School of Health Science & Nursing, Wuhan Polytechnic University, Wuhan , China 2. Corresponding author

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1 2017 International Conference on Medical Science and Human Health (MSHH 2017) ISBN: Association of Self-rated Health Status and Perceived Risk Among Chinese Elderly Patients with Type 2 Diabetes Rong NIE 1,2,a, Zhen-Zhen WANG 1,b and Jing MAO 2,c,* 1 School of Health Science & Nursing, Wuhan Polytechnic University, Wuhan , China 2 School of Nursing, Tongji Medical College, Huazhong University of Science & Technology, Wuhan , China a nie-rong@163.com, b @qq.com, c jingmao_tjmu@163.com * Corresponding author Keywords: Self-rated Health, Risk Perception, Type 2 Diabetes, Elderly People. Abstract. To explore the status of perceptions of general health and future risk, and their association among Chinese elderly patients with type 2 diabetes. A descriptive cross-sectional survey was used. Totally, 142 hospitalized patients aged 60 and over with type 2 diabetes were recruited from two local general hospitals. The data on their basic information, self-rated health, and risk perception for diabetes-related complications were collected by questionnaires and/or from medical records. Among the participants, 80.2% indicated that their general health was poor or fair, and only 2.1% reported very good health. Low perception of risk for diabetes complications was observed, which was incongruent with the physiologic indexes of risk. In multiple regression analysis, self-rated health had a small but significant impact on one s perceived future risk. A better self-rate general health status was associated with a lower level of risk perception. Accordingly, it is important to develop appropriate health education programs by addressing risk factors and risk status to heighten their perceived risk for diabetes complications in this group of people. Introduction According to a population-based survey in 2010, the estimated prevalence of diabetes among a representative sample of Chinese adults was 11.6%, within which over 90% were living with type 2 diabetes mellitus (T2DM) [1]. It makes China be the largest absolute disease burden of diabetes in the world. Compared with their counterparts without diabetes, individuals with T2DM have a greater risk of developing microvascular and macrovascular complications, which could be prevented or delayed by a change of risk-related behaviors. Perception of risk, defined as the individuals judgment of the likelihood of experiencing an adverse event, has been regarded as an influential factor on healthy or preventive behaviors. It has been suggested that an underestimation of personal health risk could reduce the motivation of preventive health behaviors and decrease compliance with medical prevention strategies [2]. Self-rated health (SRH), a subjective reflection of health status, has been described as an important predictor of future health and a disease risk screening tool, and may be related to one s perception for future risk [3]. However, little is known about the level of risk perception for developing future diabetes-related complications in Chinese elderly patients with T2DM, and its relation to one s perceived health status. Therefore, the aim of this study was to describe their risk perception for future complications and SRH, and 146

2 evaluate their association in this group of people in order to provide useful information in planning targeted risk-reduction strategies. Subjects and Methods A descriptive cross-sectional design was used by collecting data on a convenience sample of 142 Chinese adults aged 60 and over with T2DM who were recruited from Department of Endocrinology in two local general hospitals, Wuhan. Participants signed a written informed consent form before participation, and were surveyed about their demographic information, clinical parameters, current glucose control (HbA1c), comorbid conditions, SRH, and perceived risk of developing diabetes-related complications. The study was conducted between April and August SPSS 20.0 was used to analyze the data. Results Demographic and Clinical Characteristics The mean age was ± 5.8 years. Half of the sample were female. The majority were married (90.8%), and covered by any type of insurance (90.8%). Their educational level was as follows: primary school and below, 34.5%; middle school, 23.9%; high school, 22.5%; and college and above, 19.0%. The percentage of average households monthly income (RMB) was: < 1000, 2.8%; , 24.6%; , 59.8%; 5000, 12.6%, respectively. The sample clinical characteristics are shown in Table 1. The mean duration of diabetes was ± 6.78 years. The mean HbA1c% level was 8.30 ± Over half of the participants were taking insulin for diabetes (61.9%). Only 31.7% had a family history of diabetes. The frequency of the participants that already had diabetes-related complications, which were retrieved from medical records, was as follows: hypertension, 66.2% (n = 94); extremity neuropathy, 64.8% (n = 92); vision problem, 60.6% (n = 86); heart disease, 16.2% (n = 23); kidney disease, 12.7% (n = 18); stroke 8.5% (n = 12); amputation, 5.6% (n = 8). Table 1. Clinical characteristics and SRH of the sample (n = 142). Variable Mean(SD) N % Duration of diabetes( year) 11.70(6.78) BMI( kg/m 2 ) 24.28(3.82) HbA1c(%), >7 8.30(1.88) Family history of diabetes Treatment Oral medications Insulin oral + insulin Complications No yes SRH Poor Fair Good Very good

3 SRH Most of the participants (80.2%) indicated that their general health was poor or fair, and only 2.1% reported very good health. Not one reported excellent health. (Table 1). Risk perception The mean score of risk perception for developing diabetes-related complications was 2.28 ± 0.75 (range 1-5), indicating that the participants had low perceived risk overall. The mean scores of perceived personal risk for specific diabetes complications ranged from 1.13 to The level from highest to lowest was as following: vision problems, high blood pressure, numb feet, heart attack, kidney failure, blindness, stroke, foot amputation, and cancer. (Table 2). Table 2. Level of perceived personal risk for specific diabetes complications (n = 142). Complications Mean SD Range Heart attack Foot amputation Cancer Vision problems High blood pressure Numb feet Stroke Blindness Kidney failure Correlation of SRH and Risk Perception for Developing Future Complications In univariate analysis, all potential demographic and clinical variables were examined to identify their relationship with risk perception for future complications. The results revealed that only duration of illness was significantly related. In the multivariate model, the measure of SRH was added. The variance inflation factor (VIF) scores ranged from to (tolerance scores ranged from to 0.961), indicating that multicollinearity was not violated. The overall model was significant, accounting for 9.7% of the variance in risk perception (F = 7.474, P < 0.001). After adjusting for duration of illness, a better self-rate general health status (β = 0.178, P = 0.029) was associated with a lower level of risk perception. Discussion Prior studies have demonstrated that elevated hemoglobin A1C (HbA1c) is strongly correlated with diabetic microvascular and macrovascular disease in T2DM [4, 5]. In this study, 72.5% of the participants had HbA1c over 7, and 66.2% had blood pressure greater than the recommended goal, according to Chinese Diabetes Association[6],which makes this group at higher risk for developing diabetes-related complications. However, the overall perception of future risks (2.28 ± 0.75) was low, which is in line with Calvin s study in African Americans [7]. The findings show that there is a discrepancy between the actual risk and perceive risk among these Chinese diabetic patients, indicating the need to improve risk perception. Specifically, regarding the perceived personal risk for specific diabetes complications, stroke, foot amputation, and cancer were rated as lowest perceived risk to one s personal health, with the exception of vision problems, high blood pressure, numb feet, which is not 148

4 consistent with Calvin s study [7]. In addition, hypertension, extremity neuropathy, and vision problem were the top 3 complications found in the participants. Prior report has shown that variability among diseases may impact the amounts of risk perceptions they elicit [8]. It is possible that stroke, amputation, and cancer often be perceived as more severe and less likely to occur than the three diseases with higher perceived risk. Individuals usually hold a greater concern for problems which appear to have an immediate effect on everyday life, such as vision problems, high blood pressure, and numb feet. Consequently, in the present study, it could be expected that risk perception about a specific disease vary across different illnesses. The result of this study also showed that most of the participants (80.2%) rated their general health as fair or poor. This figure is higher than that in health adults aged over 60 years in Shandong, China (61.5%) [9], and a prior study among Korean diabetic patients living in America (68.5%) [10]. Such difference could be explained by the impact of illness identification and different ethnicity as some previous studies have found that negative impact of T2DM diagnosis on people s SRH [9], and that Asian Americans are more likely than other US population to report fair or poor health even though they are often described as having fewer chronic diseases [11]. It is suggested in literatures that low SRH in patients with diabetes be found to be associated with more health care use[12], increased glucometabolic disturbance [13], more behavioral risk factors [14]. In addition, in an elderly cohort, SRH has been found to be a significant and independent predictor of mortality [15]. Therefore, it is important to pay more attention to a population with diabetes who have low perception of their general health. In this study, SRH was found to be negatively associated with perceive risk of developing diabetes-related complications, indicating that individuals with T2DM who perceive their own health as good may incorrectly perceive their future risk to be low. It is consistent with studies of Frijling s [16] and Calvin s [7]. It is possible that people who believe they are in good health are those who feel less vulnerable to getting any illness. Therefore, health care providers should develop appropriate health education programs and take efforts to effectively communicate their long-term risk to individuals with diabetes, especially those who report their general health as good, so that they could understand their risk of future complications and adopt risk reduction behaviors to prevent or delay the progress of their illness. Several limitations should be noticed. First, a convenient sampling method was used which limits the generalization of this study. Second, the perceptions of the participants general health and future risk were self-reported, social desirability bias could not be avoided. Third, because it was a cross-sectional study, causality could not be established among the variables. Summary In summary, this study suggests that elderly diabetic patients may be prone to report fair or poor health in response to the general health question and underestimate their risk of future complications. Diabetes educators need to address the information that suboptimal control of their illness increases one s risk for all the complications of diabetes. For the group of Chinese diabetic patients, it is necessary to identify interventions to facilitate developing realistic perceptions of risk for diabetes complications and take appropriate health protective behaviors to prevent future risk. Moreover, continual discussion is needed about diabetes complications even after hospital discharge in order to enhance one s risk perception. 149

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