European Journal of Epidemiology

, Volume 31, Issue 2, pp 177–185 | Cite as

Trajectories of self-rated health in the last 15 years of life by cause of death

  • Sari Stenholm
  • Mika Kivimäki
  • Marja Jylhä
  • Ichiro Kawachi
  • Hugo Westerlund
  • Jaana Pentti
  • Marcel Goldberg
  • Marie Zins
  • Jussi Vahtera


Poor self-rated health is associated with increased risk of mortality, but no previous study has examined how long-term trajectories of self-rated health differ among people at risk of subsequent death compared to those who survive. Data were drawn from French occupational cohort (the GAZEL study, 1989–2010). This nested case–control study included 915 deceased men and women and 2578 controls matched for sex, baseline age, occupational grade and marital status. Self-rated health was measured annually and dichotomized into good versus poor health. Trajectories of poor self-rated health up to 15 years were compared among people who subsequently died to those who survived. Participants contributed to an average 10.3 repeated assessments of self-rated health. Repeated-measures log-binomial regression analysis with generalized estimating equations showed an increased prevalence of poor self-rated health in cases 13–15 years prior to death from ischemic and other cardiovascular disease [multivariable-adjusted risk ratio 2.06, 95 % confidence interval (CI) 1.55–2.75], non-smoking-related cancers (1.57, 95 % CI 1.30–1.89), and suicide (1.78, 95 % CI 1.00–3.16). Prior to death from ischemic and other cardiovascular disease, increased rates of poor self-rated health were evident even among persons who were free of cardiovascular diseases (2.05, 95 % CI 1.50–2.78). In conclusion, perceptions of health diverged between the surviving controls and the deceased already 15 years prior to death. For cardiovascular mortality, decline in self-rated health started before diagnosis of the disease leading to death. The findings suggest that declining self-rated health might capture pathological changes before and beyond the disease diagnosis.


Self-rated health Cause-specific mortality Trajectory Cohort study 



This work was supported by the EU’s Era-Age 2 program (Academy of Finland 264944), Academy of Finland (286294) and the Swedish Research Council for Health, Working Life and Welfare (Forte, 2012-1661). Mika Kivimäki is supported by the Medical Research Council (K013351) and a professorial fellowship from the Economic and Social Research Council, UK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors disclose no conflict of interest.

Ethical standard

This study was approved by the French national ethics committee [Commission nationale de l’informatique et des libertés (CNIL)] and informed consent was obtained from all participants.

Supplementary material

10654_2015_71_MOESM1_ESM.docx (156 kb)
Supplementary material 1 (DOCX 155 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Sari Stenholm
    • 1
    • 2
  • Mika Kivimäki
    • 3
    • 4
    • 5
  • Marja Jylhä
    • 2
  • Ichiro Kawachi
    • 6
  • Hugo Westerlund
    • 7
  • Jaana Pentti
    • 4
  • Marcel Goldberg
    • 8
  • Marie Zins
    • 8
  • Jussi Vahtera
    • 1
    • 4
    • 9
  1. 1.Department of Public HealthUniversity of TurkuTurkuFinland
  2. 2.School of Health Sciences and the Gerontology Research Center (GEREC)University of TampereTampereFinland
  3. 3.Department of Epidemiology and Public HealthUniversity College LondonLondonUK
  4. 4.Finnish Institute of Occupational HealthHelsinkiFinland
  5. 5.Department of Public Health, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
  6. 6.Department of Society, Human Development, and HealthHarvard School of Public HealthBostonUSA
  7. 7.University of StockholmStockholmSweden
  8. 8.INSERM, UMS 011Hôpital Paul BrousseVillejuifFrance
  9. 9.Turku University HospitalTurkuFinland

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