Mortality Prediction with a Single General Self-Rated Health Question. A Meta-Analysis

Section of General Internal Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 04/2006; 21(3):267-75. DOI: 10.1111/j.1525-1497.2005.00291.x
Source: PubMed


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.
Systematic MEDLINE and EMBASE database searches for studies published from January 1966 to September 2003.
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 standardized 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 co-morbid illness, functional status, cognitive status, and depression, and across subgroups defined by gender and country of origin.
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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Available from: Nicole B Gabler, Jul 07, 2014
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    • "(1) excellent, (2) very good, (3) good, (4) fair, (5) poor' (Bowling 2005; DeSalvo et al. 2006 "
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    • "Poor self-reported health has long been associated with mortality (Kaplan and Camacho, 1983; Sundquist and Johannsson, 1997) and health care utilisation (Miilunpalo et al., 1997). A meta-analysis suggests that persons with " poor " self-rated health have a two-fold higher mortality risk compared with persons with " excellent " self-rated health even after adjustment for key covariates such as functional status, depression, and comorbidity (DeSalvo et al., 2006). Baker et al. (1997) noted a stronger association between self-assessed health and literacy than between self-assessed health and educational qualifications. "
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    • "In some cases subjective evaluations of health are better predictors of mortality than objective health-status measures and other known risk factors (DeSalvo et al., 2005). The SF-12 is the abridged version of the 36-item Short Form Health Survey (SF-36). "
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