Self-rated general health among 40-year-old Danes and its association with all-cause mortality at 10-,20-,and 29 years' follow-up

Abstract

Aims: Self-rated general health (SRH) predicts future mortality. We examined all-cause mortality at 10, 20, and 29 years' follow-up and its association with SRH measured at the age of 40 years in a cohort of 1,198 healthy Danes born in 1936 and who were residents in suburban Copenhagen. Methods: The association between SRH (dichotomized into good versus poor) and all-cause mortality was estimated in standard time-homogenous Cox regression models adjusting for covariates related to mortality, and in time-heterogeneous Cox regression models without covariate adjustment, where time-heterogeneity features as a separate risk assessment for each of the three follow-up periods defined by the follow-up examinations. Results: At the age of 40 years, 153 (14.6%) of 1,045 participants reported poor and 85.4% good SRH. Dead participants totalled 36 at the 10-year, 96 at the 20-year, and 207 at the 29-year follow-up. For poor SRH, mortality hazard ratios (multivariate analysis) were persistently significant, but slowly declining with follow-up time. The time-heterogeneous models explain this feature: increased mortality risk was significant only in the first decade after assessment: 2.30 (95% CI 1.11-4.78) vs. 0.91 (95% CI 0.36-2.31) and 0.73 (95% CI 0.34-1.55). Conclusions: The association between poor SRH and mortality emphasizes the importance of health personnel taking account of people's health rating, particularly when a recent assessment has been made. SRH is related to death, even when controlling for known covariates, but it is not a long-term effect.

Keywords

Denmark follow-up studies health status longitudinal studies mortality self-rated health

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References

Geest TA , Engberg M. , Lauritzen T. Discordance between self-evaluated health and doctor-evaluated health in relation to general health promotion . Scand J Prim Health Care 2004;22:146-51.

Kivinen P. , Halonen P. , Eronen M. , Nissinen A. Self-rated health, physician-rated health and associated factors among elderly men: Rhe Finnish cohorts of the Seven Countries Study . Age Ageing 1998;27:41-7.

Moller L. , Kristensen TS , Hollnagel H. Self rated health as a predictor of coronary heart disease in Copenhagen, Denmark . J Epidemiol Community Health 1996 ;50(:423-8.

Benyamini Y. , Idler EL Community studies reporting association between self-rated health and mortality: Additional studies, 1995 to 1998 . Res Aging 1999;21:392-401.

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

DeSalvo KB , Bloser N. , Reynolds K. , He J. , Muntner P. Mortality Prediction with a single general self-rated health question . J Gen Intern Med 2006;21:267-75.

Strawbridge WJ , Wallhagen MI Self-Rated health and mortality over three decades . Res Aging 1999;21:402-16.

Simons LA , McCallum J. , Friedlander Y. , Simons J. Predictors of mortality in the prospective Dubbo study of Australian elderly . Aust N Z J Med 1996;26:40-8.

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;25:259-65.

10.

Meinow B. , Kareholt I. , Parker MG , Thorslund M. The effect of the duration of follow-up in mortality analysis: The temporal pattern of different predictors . J Gerontol B Psychol Sci Soc Sci 2004;59:S181-S189.

11.

Benyamini Y. , Blumstein T. , Lusky A. , Modan B. Gender differences in the self-rated health-mortality association: Is it poor self-rated health that predicts mortality or excellent self-rated health that predicts survival ? Gerontologist 2003;43:396-405.

12.

Hollnagel H. , Saelan H. , Garde K. , Larsen S. [The concept of representativity in epidemiological studies. Examples from population study of 40 year olds in Glostrup] . Ugeskr Laeger 1981;143:1781-8.

13.

Hollnagel H. The health structure of 40-year-old men and women in the Glostrup area, Denmark - an epidemiological survey: General design, sampling results and referrals for further medical care . Dan Med Bull 1980,27:121-30.

14.

Moller LF , Kristensen TS , Hollnagel H. [Social status and cardiovascular risk factors in Danish males] . Ugeskr Laeger 1991;154:8-13.

15.

Drivsholm T. , Eplov LF , Davidsen M. , Jorgensen T. , Ibsen H. , Hollnagel H. , et al. Representativeness in population-based studies - a detailed description of non-response in a Danish cohort-study. Scand J Public Health 2006;34:623-3.

16.

Saltin B. , Grimby G. Physiological analysis of middle-aged and old former athletes: Comparison with still active athletes of the same ages . Circulation 1968;38:1104-15.

17.

Rose GA , Blackburn H. Cardiovascular survey methods . Monogr Ser World Health Organ 1968;56:1-188.

18.

Dunn OJ Multiple Comparisons among means . J Am Statistical Association 1961;56:52-64.

19.

Nan B. , Lin X. , Lisabeth LD , Harlow SD A varying-coefficient Cox model for the effect of age at a marker event on age at menopause . Biometrics 2005;61:576-83.

20.

Maddox GL , Douglass EB Self-assessment of health: A longitudinal study of elderly subjects . J Health Soc Behav 1973;14:87-93.

21.

McCullough ME , Laurenceau JP Gender and the natural history of self-rated health: A 59-year longitudinal study . Health Psychol 2004;23:651-5.

22.

Idler EL Discussion: Gender differences in self-rated health, in mortality, and in the relationship between the two . Gerontologist 2003;43:372-5.

23.

Deeg DJ , Kriegsman DM Concepts of self-rated health: Specifying the gender difference in mortality risk . Gerontologist 2003;43:376-86.

24.

Helmer C. , Barberger-Gateau P. , Letenneur L. , Dartigues JF Subjective health and mortality in French elderly women and men . J Gerontol B Psychol Sci Soc Sci 1999;54: S84-S92.

25.

Van Doom C. , Kasl SV Can parental longevity and self-rated life expectancy predict mortality among older persons? Results from an Australian cohort . J Gerontol B Psychol Sci Soc Sci 1998 ;53:S28-S34.

26.

Heistaro S. , Jousilahti P. , Lahelma E. , Vartiainen E. , Puska P. Self rated health and mortality: a long term prospective study in eastern Finland . J Epidemiol Community Health 2001; 55:227-32.

27.

Joutsenniemi KE , Martelin TP , Koskinen SV , Martikainen PT , Harkanen TT , Luoto RM , et al. Official marital status, cohabiting, and self-rated health: Time trends in Finland, 1978-2001 . Eur J Public Health 2006;16: 476-83.

28.

Pijls LT , Feskens EJ , Kromhout D. Self-rated health, mortality, and chronic diseases in elderly men. The Zutphen Study, 1985-1990 . Am J Epidemiol 1993;138:840-8.

29.

Appels A. , Bosma H. , Grabauskas V. , Gostautas A. , Sturmans F. Self-rated health and mortality in a Lithuanian and a Dutch population . Soc Sci Med 1996;42:681-9.

30.

Heidrich J. , Liese AD , Lowel H. , Keil U. 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;12:338-45.

31.

Idler EL , Kasl S. Health perceptions and survival: Do global evaluations of health status really predict mortality ? J Gerontol 1991;46:S55-S65.

32.

Manderbacka K. Examining what self-rated health question is understood to mean by respondents . Scand J Soc Med 1998;26:145-53.

33.

Malterud K. , Hollnagel H. Positive self-assessed general health in patients with medical problems: A qualitative study from general practice . Scand J Prim Health Care 2004;22: 11-15.