Self-rated health disparities among disadvantaged older adults in ethnically diverse urban neighborhoods in a Middle Eastern country

ABSTRACT

Objectives: This paper examines differentials in self-rated health (SRH) among older adults (aged 60+ years) across three impoverished and ethnically diverse neighborhoods in post-conflict Lebanon and assesses whether variations are explained by social and economic factors.

Design: Data were drawn from the Older Adult Component (n = 740) of the Urban Health Survey, a population-based cross-sectional study conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom), and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. The role of the social capital and economic security constructs in offsetting poor SRH was assessed using multivariate ordinal logistic regression analyses.

Results: Older adults in Nabaa fared better in SRH compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor SRH being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9%, and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, and 43.5% in Burj El-Barajneh. The economic security construct attenuated the odds of poorer SRH in Burj El-Barajneh as compared to Nabaa from 2.57 (95% confidence interval, CI: 1.89–3.79) to 1.42 (95% CI: 0.96–2.08), but had no impact on this association in Hey El-Sellom (odds ratio, OR: 2.12, 95% CI: 1.39–3.24). The incorporation of the social capital construct in the fully adjusted model rendered this association insignificant in Hey El-Sellom (OR: 1.49, 95% CI: 0.96–2.32), and led to further reductions in the magnitude of the association in Burj El-Barajneh camp (OR: 1.18, 95% CI: 0.80–1.76).

Conclusions: The social context in which older adults live and their financial security are key in explaining disparities in SRH in marginalized communities. Social capital and economic security, often overlooked in policy and public health interventions, need to be integrated in dimensions of well-being of older adults, especially in post-conflict settings.

KEYWORDS:

• Self-rated health
• ethnicity
• displacement
• older adults
• urban health
• conflict
• Lebanon

Disclosure statement

No potential conflict of interest was reported by the authors.

Key messages

 (1) Older adults living in a formal neighborhood had better self-rated health than those living in an informal settlement. Self-rated health among the latter also fared better than among those living in refugee camps.

(2) Social capital and economic security are key in explaining disparities in self-rated health among older adults in marginalized communities.

(3) Both community- and individual-level social capital resources contribute to self-rated health among older adults in disadvantaged communities.

(4) There is a need for integrating social capital and economic security in programs and policy geared towards promoting older adults' well-being, especially in post-conflict regions.

Additional information

Funding

This publication was made possible by the partial support provided to authors by the Biostatistics, Epidemiology, and Biomathematics Research Core at the Weill Cornell Medicine-Qatar. This study was also part of a larger multidisciplinary research project on urban health supported by grants from the Wellcome Trust [grant number 061495/Z/00/Z], the Andrew W. Mellon Foundation [940200692/200200709], and the Ford Foundation [grant number 990-1511-1]. The statements made herein are solely the responsibility of the authors.