Self-rated health in relation to age and gender: Influence on mortality risk in the Malmö Preventive Project

Abstract

Aims: A study was undertaken to examine whether poor self-rated health (SRH) can independently predict all-cause mortality during 22-year follow-up in middle-aged men and women. Subjects and methods: Data are derived from a population-based study in Malmö, Sweden. This included baseline laboratory testing and a self-administered questionnaire. The question on global SRH was answered by 15,590 men (mean age 46.4 years) and 10,089 women (49.4 years). Social background characteristics (occupation, marital status) were based on data from national censuses. Mortality was retrieved from national registers. Results: At screening 4,261 (27.3%) men and 3,085 (30.6%) women reported poor SRH. Among subjects rating their SRH as low, 1,022 (24.0%) men and 228 (7.4%) women died during follow-up. Corresponding figures for subjects rating their SRH as high were 1801 (15.9%) men and 376 (5.4%) women. An analysis of survival in subjects reporting poor SRH revealed an age-adjusted hazard risk ratio (HR, 95%CI) for men HR 1.5 (1.4—1.7), and for women HR 1.4 (1.2—1.6). The corresponding HR after adjusting for possible social confounders was for men HR 1.3 (1.1—1.4), and women HR 1.1 (0.9—1.4). When additional adjustment was made for biological risk factors the association for men was still significant, HR 1.2 (1.1—1.3). Conclusion: Poor SRH predicts increased long-term mortality in healthy, middle-aged subjects. For men the association is independent of both social background and selected biological variables. The adjustment for biological variables can be questioned as they might represent mediating mechanisms in a possible causal chain of events.

Keywords

Epidemiology gender lifestyle mortality self-rated health social

Get full access to this article

View all access options for this article.

References

Mossey JM , Shapiro E. Self-rated health: A predictor of mortality among the elderly. Am J Public Health 1982;72:801—7.

Kaplan GA , Camacho T. Perceived health and mortality: A nine-year follow-up of the human population laboratory cohort. Am J Epidemiol 1983;117:292—305.

Idler EL , Kasl SV , Lemke JH Self-evaluated health and mortality among the elderly in New Haven, Connecticut and Iowa and Washington counties, Iowa, 1982—1986. Am J Epidemiol 1990;131:91—103.

Idler EL , Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies . J Health Soc Behav 1997;38:21—37.

Sundkvist J. , Johansson S-E. Self-reported poor health and low educational level predictors for mortality: A population based follow up study of 39 156 people in Sweden. J Epidemiol Community Health 1997;51:35—40.

Kaplan GA , Goldberg DE , Everson SA , Cohen RD , Salonen R. , Tuomilehto J. , et al. Perceived health status and morbidity and mortality: Evidence from the Kuopio Ischaemic Heart Disease Risk Factor Study. Int J Epidemiol 1996;25:259—64.

Bue-Björner J. , Söndergaard-Kristensen T. , Orth-Gomér K. , Tibblin G. , Sullivan M. , Westerholm P. Self-rated health — a useful concept in research, prevention and clinical medicine. Uppsala: Swedish Council for Planning and Coordination of Research (Forskningsrådsnämnden) , 1996.

Undén A-L. , Elofsson S. Självupplevd hälsa — Faktorer som påverkar människors egen bedömning (Subjective health — factors influencing people's own rating). Stockholm: Swedish Council for Planning and Coordination of Research (Forskningsrådsnämnden), 1998 .

Larsson D. , Hemmingsson T. , Allebeck P. , Lundberg I.

Self-rated health and mortality among young men: What is the relation and how may it be explained?

Scand J Public Health 2002;30:259—66.

10.

Power C. , Matthews S. , Manor O. Inequalities in self-rated health: Explanations from different stages of life . Lancet 1998;351:1009—14.

11.

Blank N. , Diderichsen F. Social inequalities in the experience of illness in Sweden: A ``double suffering'' . Scand J Soc Med 1996;24:81—9.

12.

Blank N. , Diedrichsen F. The prediction of different experiences of longterm illness: A longitudinal approach in Sweden. J Epidemiol Community Health 1996;50: 156—61.

13.

Trell E. Community-based preventive medical department for individual risk factor assessment and intervention in an urban population. Prev Med 1983;12:397—402.

14.

Berglund G. , Nilsson P. , Eriksson K-F. , Nilsson J-Å. , Hedblad B. , Kristensson H. , et al. Long-term outcome of the Malmö Preventive Project: Mortality and cardiovascular morbidity. J Intern Med 2000;247:19—29.

15.

Lundberg O. , Manderbakka K. Assessing reliability of a measure of self-rated health. Scand J Soc Med 1996 ;24:218—24.

16.

Fex G. , Kristenson H. , Trell E. Correlations of serum lipids and lipoproteins with gammaglutamyltransferase and attitude to alcohol consumption. Ann Clin Biochem 1982;19:345—9.

17.

Agarwal DP Cardioprotective effects of light—moderate consumption of alcohol: A review of putative mechanisms. Alcohol 2002;37:409—15.

18.

Vogel RA Alcohol, heart disease, and mortality: A review. Rev Cardiovascular Med 2002;3:7—13.

19.

Kaplan G. , Baron-Epel O.

What lies behind the subjective evaluation of health status?

Soc Sci Med 2003 ;56:1669—76.

20.

Manderbakka K. , Kåreholt I. , Martikainen P. The effect of point of reference on the association between self-rated health and mortality. Soc Sci Med 2003;56:1447—52.

21.

Denton M. , Prus S. , Walters V. Gender differences in health: A Canadian study of the psychosocial, structural and behavioural determinants of health. Soc Sci Med 2004;58:2585—600.

22.

Eriksson I. , Undén AL , Elofsson S. Self-rated health. Comparisons between three different measures. Results from a population study. Int J Epidemiol 2001;30:326—33.

23.

Goldstein MS , Siegel JM , Boyer R. Predicting changes in perceived health status . Am J Public Health 1984;74:611—4.

24.

Pope GC Medical conditions, health status, and health service utilization . Health Serv Res 1988;22:857—77.

25.

Fylkesnes K. , Förde OH

The Tromsö study: Predictors of self-evaluated health — has society adopted the expanded health concept?

Soc Sci Med 1991;32:141—6.

26.

Kristenson M. Self-rated health and biological mechanisms: A literature review. In: Nilsson P , Orth-Gomér K , editors. Self-rated health in a European perspective. Forskningsrådsnämnden, Uppsala, 2000.

27.

Weinehall L. , Johnson O. , Jansson JH , Boman K. , Huhtasaari F. , Hallmans G. , et al. Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case-control study from northern Sweden. J Intern Med 1998;243:99—107.

28.

Emmelin M. , Weinehall L. , Stegmayr B. , Dahlgren L. , Stenlund H. , Wall S. Self-rated health strengthens the effect of biomedical risk factors in predicting stroke, especially for men — an incident case referent study. J Hypertens 2003;21:887—96.

29.

Svartvik L. , Lidfeldt J. , Nerbrand C. , Samsioe G. , Scherstén B. , Nilsson PM Dyslipidemia and impaired well-being in middle-aged women reporting low sense of coherence . Scand J Prim Health Care 2000;18:177—82.