Mortality prediction with a single general self-rated health question

A meta-analysis
  • Karen B. DeSalvoEmail author
  • Nicole Bloser
  • Kristi Reynolds
  • Jiang He
  • Paul Muntner
Clinical Review


OBJECTIVE: Health planners and policy makers are increasingly asking for a feasible method to identify vulnerable persons with the greatest health needs. We conducted a systematic review of the association between a single item assessing general self-rated health (GSRH) and mortality.

DATA SOURCES: Systematic MEDLINE and EMBASE database searches for studies published from January 1966 to September 2003.

REVIEW METHODS: Two investigators independently searched English language prospective, community-based cohort studies that reported (1) all-cause mortality, (2) a question assessing GSRH; and (3) an adjusted relative risk or equivalent. The investigators searched the citations to determine inclusion eligibility and abstracted data by following a standarized protocol. Of the 163 relevant studies identified, 22 cohorts met the inclusion criteria. Using a random effects model, compared with persons reporting “excellent” health status, the relative risk (95% confidence interval) for all-cause mortality was 1.23 [1.09, 1.39], 1.44 [1.21, 1.71], and 1.92 [1.64, 2.25] for those reporting “good,” “fair,” and “poor” health status, respectively. This relationship was robust in sensitivity analyses, limited to studies that adjusted for comorbid illness, functional status, cognitive status, and depression, and across subgroups defined by gender and country of origin.

CONCLUSIONS: Persons with “poor” self-rated health had a 2-fold higher mortality risk compared with persons with “excellent” self-rated health. Subjects’ responses to a simple, single-item GSRH question maintained a strong association with mortality even after adjustment for key covariates such as functional status, depression, and co-morbidity.

Key words

meta-analysis mortality risk assessment self-rated health quality of life 


  1. 1.
    Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37.CrossRefPubMedGoogle Scholar
  2. 2.
    Kawada T. Self-rated health and life prognosis. Arch Med Res. 2003;34:343–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982;72:800–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Burstrom B, Fredlund P. 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;55:836–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Yu ES, Kean YM, Slymen DJ, et al. Self-perceived health and 5-year mortality risks among the elderly in Shanghai, China. Am J Epidemiol. 1998;147:880–9 [see comment].PubMedGoogle Scholar
  6. 6.
    Sundquist J, Johansson SE. 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.CrossRefPubMedGoogle Scholar
  7. 7.
    Grand A, Grosclaude P, Bocquet H, et al. Disability, psychosocial factors and mortality among the elderly in a rural French population. J Clin Epidemiol. 1990;43:773–82.CrossRefPubMedGoogle Scholar
  8. 8.
    McGee DL, Liao Y, Cao G, et al. Self-reported health status and mortality in a multiethnic US cohort. Am J Epidemiol. 1999;149:41–6.PubMedGoogle Scholar
  9. 9.
    Greiner PA, Snowdon DA, Greiner LH. Self-rated function, self-rated health, and postmortem evidence of brain infarcts: findings from the Nun Study. J Gerontol. 1999;54:S219–22.Google Scholar
  10. 10.
    Appels A, Bosma H, Grabauskas V, et al. Self-rated health and mortality in a Lithuanian and a Dutch population. Soc Sci Med. 1996;42:681–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Tsuji I, Minami Y, Keyl PM, et al. The predictive power of self-rated health, activities of daily living, and ambulatory activity for cause-specific mortality among the elderly: a three-year follow-up in urban Japan. J Am Geriatr Soc. 1994;42:153–6.PubMedGoogle Scholar
  12. 12.
    McCallum J, Shadbolt B, Wang D. Self-rated health and survival: a 7-year follow-up study of Australian elderly. Am J Public Health. 1994;84:1100–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Heidrich J, Liese AD, Loweí H, et al. 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.CrossRefPubMedGoogle Scholar
  14. 14.
    Kaplan GA, Goldberg DE, Everson SA, 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.CrossRefPubMedGoogle Scholar
  15. 15.
    Idler EL, Russell LB, Davis D. Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and Nutrition Examination Survey. Am J Epidemiol. 2000;152:874–83.CrossRefPubMedGoogle Scholar
  16. 16.
    Thomas C, Kelman HR, Kennedy GJ, et al. Depressive symptoms and mortality in elderly persons. J Gerontol. 1992;47:S80–7.PubMedGoogle Scholar
  17. 17.
    Jylha M, Guralnik JM, Ferrucci L, et al. Is self-rated health comparable across cultures and genders? J Gerontol. 1998;53:S144–52.Google Scholar
  18. 18.
    Mansson NO, Rastam L. Self-rated health as a predictor of disability pension and death—a prospective study of middle-aged men. Scand J Public Health. 2001;29:151–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Engstrom G, Hedblad B, Janzon L. Subjective well-being associated with improved survival in smoking and hypertensive men. J Cardiovasc Risk. 1999;257–61.Google Scholar
  20. 20.
    Ginsberg GM, Hammerman-Rozenberg R, Cohen A, et al. Independence in instrumental activities of daily living and its effect on mortality. Aging Clin Exp Res. 1999;11:161–8.Google Scholar
  21. 21.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clin Trials. 1986;7:177–88.CrossRefPubMedGoogle Scholar
  22. 22.
    Greenland S, Longnecker M. Methods for trend estimating from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;1301–9.Google Scholar
  23. 23.
    Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. Br Med J. 1997;3:629–34.Google Scholar
  24. 24.
    Bath PA. Self-rated health as a risk factor for prescribed drug use and future health and social service use in older people. J Gerontol A Biol Sci Med Sci. 1999;54:M565–70.PubMedGoogle Scholar
  25. 25.
    Bernard SL, Kincade JE, Konrad TR, et al. Predicting mortality from community surveys of older adults: the importance of self-rated functional ability. J Gerontol. 1997;52:S155–63.Google Scholar
  26. 26.
    Hays JC, Schoenfeld D, Blazer DG, et al. Global self-ratings of health and mortality: hazard in the North Carolina Piedmont. J Clin Epidemiol. 1996;49:969–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Helmer C, Barberger-Gateau P, Letenneur L, et al. Subjective health and mortality in French elderly women and men. J Gerontol. 1999;54:S84–92.Google Scholar
  28. 28.
    Idler EL, Kasl S. Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol. 1991;46:S55–65.PubMedGoogle Scholar
  29. 29.
    Korten AE, Jorm AF, Jiao Z, et al. Health, cognitive, and psychosocial factors as predictors of mortality in an elderly community sample. J Epidemiol Community Health. 1999;53:83–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Nybo H, Petersen HC, Gaist D, et al. Predictors of mortality in 2,249 nonagenarians—the Danish 1905-Cohort Survey. J Am Geriatr Soc. 2003;51:1365–73.CrossRefPubMedGoogle Scholar
  31. 31.
    Ruigomez A, Alonso J, Anto JM. Relationship of health behaviours to five-year mortality in an elderly cohort. Age Ageing. 1995;24:113–39.CrossRefPubMedGoogle Scholar
  32. 32.
    Mossey J, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982;72:800–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Kaplan G, Barell V, Lusky A. Subjective state of health and survival in elderly adults. J Gerontol. 1988;43:S114–20.PubMedGoogle Scholar
  34. 34.
    Liang J. Self-reported physical health among aged adults. J Gerontol. 1986;41:248–60.PubMedGoogle Scholar
  35. 35.
    Saliba D, Elliott M, Rubenstein LZ, et al. The vulnerable elders survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 2001;49:1691–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Krause NM, Jay GM. What do global self-rated health items measure? Med Care. 1994;32:930–42.CrossRefPubMedGoogle Scholar
  37. 37.
    Ferraro K. Self-ratings of health among the old and the old-old. J Health Soc Behav. 1980;20:45–51.Google Scholar
  38. 38.
    Mutran E, Ferraro K. Medical needs and use of services among older men and women. J Gerontol. 1988;43:S162–71.PubMedGoogle Scholar
  39. 39.
    Kaplan G, Baron-Epel O. What lies behind the subjective evaluation of health status? Soc Sci Med. 2003;56:1669–76.CrossRefPubMedGoogle Scholar
  40. 40.
    Cockerham W, Sharp K, Wilcox J. Aging and perceived health status. J Gerontol. 1983;38:349–55.PubMedGoogle Scholar
  41. 41.
    Iezzoni LI. Statistically derived predictive models: caveat Emptor. J Gen Intern Med. 1999;14:388–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Fan VS, Au D, Heagerty P, et al. Validation of case-mix measures derived from self-reports of diagnoses and health. J Clin Epidemiol. 2002;55:371–80.CrossRefPubMedGoogle Scholar
  43. 43.
    DeSalvo KB, Fan VS, McDonnell MB, et al. Predicting mortality and health care utilization with a single question. Health Serv Res, in press.Google Scholar
  44. 44.
    Moher D, Pham B, Klassen TP, et al. What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol. 2000;53:964–72.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Karen B. DeSalvo
    • 1
    • 2
    • 3
    Email author
  • Nicole Bloser
    • 1
    • 2
  • Kristi Reynolds
    • 2
  • Jiang He
    • 1
    • 2
  • Paul Muntner
    • 1
    • 2
  1. 1.Section of General Internal MedicineTulane University School of MedicineNew Orleans
  2. 2.Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansUSA
  3. 3.Department of Health Systems ManagementTulane University School of Public Health and Tropical MedicineNew OrleansUSA

Personalised recommendations