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Mortality prediction with a single general self-rated health question

A meta-analysis

Abstract

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.

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References

  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.

    Article  CAS  PubMed  Google Scholar 

  2. Kawada T. Self-rated health and life prognosis. Arch Med Res. 2003;34:343–7.

    Article  PubMed  Google Scholar 

  3. Mossey JM, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982;72:800–8.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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].

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  16. Thomas C, Kelman HR, Kennedy GJ, et al. Depressive symptoms and mortality in elderly persons. J Gerontol. 1992;47:S80–7.

    CAS  PubMed  Google Scholar 

  17. Jylha M, Guralnik JM, Ferrucci L, et al. Is self-rated health comparable across cultures and genders? J Gerontol. 1998;53:S144–52.

    CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

  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.

    CAS  Google Scholar 

  21. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  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.

  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. 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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  28. Idler EL, Kasl S. Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol. 1991;46:S55–65.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  32. Mossey J, Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982;72:800–8.

    Article  CAS  PubMed  Google Scholar 

  33. Kaplan G, Barell V, Lusky A. Subjective state of health and survival in elderly adults. J Gerontol. 1988;43:S114–20.

    CAS  PubMed  Google Scholar 

  34. Liang J. Self-reported physical health among aged adults. J Gerontol. 1986;41:248–60.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  36. Krause NM, Jay GM. What do global self-rated health items measure? Med Care. 1994;32:930–42.

    Article  CAS  PubMed  Google Scholar 

  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. Mutran E, Ferraro K. Medical needs and use of services among older men and women. J Gerontol. 1988;43:S162–71.

    CAS  PubMed  Google Scholar 

  39. Kaplan G, Baron-Epel O. What lies behind the subjective evaluation of health status? Soc Sci Med. 2003;56:1669–76.

    Article  PubMed  Google Scholar 

  40. Cockerham W, Sharp K, Wilcox J. Aging and perceived health status. J Gerontol. 1983;38:349–55.

    CAS  PubMed  Google Scholar 

  41. Iezzoni LI. Statistically derived predictive models: caveat Emptor. J Gen Intern Med. 1999;14:388–9.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  43. DeSalvo KB, Fan VS, McDonnell MB, et al. Predicting mortality and health care utilization with a single question. Health Serv Res, in press.

  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.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Karen B. DeSalvo MD, MPH, MSc.

Additional information

The authors have no conflicts of interest to report.

Dr. DeSalvo is a Robert Wood Johnson Foundation Generalist Faculty Physician Program Scholar.

She is supported by a grant from the NIH #K12HD 43,451 whose funding was used to support this project.

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DeSalvo, K.B., Bloser, N., Reynolds, K. et al. Mortality prediction with a single general self-rated health question. J Gen Intern Med 21, 267 (2006). https://doi.org/10.1111/j.1525-1497.2005.00291.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.00291.x

Key words

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