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Open Access Research article

Inequalities in self-rated health among 45+ year-olds in Almaty, Kazakhstan: a cross-sectional study

Akmaral K Abikulova1, Kazbek A Tulebaev2, Aikan A Akanov2, Botagoz S Turdalieva1, Sundetgali B Kalmahanov1, Ainur B Kumar1, Aigulsum K Izekenova1, Bakhyt A Mussaeva1 and Andrej M Grjibovski34*

  • * Corresponding author: Andrej M Grjibovski

Author Affiliations

1 School of Public Health, Kazakh National Medical University, Almaty, Kazakhstan

2 Kazakh National Medical University, Almaty, Kazakhstan

3 International School of Public Health, Northern State Medical University, Arkhangelsk, Russia

4 Department of International Public Health, Norwegian Institute of Public Health, Postbox 4404, Nydalen, 0403, Oslo, Norway

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BMC Public Health 2013, 13:654  doi:10.1186/1471-2458-13-654

Published: 15 July 2013



Self-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries. However, no studies have been performed in Central Asia. The aim of the study was to assess gender-, ethnic-, and social inequalities in SRH in Almaty, Kazakhstan.


Altogether, 1500 randomly selected adults aged 45 years or older were invited to participate in a cross-sectional study and 1199 agreed (response rate 80%). SRH was classified as poor, satisfactory, good and excellent. Multinomial logistic regression was applied to study associations between SRH and socio-demographic characteristics. Crude and adjusted odds ratios (OR) for poor vs. good and for satisfactory vs. good health were calculated with 95% confidence intervals (CI).


Altogether, poor, satisfactory, good and excellent health was reported by 11.8%, 53.7%, 31.0% and 3.2% of the responders, respectively. Clear gradients in SRH were observed by age, education and self-reported material deprivation in both crude and adjusted analyses. Women were more likely to report poor (OR = 1.9, 95% CI: 1.2-3.1) or satisfactory (OR = 1.6, 95% CI: 1.2-2.1) than good health. Ethnic Russians and unmarried participants had greater odds for poor vs. good health (OR = 2.3, 95% CI: 1.5-3.7 and OR = 4.0, 95% CI: 2.7-6.1, respectively) and for satisfactory vs. good health (OR = 1.4, 95% CI: 1.1-1.9 and OR = 1.9, 95% CI: 1.4-2.5, respectively) in crude analysis, but the estimates were reduced to non-significant levels after adjustment. Unemployed and pensioners were less likely to report good health than white-collar workers while no difference in SRH was observed between white- and blue-collar workers.


Considerable levels of inequalities in SRH by age, gender, education and particularly self-reported material deprivation, but not by ethnicity or marital status were found in Almaty, Kazakhstan. Further research is warranted to identify the factors behind the observed associations in Kazakhstan.

Central Asia; Kazakhstan; Self-rated health; Determinants; Socio-demographic