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
    • "standard question about the perceived overall actual health status (grades 1–5) during the past 12 months. This measure is a well-known reliable health indicator with a strong potential of predicting further morbidity, health care costs, and even future mortality experience (Benjamins et al., 2004;DeSalvo et al., 2006;Jylhä, 2009;Miilunpalo et al., 1997). To complete the information on the recent health experience (during the past 3 months), the symptom scores of the two subscales (physical and anxiety) were used as additional independent predictors in the full model. "
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    • "Second, key covariates were available in all the cohorts, which provided better opportunities to produce more robust results and focus on the independent associations between insomnia symptoms and mortality, after considering for example baseline health. In particular, self-rated health had a strong contribution to the examined associations, which could be expected as it is associated both with insomnia (Arber et al., 2009;Lallukka et al., 2012) and mortality (DeSalvo et al., 2006; Idler andBenyamini, 1997). Inclusion of wider age cohorts enabled this study to show the association among midlife and ageing employees. "

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    • "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.
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