Highlights
- •The association of self-rated health with mortality is confirmed by the large CHANCES study.
- •Self-rated health is a simple tool that may be used to identify elders at risk of early mortality.
- •Changing factors related to self-rated health is important for the elders to feel and be healthy.
Abstract
Objectives
To evaluate, among the elderly, the association of self-rated health (SRH) with mortality,
and to identify determinants of self-rating health as “at-least-good”.
Study design
Individual data on SRH and important covariates were obtained for 424,791 European
and United States residents, ≥60 years at recruitment (1982–2008), in eight prospective
studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the
United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios,
HRs) in relation to SRH were calculated and subsequently combined with random-effect
meta-analyses.
Main outcome measures
All-cause, cardiovascular and cancer mortality.
Results
Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH “fair”
or “poor” vs. “at-least-good” was associated with increased mortality: HRs 1.46 (95%
CI 1·23–1.74) and 2.31 (1.79–2.99), respectively. These associations were evident:
for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup
analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently,
for medical history explained only a modest amount of the unadjusted associations.
Factors favourably associated with SRH were: sex (males), age (younger-old), education
(high), marital status (married/cohabiting), physical activity (active), body mass
index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence).
Conclusion
SRH provides a quick and simple tool for assessing health and identifying groups of
elders at risk of early mortality that may be useful also in clinical settings. Modifying
determinants of favourably rating health, e.g. by increasing physical activity and/or
by eliminating obesity, may be important for older adults to “feel healthy” and “be
healthy”.
Abbreviations:
CHANCES (Consortium on Health and Ageing Network of Cohorts in Europe and the United States), CI (confidence interval), HR (hazard ratio), OR (odds ratio), SRH (self-rated health)Keywords
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References
- Analysis of the validity of health questionnaires.Soc. Forces. 1958; 36: 223-232
- Statistics Netherlands. Health Interview Surveys: Towards International Harmonization of Methods and Instruments.WHO Office for Europe, Copenhagen1996
- The Elderly in Eleven Countries: A Sociomedical Study.in: Heikkinen E. Waters E. Brzezinski Z.J. World Health Organization, Regional Office for Europe, Copenhagen1983
- Self-rated health and associated factors among men of different ages.J. Gerontol. 1986; 41: 710-717
- Are different measures of self-rated health comparable? An assessment in five European countries.Eur. J. Epidemiol. 2008; 23: 773-781
- Self-rated health: a predictor of mortality among the elderly.Am. J. Public Health. 1982; 72: 800-808
- Self-rated health and mortality: a review of twenty-seven community studies.J. Health Soc. Behav. 1997; 38: 21-37
- Self-reported health status and mortality in a multiethnic US cohort.Am. J. Epidemiol. 1999; 149: 41-46
- Self-rated health and its relation to all cause and cardiovascular mortality in Southern Germany. Results from the MONICA Augsburg cohort study 1984–1995.Ann. Epidemiol. 2002; 12: 338-345
- Self-rated general health among 40-year-old Danes and its association with all-cause mortality at 10-, 20-, and 29 years’ follow-up.Scand. J. Public Health. 2008; 36: 3-11
- Self-rated health and mortality in the UK: results from the first comparative analysis of the England and Wales, Scotland, and Northern Ireland longitudinal studies.Popul. Trends. 2010; 139: 11-36
- Self-rated health and mortality in a prospective Chinese elderly cohort study in Hong Kong.Prev. Med. 2014; 67: 112-118
- Mortality prediction with a single general self-rated health question. A meta-analysis.J. Gen. Intern. Med. 2006; 21: 267-275
- Gender differences in processing information for making self-assessments of health.Psychosom. Med. 2000; 62: 354
- Concepts of self-rated health: specifying the gender difference in mortality risk.Gerontologist. 2003; 43: 376-386
- Are gender differences in the relationship between self-rated health and mortality enduring? Results from three birth cohorts in Melton Mowbray, United Kingdom.Gerontologist. 2003; 43 (discussion 372-5): 406-411
- Gender differences in the relationship between self-rated health (SRH) and 6-year mortality risks among the elderly in Japan.Arch. Gerontol. Geriatr. 2008; 47: 311-317
- Sex gender and socioeconomic differences in the predictive ability of self-rated health for mortality.PLoS One. 2012; 7: e30179
- Self rated health: is it as good a predictor of subsequent mortality among adults in lower as well as in higher social classes?.J. Epidemiol. Community Health. 2001; 55: 836-840
- Does the predictive power of self-rated health for subsequent mortality risk vary by socioeconomic status in the US?.Int. J. Epidemiol. 2007; 36: 1214-1221
- The predictive ability of self assessed health for mortality in different educational groups.Int. J. Epidemiol. 2007; 36: 1207-1213
- The association between self-rated health and mortality in different socioeconomic groups in the GAZEL cohort study.Int. J. Epidemiol. 2007; 36: 1222-1228
- Self-rated health and mortality in older men and women: a time-dependent covariate analysis.Arch. Gerontol. Geriatr. 2009; 48: 14-18
- Does the association between self-rated health and mortality vary by social class?.Soc. Sci. Med. 2009; 68: 275-280
- Longitudinal study of associations between perceived health status and self reported diseases in the French Gazel cohort.J. Epidemiol. Community Health. 2001; 55: 233-238
- The relationship between self-rated health and objective health status: a population-based study.BMC Public Health. 2013; 13: 320
- A single-Item self-rated health measure correlates with objective health status in the elderly: a survey in suburban beijing.Front Public Health. 2014; 2: 27
- The Consortium on health and ageing: network of cohorts in Europe and the United States (CHANCES) project–design, population and data harmonization of a large-scale, international study.Eur. J. Epidemiol. 2014; 29: 929-936
K. Kuulasmaa, T. Palosaari, editors. Contributors from Partners of the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). CHANCES cohort descriptions, assessment of the availability and quality of data, and definitions of variables. MORGAM Project e-publications [Internet]. 2015; (6). URN:NBN:fi-fe201501151161. http://www.thl.fi/publications/morgam/chances_d9/index.html Published February 6, 2015. Updated June 3, 2015. (Accessed June 8, 2016).
- Meta-analysis in clinical trials.Control. Clin. Trials. 1986; 7: 177-188
- Quantifying heterogeneity in a meta-analysis.Stat. Med. 2002; 21: 1539-1558
- 5 year mortality predictors in 498,103 UK Biobank participants: a prospective population-based study.Lancet. 2015; 386: 533-540
- True health vs. response styles: exploring cross-country differences in self-reported health.Health Econ. 2007; 16: 163-178
- Self-assessed health, reference levels and mortality.Appl. Econs. 2008; 40: 569-582
- Self-reported physical health among aged adults.J. Gerontol. 1986; 41: 248-260
- Subjective state of health and survival in elderly adults.J. Gerontol. 1988; 43: 114S-120S
- Do workers underreport morbidity? The accuracy of self-reports of chronic conditions?.Soc. Sci. Med. 2012; 75: 15891594
- Exploring self-rated health among adolescents: a think-aloud study.BMC Public Health. 2016; 16 ([published online ahead of print February 16, 2016]): 156https://doi.org/10.1186/s12889-016-2837-z
- Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data.Soc. Sci. Med. 2003; 57: 1621-1629
- The ability of self-rated health to predict mortality among community-dwelling elderly individuals differs according to the specific cause of death: data from the NEDICES Cohort.Gerontology. 2013; 59: 368-377
- Psychosocial and behavioural contributors to health: age-related increases in physical disability are reduced by physical fitness.Psychol Health. 2010; 25: 805-820
- Commentary: heterogeneity in meta-analysis should be expected and appropriately quantified.Int. J. Epidemiol. 2008; 37: 1158-1160
Article info
Publication history
Published online: June 17, 2017
Accepted:
June 8,
2017
Received in revised form:
May 27,
2017
Received:
November 3,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
