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
    • "Porta et al., 2010, 2012; Prüss-Ustün et al., 2011; World Health Organization, 2013). Self-rated health (SRH) does not just capture the individual's subjective well-being: decades of research have shown that it is also a simple and powerful predictor of morbidity and mortality (Baron-Epel, 2004; Bjorner et al., 2005; Brunström and Fredlund, 2001; DeSalvo et al., 2006; Diehr et al., 2001, 2002; Eriksson et al., 2001; Idler and Benyamini, 1997, Idler et al., 2000). SRH is most commonly rated using a five-point scale ranging from excellent health to poor health. "
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    ABSTRACT: Background: Self-rated health (SRH) is a powerful predictor of mortality, morbidity, and need for health services. SRH generally increases with educational level, and decreases with age, number of chronic conditions, and body mass index (BMI). Because human concentrations of most persistent organic pollutants (POPs) also vary by age, education, and BMI, and because of the physiological and clinical effects of POPs, we hypothesized that body concentrations of POPs are inversely associated with SRH. Objectives: To analyze the relation between serum concentrations of POPs and SRH in the general population of Catalonia, Spain, taking into account sociodemographic factors and BMI, as well as chronic health conditions and mental disorders, measured by the General Health Questionnaire-12 (GHQ-12). Methods: POP serum concentrations were measured by gas chromatography with electron-capture detection in 919 participants of the Catalan Health Interview Survey. Results: Individuals with higher concentrations of POPs had significantly poorer SRH; e.g., the median concentration of HCB in subjects with poor SRH was twice as high as in subjects with excellent SRH (366ng/g vs. 169ng/g, respectively; p-value<0.001). In crude models and in models adjusted for sex and BMI, the POPs-SRH association was often dose-dependent, and the likelihood of poor or regular SRH was 2 to 4-times higher in subjects with POP concentrations in the top quartile. In models adjusted for age or for chronic conditions virtually all ORs were near unity. No associations were found between POP levels and GHQ-12. Conclusions: Individuals with higher concentrations of POPs had significantly poorer SRH, an association likely due to age and chronic conditions, but not to sex, education, social class, BMI, or mental disorders.
    Environmental Research 10/2015; 143(Pt A):211-220. DOI:10.1016/j.envres.2015.10.005 · 4.37 Impact Factor
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    • "The construct of self-rated health has been widely used in survey research, including large-scale international comparative studies (Bambra and Eikemo 2009). A consistent finding is that selfrated global health predicts subsequent chronic disease status (Shadbolt 1997) and mortality , after controlling for specific health status indicators (DeSalvo et al. 2006; Idler and Benyamini 1997). Also, self-rated health correlates with 'objective' measures of health status, such as disease status and blood markers (Wu et al. 2013), and a range of social, socio-economic, psychological, and health behavior related factors (Amstadter et al. 2010; Cano et al. 2003; Kawachi et al. 1999; Kunst et al. 2005; Operario et al. 2004). "

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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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    ABSTRACT: Background: Little is known about the health and well-being of the 'hidden majority' of parents with mild intellectual disability (ID), who are less likely to be in contact with disability services. Method: We sought to add to knowledge in this area by examining the health and living conditions of parents with and without intellectual impairment in a large contemporary nationally representative sample of UK parents aged between 16 and 49 years old (n = 14 371). Results: Our results indicated that, as expected, parents with intellectual impairment were at significantly greater risk than other parents of having poorer self-reported general, mental and physical health. They were also at significantly greater risk of experiencing higher rates of household socio-economic disadvantage and environmental adversities and lower rates of neighbourhood social capital and intergenerational support. Adjusting risk estimates to take account of between group differences in household socio-economic disadvantage eliminated statistically significant differences in health status between parents with and without intellectual impairment on all but one indicator (obesity). Further adjusting risk estimates to take account of between group differences in neighbourhood adversity, neighbourhood social capital and intergenerational support had minimal impact on the results. Conclusions: That controlling for between-group differences in exposure to socio-economic disadvantage largely eliminated evidence of poorer health among parents with intellectual impairment is consistent with the view that a significant proportion of the poorer health of people with IDs may be attributable to their poorer living conditions rather than biological factors associated with ID per se.
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