Poor Self-Rated Health and Associated Factors among Older Persons in Malaysia: A Population-Based Study

**Background:** Self-rated health (SRH) is a validated subjective measure recommended by the WHO for health monitoring, as it reliably predicts morbidity, mortality, and functional decline. While SRH has been studied globally among older populations, limited recent data exist for Malaysia. Previous Malaysian studies reported lower SRH prevalence (17.0–17.2%) but used older datasets. This study aimed to determine the prevalence of poor SRH and its associated factors among older Malaysians using the most recent national data.

**Methods:** This study analyzed data from the National Health and Morbidity Survey 2018 (NHMS 2018), a nationwide, population-based cross-sectional survey employing two-stage stratified cluster sampling. The sample included 3,977 older persons aged 60 years and above (47.1% male, 52.9% female; 57.5% rural). Data were collected via face-to-face interviews using a bilingual structured questionnaire on mobile tablets from July to September 2018. SRH was assessed with the question 'How do you rate your general health?' and responses were dichotomized into 'Good' (very good/good) and 'Poor' (moderate/not good/very bad). Independent variables included sociodemographics (sex, locality, education, employment, marital status, income, living arrangements), lifestyle behaviors (smoking, physical activity via GPAQ, fruit/vegetable intake), self-reported chronic diseases (diabetes, hypertension, hypercholesterolemia), depressive symptoms (Geriatric Depression Scale-14, cutoff >6), and functional status (Barthel Index, cutoff <20 indicating limitations). Chi-square tests assessed bivariate associations; multivariable logistic regression calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI).

**Key Results:** The overall prevalence of poor SRH was 32.6% (95% CI: 28.83–36.68). In bivariate analysis, poor SRH was significantly associated with lower education (non-formal: 42.8%; tertiary: 20.3%; p<0.001), unemployment (34.5% vs. 26.7%; p<0.001), being single (38.0% vs. 30.1%; p<0.001), low income (<MYR 1000: 37.9%; ≥MYR 2000: 20.9%; p<0.001), diabetes (37.9% vs. 30.7%; p=0.005), hypertension (37.0% vs. 28.1%; p<0.001), hypercholesterolemia (37.1% vs. 29.5%; p=0.003), physical inactivity (45.8% vs. 27.1%; p<0.001), depressive symptoms (62.7% vs. 27.6%; p<0.001), and limitations in ADLs (55.8% vs. 27.9%; p<0.001). In the multivariable model, five factors remained significant independent predictors: depressive symptoms (aOR 2.92; 95% CI: 2.01–4.24; p<0.001), limitations in ADLs (aOR 1.82; 95% CI: 1.31–2.54; p<0.001), individual monthly income <MYR 1000 (aOR 1.66; 95% CI: 1.22–2.26; p=0.001), physical inactivity (aOR 1.40; 95% CI: 1.08–1.82; p=0.011), and self-reported hypertension (aOR 1.23; 95% CI: 1.02–1.49; p=0.032). Gender, locality, education, employment, marital status, living arrangements, diabetes, hypercholesterolemia, smoking, and fruit/vegetable consumption were not significant in the adjusted model.

**Clinical Implications:** The prevalence of poor SRH among older Malaysians (32.6%) is substantial and higher than earlier local estimates, suggesting a possible genuine increase in health problems or improved detection. Depression emerged as the strongest predictor, with nearly threefold higher odds of poor SRH, underscoring the critical need for integrating mental health screening and services into geriatric care. Functional limitations (ADL impairments) nearly doubled the odds, highlighting the importance of rehabilitation and supportive services to maintain independence. Low income and physical inactivity—both modifiable socioeconomic and behavioral factors—were also significant, pointing to the need for targeted public health interventions such as subsidized health programs, income support, and community-based physical activity initiatives for older adults. Hypertension was the only chronic disease that remained significant after adjustment, suggesting that blood pressure control should be prioritized. The cross-sectional design precludes causal inference, and self-reported chronic conditions may introduce information bias. Nonetheless, these findings provide actionable evidence for policymakers and healthcare providers to develop integrated, multi-component strategies addressing mental health, functional status, socioeconomic disparities, and lifestyle behaviors to improve health outcomes in Malaysia's rapidly aging population.