health status by older men in the study, the reported disease pattern for men argue for programs focused on healthy lifestyles, behaviour change and screening for chronic diseases. Treatment of complications as well as rehabilitation will need to be strengthened and/or developed. These not only can yield dividends in terms of personal health but can help reduce admissions to hospital, length of stays at such institutions and attendant health care costs. The study findings provide a springboard for further work in developing countries such as Jamaica that specifically focuses on the health of elderly men, given the dearth of such studies.

DOI: 10.3149/jmh.1202.106

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CHLOE MORRIS PHD, *, KENNETH JAMES MBBS, * DESMALE HOLDER-NEVINS PHD, * and DENISE ELDEMIRE-SHEARER PHD, *

* University of the West Indies, Mona, Jamaica.

Correspondence concerning this article should be addressed to Chloe Morris, Mona Ageing & Wellness Centre and Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica. Email: chloe.morris@uwimona.edu.jm
Table 1
Respondent Characteristics (N = 1530)

Category Characteristic Urban [n, (%)] Rural [n, (%)]
 N = 748 N=782
 (48.9%) (51.1%)

Age groups
 60-64 196 (26.2) 216 (27.6)
 65-69 184 (24.6) 190 (24.3)
 70-74 165 (22.1) 180 (23)
 75-80 99 (13.2) 90 (11.5)
 80+ 104 (13.9) 106 (13.6)

Highest level of education
 No formal Education 80 (10.7) 77 (9.2)
 Basic School 432 (57.8) 407 (52)
 Primary/All Age 204 (27.3) 243 (31.1)
 Secondary/High 13 (l.7) 39 (5)
 Trade/Vocational 7 (0.9) 6 (0.8)
 Certificate/Diploma 6 (0.8) 10 (1.3)
 Bachelors and above 6 (0.8) 5 (0.6)

Marital status
 Single 278 (37.2) 250 (32.0)
 Married 342 (45.7) 335 (42.8)
 Common-law 46 (6.1) 61 (7.8)
 Separated 39 (5.2) 41 (5.2)
 Widowed 43 (5.7) 95 (12.1)

Head of household
 Self 658 (88.0) 687 (87.9)
 Partner 47 (6.3) 48 (6.1)
 Children 20 (2.7) 31 (4.0)
 Parents/Siblings 18 (2.0) 11 (1.4)
 Employer 5 (0.7) 5 (0.6)

Ownership
 Yes 276 (36.9) 368 (47.1)
 No 472 (63.1) 414 (52.9)

Category Characteristic P-value

Age groups
 60-64 Not significant
 65-69
 70-74
 75-80
 80+

Highest level of education
 No formal Education [chi square] = 17.99; p < 0.01
 Basic School
 Primary/All Age
 Secondary/High
 Trade/Vocational
 Certificate/Diploma
 Bachelors and above

Marital status
 Single [chi square] = 22.56; p < 0.001
 Married
 Common-law
 Separated
 Widowed

Head of household
 Self Not significant
 Partner
 Children
 Parents/Siblings
 Employer

Ownership
 Yes [chi square] = 16.19; p < 0.001
 No

Table 2
Self-Reported Health Status Characteristics by Residence
and Age-Group (%)

Variables Excellent Good health Fair health
 health (N= 1038) (N = 480)
 (N = 357)

Residence
 Urban 18.4 56.1 25.5
 Rural 21.1 53.7 25.2
Age
 60-64 16.7 59.5 23.8
 65-69 19.7 55.3 25.0
 70-74 23.4 51.7 24.9
 75-79 21.8 50.6 27.6
 80+ 18.5 53.8 27.7

Table 3
Self-Reported Health Status by Health Condition/Disease,
Visits to Health Provider

Variables Excellent Good health Fair health
 health (N = 787) (N = 364)
 (N = 284)

* Cancer
+ 9.6 59.4 31.0
- 21.7 54.0 24.3
* Hypertension
+ 44.7 49.3 5.9
- 16.8 55.5 27.7
* Heart Disease
+ 36.0 59.3 4.7
- 18.8 54.6 26.7
* Prostate
+ 25.7 63.3 11.0
- 19.3 54.1 26.5
* Diabetes
+ 35.8 48.1 16.0
- 18.5 55.4 26.1
* Kidney/bladder
+ 9.7 48.3 48.2
- 21.2 55.8 23.0
* Other
+ 31.5 55.2 15.7
- 19.0 55.0 26.0
* Visited doctor in [less than or equal to] year
+ 46.4 53.2 0.4
- 13.8 55.2 31.0
* Visit to health centre in [less than or equal to] year
+ 27.3 62.7 10.0
- 18.0 53.0 29.0

* = t statistically significant at 5% level; + = yes; -= no.

Table 4
Predictors of Excellent Health Status (Self-Reported)
Among Respondents

Variable B S.E. p-value Odds Ratios
 (95% C.I.)

Residence (rural/urban) 0.076 0.146 0.603 1.1(0.8-1.4)
Marital Status
 (Not in union/Union) -0.220 0.158 0.163 0.8(0.6-1.1)
Domicile Ownership *
 (Does not own/Owns) -1.036 0.161 0.000 0.4(0.3-0.5)
Living arrangement *
 (Lives alone /Lives 0.464 0.168 0.006 1.6(1.1-2.2)
 with others)
Working Status *
(Not working/Working) -0.499 0.163 0.002 0.6(0.4-0.8)
Smoking
 (Never smoked/Ever 0.187 0.155 0.226 1.2(0.9-1.6)
 smoked)
Age *
 (60-69 yrs/70 yrs -0.385 0.148 0.009 0.7(0.5-0.9)
 and over)
Health centre visit
 within 1 yr *
 (No/Yes) -1.328 0.167 0.000 0.3(0.2-0.4)
Doctor's visit
 within 1 yr *
 (No/Yes) -0.589 0.171 0.001 0.6(0.4-0.8)
Any current reported
 disease *
 (No/Yes) 0.596 0.249 0.017 1.8(1.1-3.0)

Notes: For each variable the last category is the reference
category; e.g., for residence, urban is the reference category. The
first category was coded as 1 and all reference categories were
coded = 0. * indicates statistically significant predictors in
logistic regression model with these variables. Dependent variable
coded as Excellent = 1, all other = 0 (reference).

Figure 1. Self-reported health status by men 60+ years.

Excellent 19,8

Good 54,8

Fair 25,4

Note: Table made from bar graph.

Figure 2. Self-reported distribution of factors which contribute to
men's health. N.B. Displayed numbers represent the proportion of men
reporting each separate factor. Percentages are not intended
to add up to 100. Multiple responses may be given by any individual.

Diet 35,5

Exercise 27,8

Sleep/Rest 9,5

Age 4,4

Religion 4,3

No Chronic Disease 1,8

Regular Check-ups 4,8

Family 2,3

Note: Table made from bar graph.

Figure 3. Prevalence of disease conditions reported (%). N.B. Displayed
numbers represent the proportion of men reporting each separate disease
condition. Percentages are not intended to add up to 100. Multiple
responses may be given by any individual.

Cancer 16,7

Hypertension 10,1

Heart Disease 5,6

Prostate Problems 7,3

Diabetes 7,1

Kidney/Bladder 13

Other 5,9

Note: Table made from bar graph.

Figure 4. Self-report of ever having a prostate examination by men's
age.

60-64 29,9

65-69 36,6

70-74 32,8

75-79 39,7

80+ 40,5

Note: Table made from bar graph.
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Author:Morris, Chloe; James, Kenneth; Holder-Nevins, Desmale; Eldemire-Shearer, Denise
Publication:International Journal of Men's Health
Geographic Code:5JAMA
Date:Jun 22, 2013
Words:6791
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