Ethics code: IR.IAU.SRB.REC.1403.508
1- Department of Social Sciences, Faculty of Literature, Humanities and Social Sciences, SR.C., Islamic Azad University, Tehran, Iran
2- Population Health Research Group, Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran
3- Department of Youth and Intergenerational Relations, Iranian Research Institute for Humanities and Social Studies, ACECR, Tehran, Iran
2- Population Health Research Group, Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran
3- Department of Youth and Intergenerational Relations, Iranian Research Institute for Humanities and Social Studies, ACECR, Tehran, Iran
Abstract: (11 Views)
Objective(s): Self-rated health (SRH) is a widely used indicator of population health that captures individuals’ overall assessment of their physical, psychological, and social well-being. Growing evidence suggests that health perceptions are shaped not only by individual characteristics but also by broader social and environmental contexts. Given the pronounced socioeconomic and spatial inequalities across Tehran, this study examined the association of environmental conditions and access to healthcare services with self-rated health among adults living in the city.
Methods: A cross-sectional study was conducted in 2025 among 400 adults residing in Tehran, Iran. Participants were recruited through convenience sampling and completed a researcher-developed online questionnaire. Data were collected on sociodemographic characteristics, social class, neighborhood environmental conditions, and access to healthcare services. Descriptive statistics were used to characterize the study population. Univariate and multivariable logistic regression analyses were performed to identify factors associated with poor self-rated health. Analyses were conducted using SPSS version 26.
Results: Overall, 72.3% of respondents reported good or very good health. In the adjusted model, age (OR=1.018, 95% CI: 1.003–1.034, P<0.001), social class (OR=3.660, 95% CI: 1.800–7.442, P=0.002), access to healthcare services (OR=1.113, 95% CI: 1.009–1.229, P=0.003), and neighborhood environmental conditions (OR=0.893, 95% CI: 0.799–0.999, P=0.004) were independently associated with self-rated health. Individuals from lower social classes, those experiencing poorer access to healthcare, and those living in less favorable environmental conditions exhibited higher odds of reporting poor health.
Conclusion: The findings underscore the importance of social and environmental determinants in shaping health perceptions among urban populations. Beyond individual-level characteristics, inequities in access to healthcare services and neighborhood environmental quality appear to play a significant role in self-rated health. Policies aimed at improving urban living conditions and promoting equitable access to healthcare may contribute to reducing health disparities and enhancing population health in metropolitan settings.
Methods: A cross-sectional study was conducted in 2025 among 400 adults residing in Tehran, Iran. Participants were recruited through convenience sampling and completed a researcher-developed online questionnaire. Data were collected on sociodemographic characteristics, social class, neighborhood environmental conditions, and access to healthcare services. Descriptive statistics were used to characterize the study population. Univariate and multivariable logistic regression analyses were performed to identify factors associated with poor self-rated health. Analyses were conducted using SPSS version 26.
Results: Overall, 72.3% of respondents reported good or very good health. In the adjusted model, age (OR=1.018, 95% CI: 1.003–1.034, P<0.001), social class (OR=3.660, 95% CI: 1.800–7.442, P=0.002), access to healthcare services (OR=1.113, 95% CI: 1.009–1.229, P=0.003), and neighborhood environmental conditions (OR=0.893, 95% CI: 0.799–0.999, P=0.004) were independently associated with self-rated health. Individuals from lower social classes, those experiencing poorer access to healthcare, and those living in less favorable environmental conditions exhibited higher odds of reporting poor health.
Conclusion: The findings underscore the importance of social and environmental determinants in shaping health perceptions among urban populations. Beyond individual-level characteristics, inequities in access to healthcare services and neighborhood environmental quality appear to play a significant role in self-rated health. Policies aimed at improving urban living conditions and promoting equitable access to healthcare may contribute to reducing health disparities and enhancing population health in metropolitan settings.
Keywords: Self-rated health, Social determinants of health, Environmental factors, Healthcare access, Health inequalities, Tehran.
type of study: Descriptive |
Subject:
Public Health
Received: 2026/06/2 | Accepted: 2026/05/2 | ePublished ahead of print: 2026/06/13
Received: 2026/06/2 | Accepted: 2026/05/2 | ePublished ahead of print: 2026/06/13
References
1. Marmot M. Social determinants of health inequalities. Journal of Lancet 2005; 365:1099-1104 [DOI:10.1016/S0140-6736(05)71146-6]
2. World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization; 2008. Available at: https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1 [Access date 09/06/2026]
3. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Geneva: World Health Organization; 2010. Available at: https://iris.who.int/handle/10665/44489 [Access date 08/02/2026]
4. Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Journal of Lancet 2008; 372:1661-1669 [DOI:10.1016/S0140-6736(08)61690-6]
5. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior 1997; 38:21-37 [DOI:10.2307/2955359]
6. Jylhä M. What is self-rated health and why does it predict mortality? Social Science and Medicine 2009; 69:307-316 [DOI:10.1016/j.socscimed.2009.05.013]
7. DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question: a meta-analysis. Journal of General Internal Medicine 2006; 21:267-275 [DOI:10.1111/j.1525-1497.2005.00291.x]
8. Garbarski D. Research in and prospects for the measurement of health using self-rated health. Public Opinion Quarterly 2016; 80:977-997 [DOI:10.1093/poq/nfw033]
9. Zajacova A, Dowd JB. Reliability of self-rated health in US adults. American Journal of Epidemiology 2011; 174:977-983 [DOI:10.1093/aje/kwr204]
10. Manor O, Matthews S, Power C. Dichotomous or categorical response? Analysing self-rated health and lifetime social class. International Journal of Epidemiology 2000; 29:149-157 [DOI:10.1093/ije/29.1.149]
11. Tunstall H. Neighbourhoods and health. Kawachi I and Berkman LF (eds). New York: Oxford University Press Inc, USA, 2003. Journal of Epidemiology 2005; 34:231-232. [DOI:10.1093/ije/dyh387]
12. Moor I, Spallek J, Richter M. Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors. Journal of Epidemiology and Community Health 2017; 71:565-575 [DOI:10.1136/jech-2016-207589]
13. Meyer OL, Castro-Schilo L, Aguilar-Gaxiola S. Determinants of mental health and self-rated health: a model of socioeconomic status, neighborhood safety, and physical activity. American Journal of Public Health 2014; 104:1734-1741 [DOI:10.2105/AJPH.2014.302003]
14. Kawachi I, Berkman LF. Neighborhoods and health. 1st Edition, Oxford University Press: New York, 2003 [DOI:10.1093/acprof:oso/9780195138382.003.0001]
15. Ross CE, Mirowsky J. Neighborhood disadvantage, disorder, and health. Journal of Health and Social Behavior 2001; 42:258-276 [DOI:10.2307/3090214]
16. Mujahid MS, Diez Roux AV, Morenoff JD, Raghunathan TE. Assessing the measurement properties of neighborhood scales: from psychometrics to ecometrics. American Journal of Epidemiology 2007; 165:858-867 [DOI:10.1093/aje/kwm040]
17. Rostami-Kateshali T, Montazeri A, Jafarzadehpour F. Self-rated health and socioeconomic status in Tehran, Iran: A cross-sectional study. Journal of Payesh 2026; 25:79-87[Persian] [DOI:10.66224/payesh.25.1.79]
18. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Journal of Quality-of-Life Research 2005; 14:875-882 [DOI:10.1007/s11136-004-1014-5]
19. Poortinga W, Dunstan FD, Fone DL. Perceptions of the neighborhood environment and self rated health: a multilevel analysis of the Caerphilly Health and Social Needs Study. Journal of Public Health 2007; 7:285 [DOI:10.1186/1471-2458-7-285]
20. Stronegger WJ, Titze S, Oja P. Perceived characteristics of the neighborhood and its association with physical activity behavior and self-rated health. Journal of Health and Place 2010; 16:736-743 [DOI:10.1016/j.healthplace.2010.03.005]
21. Lindén-Boström M, Persson C, Eriksson C. Neighborhood characteristics, social capital and self-rated health: a population-based survey in Sweden. Journal of Public Health 2010; 10:628 [DOI:10.1186/1471-2458-10-628]
22. Ou JY, Peters JL, Levy JI, Bongiovanni R, Rossini A, Scammell MK. Self-rated health and its association with perceived environmental hazards, the social environment, and cultural stressors in an environmental justice population. Journal of Public Health 2018; 18:970 [DOI:10.1186/s12889-018-5797-7]
23. Ma J, Mitchell G, Dong G, Zhang W. Inequality in Beijing: a spatial multilevel analysis of perceived environmental hazard and self-rated health. Journal of Annals of the American Association of Geographers 2017; 107:109-129 [DOI:10.1080/24694452.2016.1224636]
24. Chen H, Liu Y, Zhu Z, Li Z. Does where you live matter to your health? Investigating factors that influence the self-rated health of urban and rural Chinese residents: evidence drawn from Chinese General Social Survey data. Journal of Health and Quality of Life Outcomes 2017; 15:78 [DOI:10.1186/s12955-017-0658-0]
25. Haraldsdóttir S, Valdimarsdóttir UA, Guðmundsson S, et al. Poorer self-rated health in residential areas with limited healthcare supply. Journal of Public Health 2014; 42:310-318 [DOI:10.1177/1403494814522147]
26. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Journal of Medical Care 1981; 19:127-140 [DOI:10.1097/00005650-198102000-00001]
27. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health 2013; 12:18 [DOI:10.1186/1475-9276-12-18]
28. Yang TC, Matthews SA, Shoff C. Individual health care system distrust and neighborhood social environment: how are they jointly associated with self-rated health? Journal of Urban Health 2011; 88:945-958 [DOI:10.1007/s11524-011-9561-x]
29. Bindman AB, Grumbach K, Osmond D. Primary care and receipt of preventive services. Journal of General Internal Medicine 1996; 11:269-276 [DOI:10.1007/BF02598266]
30. Wang W, Shi L, Mao Z, Maitland E, Nicholas S, Liu X. Contribution of primary care to health: an individual level analysis from Tibet, China. International Journal for Equity in Health 2015; 14:107 [DOI:10.1186/s12939-015-0255-y]
31. Gomez LF, Soto-Salazar C, Guerrero J, Garcia M, Parra DC. Neighborhood environment, self-rated health and quality of life in Latin America. Journal of Health Promotion 2020; 35:196-204 [DOI:10.1093/heapro/day117]
32. Lee JA, Park JH, Kim M. Social and physical environments and self-rated health in urban and rural communities in Korea. Journal of Environmental Research and Public Health 2015; 12:14329-14341 [DOI:10.3390/ijerph121114329]
33. Subramanian SV, Kubzansky L, Berkman L, Fay M, Kawachi I. Neighborhood effects on the self-rated health of elders: uncovering the relative importance of structural and service-related neighborhood environments. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2006; 61:S153-S160 [DOI:10.1093/geronb/61.3.S153]
34. Goshtasebi A, Montazeri A, Vahdaninia M, Rahimi Foroushani A, Mohammad K. Self-reported health and socioeconomic status: results from a population-based study in Tehran, Iran. Payesh 2003; 2:187-193 [Persian]
35. Asadi-Lari M, Vaez-Mahdavi MR, Faghihzadeh S, Cherghian B, Esteghamati A, Farshad AA, Golmakani M, Haeri-Mehrizi AA, Hesari H, Kalantari N, Kamali M, Kordi R, Malek-Afzali H, Montazeri A, Moradi-Lakeh M, Motevallian A, Noorbala A, Raghfar H, Razzaghi E. Response-oriented measuring inequalities in Tehran: second round of UrbanHealth Equity Assessment and Response Tool (Urban HEART-2), concepts and framework. Journal of the Islamic Republic of Iran 2013; 27:236-248
36. Rezaei Z, Mohammadi NK, Pouragha H, Shakibazadeh E. Can a single general self-rated health question mirror social determinant of health? Journal of Public Health 2022; 51:2350-2359 [DOI:10.18502/ijph.v51i10.10994]
37. Abbasi M, Yahak S, Keshavarz Dizjini S. Measurement of social factors affecting self-declaration health: case study, districts 6 and 16 of Tehran. Journal of Bioethics and Health Law 2022; 2:1-10
38. Azmand S, Ghahramani S, Doostfatemeh M, et al. Determinants of self-rated health in socioeconomically disadvantaged women: a cross-sectional study in Iran. Journal of Public Health 2025; 25:734 [DOI:10.1186/s12889-025-21797-2]
39. Bazyar M, Kakaei H, Azadi H, Jalilian M, Mansournia MA, Malekan K, Pakzad R. Self-rated health status and associated factors in Ilam, west of Iran: results of a population-based cross-sectional study. Journal of Frontiers in Public Health 2025; 12:1435687 [DOI:10.3389/fpubh.2024.1435687]
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