The ability of self-rated health to predict mortality among community-dwelling elderly individuals differs according to the specific cause of death: data from the NEDICES cohort

Association between cumulative smoking exposure and cognitive decline in non-demented older adults: NEDICES study

Whether cumulative smoking exposure is associated with cognitive decline among older adults remains unresolved. To address this question, we used data from the Neurological Disorders in Central Spain (NEDICES) cohort study, in which 2624 older adults were evaluated at two-time points separated by three years. A 37-item version of the Mini-Mental State Examination (MMSE-37) was administered at two visits to assess cognitive change. Regarding smoking exposure, we calculated an individual baseline score based on pack-years (i.e., packs of cigarettes smoked per day multiplied by years of smoking) in current and former smokers. Thus, smoking exposure was categorized into tertiles (low: < 19.0, medium: 19.0-47.0, and high: > 47.0). We used multivariable generalized estimating equation models to assess associations between pack-years and smoking status with 37-MMSE total score change from baseline to follow-up. The MMSE-37 total score had a decline of 1.05 points (confidence interval [CI] 95% 0.62 to 1.48) in the lower tertile of pack-years, 1.16 (CI 95% 0.70 to 1.62) in the middle tertile and 1.17 (CI 95% 0.70 to 1.65) in the higher tertile compared to never smokers, after adjusting for several demographic and clinical variables. The same occurred with smoking status, i.e., a decline of 1.33 (CI 95% 0.87 to 1.79) in current smokers and 1.01 (CI 95% 0.63 to 1.40) in former smokers. Our study provides evidence of the cumulative effect of smoking on cognition in older adults. Using a prospective population-based design, we demonstrated that cumulative smoking exposure was associated with cognitive decline in non-demented older adults. More population-based evidence is required to elucidate this association in older adults without dementia.

Self-Rated Health as a Predictor of Mortality in Older Adults: A Systematic Review

The aim of this study was to investigate the link between self-reported health (SRH) and mortality in older adults. In total, 505 studies were found in PubMed and Scopus, of which 26 were included in this review. In total, 6 of the 26 studies included did not find any evidence of an association between SRH and mortality. Of the 21 studies that included community dwellers, 16 found a significant relationship between SRH and mortality. In total, 17 studies involved patients with no specific medical conditions; among these, 12 found a significant link between SRH and mortality. Among the studies in adults with specific medical conditions, eight showed a significant association between SRH and mortality. Among the 20 studies that definitely included people younger than 80 years, 14 found a significant association between SRH and mortality. Of the twenty-six studies, four examined short-term mortality; seven, medium-term mortality; and eighteen, long-term mortality. Among these, a significant association between SRH and mortality was found in 3, 7, and 12 studies, respectively. This study supports the existence of a significant relation between SRH and mortality. A better understanding of the components of SRH might help guide preventive health policies aimed at delaying mortality in the long term.

Determinants of self-reported hypertension among women in South Africa: evidence from the population-based survey

Background

Hypertension (HTN), characterized by an elevation of blood pressure, is a serious public health chronic condition that significantly raises the risks of heart, brain, kidney, and other diseases. In South Africa, the prevalence of HTN (measured objectively) was reported at 46.0% in females, nonetheless little is known regarding the prevalence and risks factors of self-reported HTN among the same population. Therefore, the aim of this study was to examine determinants of self-reported HTN among women in South Africa.

Methods

The study used data obtained from the 2016 South African Demographic and Health Survey. In total, 6,027 women aged ≥ 20 years were analyzed in this study. Self-reported HTN was defined as a case in which an individual has not been clinically diagnosed with this chronic condition by a medical doctor, nurse, or health worker. Multiple logistic regression models were employed to examine the independent factors of self-reported HTN while considering the complex survey design.

Results

Overall, self-reported HTN was reported in 23.6% (95% confidence interval [CI], 23.1–24.1) of South African women. Being younger (adjusted odds ratio [aOR], 0.04; 95% CI, 0.03–0.06), never married (aOR, 0.69; 95% CI, 0.56–0.85), and not covered by health insurance (aOR, 0.74; 95% CI, 0.58–0.95) reduced the odds of self-reported HTN. On the other hand, being black/African (aOR, 1.73; 95% CI, 1.17–2.54), perception of being overweight (aOR, 1.72; 95% CI, 1.40–2.11), and perception of having poor health status (aOR, 3.53; 95% CI, 2.53–5.21) and the presence of other comorbidities (aOR, 7.92; 95% CI, 3.63–17.29) increased the odds of self-reported HTN.

Conclusions

Self-reported HTN was largely associated with multiple sociodemographic, health, and lifestyle factors and the presence of other chronic conditions. Health promotion and services aiming at reducing the burden of HTN in South Africa should consider the associated factors reported in this study to ensure healthy aging and quality of life among women.

Are Measures of Health Status for the Total Population Good Proxies for the Health of the Older Population in International Comparison Studies?

In the face of population aging, the health of older people is becoming especially important, impacting various areas of life, societies and countries’ economies. To provide the basis for effective decisions to achieve better health, comparative analyses can be used to find best practices to follow. The aim of the research was to check whether drawing conclusions about the older population’s health based on the health status of the total population is justified in international comparison analyses. An analysis was conducted for six population health indicators for European countries from 2010–2019. Rankings were created for the total population and the older subpopulation, and then ranks for these two populations were compared using statistical methods. The statistical analyses indicate that there is a strong, statistically significant relationship between the ranks for the total and the older population. However, looking at the descriptive analysis and visual presentation of data, differences in international rankings of indicator values for these two populations can be observed. As older people comprise a specific group of the population that is growing ever bigger and increasingly significant, it would be advisable to present the results of international comparisons not only for the total, but separately for the older population as well.

The health status: the ignored risk factor in dementia incidence. NEDICES cohort

BACKGROUND

The causes of the dementia decrease in affluent countries are not well known but health amelioration could probably play a major role. Nevertheless, although many vascular and systemic disorders in adult life are well-known risk factors (RF) for dementia and Alzheimer disease (AD), health status is rarely considered as a single RF.

AIM

To analyse whether the health status and the self-perceived health (SPH) could be RF for dementia and AD and to discuss its biological basis.

METHODS

We analysed different objective health measures and SPH as RF for dementia and AD incidence in 4569 participants of the NEDICES cohort by means of Cox-regression models. The mean follow-up period was 3.2 (range: 0.03-6.6) years.

RESULTS

Ageing, low education, history of stroke, and "poor" SPH were the main RF for dementia and AD incidence, whereas physical activity was protective. "Poor" SPH had a hazard ratio = 1.66 (95% CI 1.17-2.46; p = 0.012) after controlling for different confounders.

DISCUSSION

According to data from NEDICES cohort, SPH is a better predictor of dementia and AD than other more objective health status proxies. SPH should be considered a holistic and biologically rooted indicator of health status, which can predict future development of dementia and AD in older adults.

CONCLUSIONS

Our data indicate that it is worthwhile to include the SPH status as a RF in the studies of dementia and AD incidence and to explore the effect of its improvement in the evolution of this incidence.

Self-reported health status and mortality from all-causes of death, cardiovascular disease and cancer in an older adult population in Spain

Aim

To assess the association between self-reported health (SRH) and mortality from all-causes, cardiovascular disease (CVD) and cancer, in adults 65 years and older in Spain.

Methods

We analysed data of 894 adults (504 women, 390 men) aged 65 years and above from two population-based studies, the EUREYE-Spain study and the Valencia Nutritional Survey (VNS). SRH was assessed at baseline using a single question which is widely used in epidemiological studies: “Overall, how would you consider your health at present?” and the response options were: 1. Very good, 2. Good, 3. Fair, 4. Poor, 5. Very poor. Deaths were ascertained during a 12-year follow-up period, and we used Cox proportional hazards regression models to obtain adjusted hazard ratios (HR).

Results

During the 12 years of follow-up (8566.2 person-years), we observed 400 deaths, 158 (39.5%) due to CVD and 89 (22.3%) due to cancer. Fair and poor/very poor SRH were significantly associated with higher all-cause mortality after 12-years of follow-up, HR = 1.29 (95% CI, 1.03–1.61) and HR 1.53 (95% CI, 1.09–2.15), respectively. We observed evidence of higher CVD mortality among those who reported fair and poor/very poor SRH, although the association was attenuated and lost statistical significance in the fully adjusted models.

Conclusion

This study suggests that a poor SRH status is associated with a higher all-cause mortality risk among older adults in Spain. Checking SHR status may be useful to plan health care in older adults.

The Relationship Among Pain Location, Complications, and Quality of Life in Individuals With Fibromuscular Dysplasia

BACKGROUND

Fibromuscular dysplasia (FMD), a nonatherosclerotic arterial disease, can cause pain and vascular complications. The aim of this study was to examine the impact of FMD symptoms and complications on quality of life, depression, anxiety, and self-rated health.

DESIGN

This was a cross-sectional, correlational study.

METHODS

Participants were adults with a diagnosis of FMD. Quality of life (36-Item Short Form Health Survey), anxiety and depression (Patient-Reported Outcomes Measurement Information System [PROMIS®]), self-rated health question, and symptom/complication questionnaires were mailed to patients with FMD. Scores were compared with symptoms and complications. Multivariable linear models were fit for symptoms and survey scores. Ordinal regression was used for self-rated health. Backwards selection was run for each model. Alpha of 0.05 and 95% confidence intervals were used.

RESULTS

Of the 162 (275 total; 47.8%) patients who returned surveys (156 female), 130 had carotid or vertebral artery involvement (80.2%). Migraine (p < .001), neck pain (p = .036), and flank pain (p = .025) were associated with decrease in Mental Component scores. Migraine (p = .002) and neck pain (p = .023) were associated with lower Physical Component scores. Patients reporting abdominal pain compared with those without had 4.88 points higher depression. Abdominal pain (p = .031) and pulsatile tinnitus (p = .011) were associated with greater anxiety. Migraine was associated with (p = .002) lower self-rated health. Participants with history of stroke/transient ischemic attack had 2.42 (1.08, 5.46; p = .033) times the odds of poor self-rated health compared with those without stroke/transient ischemic attack.

CONCLUSIONS

Among patients with FMD, presence of pain and history of vascular complications were related to lower quality of life and self-rated health.

Perceived Health among Adolescent and Young Adult Survivors of Childhood Cancer

Survivors of childhood cancer (SCCs) are at increased risk of late effects, which are cancer- and treatment-related side-effects that are experienced months to years post-treatment and encapsulate a range of physical, cognitive and emotional problems including secondary malignancies. Perceived health can serve as an indicator of overall health. This study aims to (1) understand how a patient reported outcome (PRO) of perceived health of SCCs compares to controls who have not had a cancer diagnosis and (2) examine the relationships between perceived health and demographic and clinical variables, and health behavior. A total of 209 SCCs (n = 113 (54.10%) males; median age at diagnosis = 6.50 years; median time off treatment = 11.10 years; mean age at study = 19.00 years) were included. SCCs completed annual assessments as part of Long-Term Survivor Clinic appointments, including a question on perceived health answered on a five-point Likert scale. Data were collected retrospectively from medical charts. Perceived health of SCCs was compared to a control group (n = 836) using data from the 2014 Canadian Community Health Survey. Most SCCs (67%) reported excellent or very good health. The mean perceived health of SCCs (2.15 ± 0.91) was not statistically different from population controls (2.10 ± 0.87). Pain (B = 0.35; p < 0.001), physical activity (B = −0.39; p = 0.013) and concerns related to health resources (B = 0.59; p = 0.002) were significant predictors of perceived health. Factors shown to influence SCCs’ perceived health may inform interventions. Exploration into how SCCs develop their conception of health may be warranted.

Association between type of exercise and health-related quality of life in adults without activity limitations: a nationwide cross-sectional study

BACKGROUND

Exercise is known to be associated with health-related quality of life (HRQoL), however, evidence on the association between type of exercise and HRQoL in the general population is limited. We performed this study to investigate the association of exercise types and their combinations with HRQoL in Korean adults.

METHODS

We analyzed data from 13,437 adults aged ≥19 years without activity limitations who had participated in the 5th Korea National Health and Nutrition Examination Survey 2010-2012. As per the American College of Sports Medicine guideline, exercise types were categorized into eight groups: walking (W), flexibility (F), resistance (R), W + F, W + R, F + R, and W + F + R exercise groups and a non-exercise group. The European Quality of Life-5 Dimension (EQ-5D) index and the European Quality of Life Visual Analogue Scale (EQ-VAS) were used to assess HRQoL.

RESULTS

The mean age of participants was 42.8 ± 0.2 years. The proportion of participants in the non-exercise group was the highest (34.7%); among the exercise groups, the walking group was the most prevalent (16.9%) and the W + R group was the least (1.2%). In analysis of covariance, the mean EQ-5D index in W (0.875), W + F (0.878), F + R (0.877), and W + F + R (0.876) groups was significantly higher compared with that in non-exerciser group (0.869) (p < 0.05). The mean EQ-VAS score in the W (64.064), F (64.427), W + F (65.676), F + R (65.811), and W + F + R (67.110) groups was higher than that in the non-exercise group (62.396) (p < 0.05). No difference was observed between R and W + R groups and non-exercise group with regard to the EQ-5D index and EQ-VAS score.

CONCLUSIONS

The W (for 30 min at least five times a week), W + F, F + R (at least two days a week), and W + F + R groups showed higher HRQoL than the non-exercise group. This study may be helpful in the development of public exercise interventions, which could help enhance HRQoL in adults.

CAUSES, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015

OBJECTIVE

To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables.

MATERIALS AND METHODS

It is a prospective population-based cohort study of adults living in the community, 2013-15 N = 48,691, age ≥50; deceased = 1,944. Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe SHARE: Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living ADL, and Frailty. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios.

RESULTS

The crude mortality rate was 18.39 (1000 person-years at risk), (99 % CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21).

CONCLUSIONS

The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms, with a different influence in the European regions. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed.

Gender differences in the effect of self-rated health (SRH) on all-cause mortality and specific causes of mortality among individuals aged 50 years and older

Although different gender associations between self-rated health (SRH) and mortality have been reported, the results of the respective studies have been inconsistent and little is known about the cause-specific relation of mortality with SRH by gender. Therefore, to evaluate the gender differences in all-cause or specific causes of mortality by SRH, this retrospective cohort study was conducted using the data of 19,770 Korean adults aged 50 years and over who underwent health screening at Seoul National University Hospital between March 1995 and December 2008. SRH was surveyed using a simple questionnaire, and the all-cause mortality and cause-specific mortality were followed up from baseline screening until December 31, 2016. Results showed that the relationship between SRH and all-cause mortality differed by gender, and the differences also varied depending on the cause of death. In men, the adjusted hazard ratio (aHR) of all-cause mortality was higher in the poor SRH group than the very good SRH groups even after adjustment for socio-demographic, clinical, and behavioral risk factors (aHR:1.97, 95% CI 1.51-2.56), and these results were similar to those for cancer, cardiovascular, and respiratory disease mortalities (aHR:1.52, 95% CI 0.93-2.50; aHR: 2.11, 95% CI 1.19-3.74; aHR:10.30, 95% CI 2.39-44.44, respectively). However, in women, the association between SRH and all-cause mortality was insignificant, and inverse relationships were found for cardiovascular and respiratory disease mortalities in the poor and very good SRH groups. Cancer mortality had a positive relation with SRH (aHR: 1.14, 95% CI 0.75-1.72; aHR: 2.58, 95% CI 1.03-6.48; aHR: 0.49, 95% CI 0.24-0.98; aHR: 0.15, 95% CI 0.04-0.57: all-cause, cancer, cardiovascular, and respiratory disease mortalities, respectively). Clinicians need to take these gender differences by SRH into account when evaluating the health status of over-middle aged adults.

Self-rated health after stroke: a systematic review of the literature

BACKGROUND

Self-rated health (SRH) allows for comparison and identification of the health status of various populations. The aim of this study was to conduct a systematic review of the literature to expand the understanding of SRH after stroke.

METHODS

This systematic review was registered with PROSPERO (CRD42017056194) and conducted according to PRISMA guidelines. Studies published until December 2018 that evaluated the SRH of adults with stroke were included.

RESULTS

Of the 2132 identified studies, 51 were included. Only four studies had experimental designs (7.8%). In 60.7% of the studies, SRH was assessed by variations on direct questions (i.e., general and comparative SRH). Analog visual scales and quality of life instruments were also used to evaluate SRH, but there is no consensus regarding whether they are appropriate for this purpose. The results of cross-sectional and longitudinal studies revealed significant associations between poor SRH and stroke as well as between SRH, function, and disability. The power of SRH to predict stroke mortality is still uncertain. Two interventions (a home-based psychoeducational program concerning stroke health care and family involvement in functional rehabilitation) effectively improved SRH.

CONCLUSIONS

Direct questions are the most common method of evaluating SRH after stroke. Studies reported significant associations between the SRH of individuals with stroke and several relevant health outcomes. However, few experimental studies have evaluated SRH after stroke. Interventions involving health education and family involvement had a significant impact on SRH.

Socioeconomic status and self-rated health in China: Findings from a cross-sectional study

To investigate whether socioeconomic status is associated with the self-rated health (SRH) status among Chinese.A cross sectional study including a national sample was conducted among Chinese adults in 2008. In total, 3225 participants were selected by a multistage cluster sampling method. Both general self-rated health and time-comparative self-rated health were measured by a standardized questionnaire. Logistic regression models were used to estimate the odds ratios (ORs) (95% confidence intervals, CIs) of occupation with SRH by occupation, and adjusted for age, sex, education, area, marriage, smoking, drinking, and health status.Overall, 34.4% of study participants reported "good" on the general SRH (male: 35.8%; female: 32.9%) and 26.2% reported "good" on the time-comparative SRH (male: 27.2%; female: 25.3%). The prevalence of "good" general SRH varied from 28.8% to 52.8% and the prevalence of time-comparative SHR varied from 21.7% to 33.9% in different occupations. The adjusted OR (Odd Ratio) for "good" on the general SRH was 1.35 (95% CI: 1.20-1.52) for the occupation of civil servants, 2.23 (95% CI: 1.96-2.54) for farmers, and 1.15 (95%CI: 1.01-1.31) for businessmen. The full adjusted OR of "good" on the time-comparative SRH was 1.36 (95% CI: 1.17-1.58) for students and was 1.25 (95% CI: 1.10-1.42) for civil servants.In presented study, 34.4% of the participants reported "good" on the general SRH, and 26.2% participants reported "good" on the time-comparative SRH. The prevalence of "good" general SRH and "good" time-comparative SRH varied among occupations.

Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study

Background

The Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank.

Objective

The objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant.

Methods

A selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist.

Results

In this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals.

Conclusions

Population-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection).

Self-rated health status and illiteracy as death predictors in a Brazilian cohort

Cohort studies assessing predictive values of self-rated health (SRH) and illiteracy on mortality in low-to-middle income countries are missing in the literature. Aiming to determine if these two variables were death predictors, an observational prospective population-based cohort study was conducted in a Brazilian small city. The cohort was established in 2002 with a representative sample of adults living in the city, and re-assessed in 2015. Sociodemographic (including illiteracy), anthropometric, lifestyle, previous CVD, and SRH data were collected. Cox proportional hazard models were designed to assess SRH and illiteracy in 2002 as death (all causes, CVD and non-CVD) predictors in 2015. From a total of 1066 individuals included in this study, 95(9%) died of non-CVD causes and 53(5%) from CVD causes. Mortality rates were higher among those with worse SRH in comparison to better health status categories for all causes of death, CVD and non-CVD deaths (p<0.001 for all outcomes). Similarly, illiterate individuals had higher mortality rates in comparison to non-illiterate for all causes of death (p<0.001), CVD (p = 0.004) and non-CVD death (p<0.001). Higher SRH negatively predicted CVD death (HR 0.44; 95%CI 0.44–0.95; p = 0.027) and all causes of death (OR 0.40; 95%CI 0.20–0.78; p = 0.008) while illiteracy positively predicted Non-CVD death (OR 1.59; 95%CI 1.03–2.54; p = 0.046). In conclusion, we found in this large Brazilian cohort followed for 13 years that better health perception was a negative predictor of death from all causes and CVD deaths, while illiteracy was a positive predictor of non-CVD deaths.

Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study

Background and purpose

Self-rated health (SRH) is a consistent and strong predictor of all-cause and cardiovascular mortality in various populations. However, the associations between SRH measures and risk of first-ever or recurrent stroke were rarely explored. We thus aim to prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in Chinese population.

Methods

A total of 494,113 participants from the China Kadoorie Biobank without prior heart diseases or cancer (486,541 without stroke and 7,572 with stroke) were followed from baseline (2004 to 2008) until December 31, 2013. General and age-comparative SRH were obtained from baseline questionnaires. First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data.

Results

We identified 27,662 first-ever stroke and 2,909 recurrent events during an average of 7.0 years of follow-up. Compared with excellent general SRH, the hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever stroke associated with good, fair, and poor general SRH were 1.04 (1.00 to 1.08), 1.19 (1.15 to 1.23), and 1.49 (1.42 to 1.56) in the multivariate model, respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.13 (1.10 to 1.17) and 1.51 (1.45 to 1.58), respectively. The relations of SRH measures with ischemic stroke, hemorrhagic stroke, and recurrent stroke were similar to that with total first-ever stroke. However, the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke.

Conclusions

This large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke, regardless of stroke subtype.

What Do We Rate When We Rate Our Health? Decomposing Age-related Contributions to Self-rated Health

Self-ratings of health (SRH) indicate current health-related quality of life and independently predict mortality. Studies show the SRH of older adults appears less influenced by physical health than the SRH of younger adults. But if physical health accounts less for the SRH of older adults, what factors take its place? To understand the relative contributions of social, emotional, and physical states to SRH by age, we analyzed data from the National Health Interview Survey 2006 to 2011 ( N = 153,341). In age-stratified regressions, physical health and functional limitations declined as correlates of SRH for older age strata, while social factors, such as gender and race, increased in importance. Oaxaca-Blinder decomposition showed that if younger respondents had similar health conditions, they would rate their health more poorly than current cohorts of older adults do. The declining influence of physical health on SRH in old age appears to be due in part to displacement by social factors.

Self-rated health and its association with mortality in older adults in China, India and Latin America-a 10/66 Dementia Research Group study

Background

empirical evidence from high-income countries suggests that self-rated health (SRH) is useful as a brief and simple outcome measure in public health research. However, in many low- and middle-income countries (LMIC) there is a lack of evaluation and the cross-cultural validity of SRH remains largely untested. This study aims to explore the prevalence of SRH and its association with mortality in older adults in LMIC in order to cross-culturally validate the construct of SRH.

Methods

population-based cohort studies including 16,940 persons aged ≥65 years in China, India, Cuba, Dominican Republic, Peru, Venezuela, Mexico and Puerto Rico in 2003. SRH was assessed by asking 'how do you rate your overall health in the past 30 days' with responses ranging from excellent to poor. Covariates included socio-demographic characteristics, use of health services and health factors. Mortality was ascertained through a screening of all respondents until 2007.

Results

the prevalence of good SRH was higher in urban compared to rural sites, except in China. Men reported higher SRH than women, and depression had the largest negative impact on SRH in all sites. Without adjustment, those with poor SRH showed a 142% increase risk of dying within 4 years compared to those with moderate SRH. After adjusting for all covariates, those with poor SRH still showed a 43% increased risk.

Conclusion

our findings support the use of SRH as a simple measure in survey settings to identify vulnerable groups and evaluate health interventions in resource-scares settings.

Self-Rated Health Status and Risk of Ischemic Heart Disease in the China Kadoorie Biobank Study: A Population-Based Cohort Study

BACKGROUND

Self-rated health (SRH) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease (IHD) have not been extensively explored, especially in a Chinese population.

METHODS AND RESULTS

More than 500 000 adults from 10 cities in China were followed from baseline (2004-2008) through December 31, 2013. Global and age-comparative SRH were reported from baseline questionnaires. Incident IHD cases were identified through links to well-established disease registry systems and the national health insurance system. During 3 423 542 person-years of follow-up, we identified 24 705 incident cases of IHD. In multivariable-adjusted models, both global and age-comparative SRH was significantly associated with incident IHD. Compared with excellent SRH, the hazard ratios for good, fair, and poor SRH were 1.02 (95% confidence interval [CI], 0.98-1.07), 1.32 (95% CI, 1.27-1.37), and 1.76 (95% CI, 1.68-1.85), respectively. Compared with better age-comparative SRH, the hazard ratios for same and worse age-comparative SRH were 1.23 (95% CI, 1.19-1.27) and 1.78 (95% CI, 1.70-1.86), respectively. The associations persisted in all subgroup analyses, although they were slightly modified by study location, education, and income levels.

CONCLUSIONS

A simple questionnaire for self-assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient tool for assessing future IHD risk.

Self-rated physical fitness and estimated maximal oxygen uptake in relation to all-cause and cause-specific mortality

This study investigated the longitudinal associations of self-rated physical fitness and estimated maximal oxygen uptake (VO2max) with all-cause and cause-specific mortality. A total of 59 741 participants in the Finnish National FINRISK Study Cohort had data on self-rated physical fitness and covariates. A subsample of 4823 participants had estimated VO2max data. Follow-up ranged from 3 to 38 years. Associations of self-rated physical fitness and VO2max with mortality were analyzed using multivariate Cox proportional hazard models. The study showed that poor self-rated physical fitness was related to all-cause mortality (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.8-2.0) and mortality due to cardiovascular (HR 2.0, 95% CI 1.9-2.2), cerebrovascular (HR 1.9, 95% CI 1.6-2.2) and respiratory diseases (HR 2.1, 95% CI 1.9-2.4), trauma (HR 1.7, 95% CI 1.3-2.0), infections (HR 1.8, 95% CI 1.3-2.7), dementia (HR 1.9, 95% CI 1.6-2.3), and cancer (HR 1.7, 95% CI 1.5-1.9). Coexisting higher age, physical inactivity, male gender, and severe chronic conditions further increased the risk. In men, higher VO2max was associated with a lower risk of lung cancer mortality (HR 0.8, 95% CI 0.7-0.96). Based on the results, self-rated physical fitness reflects a combination of unfavorable biological and lifestyle-related factors, which increase mortality risk. A simple question about perceived physical fitness may reveal at-risk individuals who would benefit from more intensive treatment of chronic conditions and other interventions aiming to promote better fitness and well-being.

Self-rated health and all-cause and cause-specific mortality of older adults: Individual data meta-analysis of prospective cohort studies in the CHANCES Consortium

OBJECTIVES

To evaluate, among the elderly, the association of self-rated health (SRH) with mortality, and to identify determinants of self-rating health as "at-least-good".

STUDY DESIGN

Individual data on SRH and important covariates were obtained for 424,791 European and United States residents, ≥60 years at recruitment (1982-2008), in eight prospective studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios, HRs) in relation to SRH were calculated and subsequently combined with random-effect meta-analyses.

MAIN OUTCOME MEASURES

All-cause, cardiovascular and cancer mortality.

RESULTS

Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH "fair" or "poor" vs. "at-least-good" was associated with increased mortality: HRs 1.46 (95% CI 1·23-1.74) and 2.31 (1.79-2.99), respectively. These associations were evident: for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently, for medical history explained only a modest amount of the unadjusted associations. Factors favourably associated with SRH were: sex (males), age (younger-old), education (high), marital status (married/cohabiting), physical activity (active), body mass index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence).

CONCLUSION

SRH provides a quick and simple tool for assessing health and identifying groups of elders at risk of early mortality that may be useful also in clinical settings. Modifying determinants of favourably rating health, e.g. by increasing physical activity and/or by eliminating obesity, may be important for older adults to "feel healthy" and "be healthy".

Self-rated health predicts decline in instrumental activities of daily living among high-functioning community-dwelling older people

Background

self-rated health (SRH) is a strong predictor of mortality, but it is unclear if SRH independently predicts a decline in instrumental activities of daily living (IADL).

Objective

to verify whether SRH is an independent predictor of IADL decline.

Design

a population-based longitudinal cohort study.

Setting

two local municipalities in Nara, Japan.

Subjects

community-dwelling older adults 65 years or older (2,638 males and 3,346 females) with independent IADL at baseline.

Methods

SRH was assessed using a single-item measure. IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Multiple logistic regressions were used to examine the association of SRH with IADL decline.

Results

during the 3-year follow-up, 13.2% of males and 8.2% of females developed IADL decline. After adjusting for age, family, body mass index, economic situations, chronic diseases, alcohol, smoking, depression, cognitive functioning and ADL, poorer SHR was significantly associated with IADL decline in both genders. Compared with very good SRH, the odds ratios of good, poor and very poor were 1.69 (95% confidence interval: 1.14-2.51), 2.10 (1.25-3.55) and 3.11 (1.50-6.45) for males, and 0.88 (0.54-1.42), 2.08 (1.16-3.75) and 3.42 (1.57-7.42) for females, respectively. Significant associations were not affected by chronic diseases, cognitive functioning or ADL but observed only among subjects aged 65-74 or those without depression.

Conclusions

this study confirms that SRH is an independent predictor of IADL decline among non-disabled community-dwelling older adults. Our findings suggest that SRH is an effective tool for identifying older people with future risk for IADL decline, particularly among the young-old or those without depression.

Prognostic Significance of Mild Cognitive Impairment Subtypes for Dementia and Mortality: Data from the NEDICES Cohort

BACKGROUND

The predictive value of diverse subtypes of mild cognitive impairment (MCI) for dementia and death is highly variable.

OBJECTIVE

To compare the predictive value of several MCI subtypes in progression to dementia and/or mortality in the NEDICES (Neurological Disorders in Central Spain) elderly cohort.

METHODS

Retrospect algorithmic MCI subgroups were established in a non-dementia baseline NEDICES cohort using Spanish adaptations of the original Mini-Mental State Examination (MMSE-37) and Pfeffer's Functional Activities Questionnaire (Pfeffer-11). The presence of MCI was defined according two cognitive criteria: using two cut-offs points on the total MMSE-37 score. Five cognitive domains were used to establish the MCI subtypes. Functional capacity (Pfeffer-11) was preserved or minimally impaired in all MCI participants. The incident dementia diagnoses were established by specialists and the mortality data obtained from Spanish official registries.

RESULTS

3,411 participants without dementia were assessed in 1994-5. The baseline prevalence of MCI varied according to the MCI definition (4.3%-31.8%). The follow-up was a mean of 3.2 years (1997-8). The dementia incidence varied between 14.9 and 71.8 per 1,000/person-years. The dementia conversion rate was increased in almost all MCI subgroups (p >  0.01), and mortality rate was raised only in four MCI subtypes. The amnestic-multi-domain MCI (aMd-MCI) had the best dementia predictive accuracy (highest positive likelihood ratio and highest clinical utility when negative).

CONCLUSIONS

Those with aMd-MCI were at greatest risk of progression to dementia, as in other surveys and might be explored with increased attention in MCI research and in dementia preventive trials.

Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population

INTRODUCTION

Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke.

METHODS

MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years.

RESULTS

11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)).

CONCLUSIONS

Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.

Self-rated health and risk of incident essential tremor: A prospective, population-based study (NEDICES)

BACKGROUND

Essential tremor (ET), a highly-prevalent, progressive, aging-associated neurological disease, poses a significant public health challenge. Aside from its associated motor features, the disease affects cognition in some patients, mood, and morale, and has been associated with increased risk of mortality in the elderly. Studies have not investigated the relationship between self-rated health and risk of ET. We determined whether baseline poor self-rated health was associated with increased risk of incident ET.

METHODS

In this prospective, population-based study of people ≥65 years of age, subjects were evaluated at baseline and 3 years later. At baseline, subjects were asked to rate their health using a single-item health question. Hazard ratios (HR) of ET according to baseline self-rated health (very good, good, fair, poor, and very poor) were estimated with Cox models.

RESULTS

The 3853 subjects had a median follow-up duration of 3.2 years. There were 82 incident ET cases. Compared to subjects who rated their health as good or very good, the risk of ET was increased for subjects who rated their health as fair (HR = 1.69, p = 0.03), and for subjects who rated their health as poor or very poor (HR = 2.12, p = 0.02). In a fully adjusted model, the risk remained increased for subjects who rated their health as poor or very poor (HR = 2.34, p = 0.01).

CONCLUSIONS

Subjects rating their health as poor/very poor at baseline were at increased risk of incident ET at follow-up. Premotor and/or early motor symptoms of ET could negatively influence self-perceptions of health status.

Self-rated health and adverse events in CKD

BACKGROUND AND OBJECTIVES

Little is known about the utility of self-rated general health assessments in persons with moderate-to-severe CKD. This study examined the ability of a single self-rated health measure to predict all-cause mortality and kidney disease progression in a cohort of 443 patients with stages 3-4 CKD, recruited between 2005 and 2011, and followed until the end of 2012. The performance of models incorporating self-rated health measures was compared with previously published predictive models and more complex models comprising a multibiomarker panel.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Participants were asked "In general, would you say your health is excellent, very good, good, fair, or poor?" Outcomes examined were time to all-cause mortality, kidney disease progression (initiation of RRT or 30% loss of eGFR), and a composite of these events. Model performances were compared using a nonparametric area under the curve (AUC) analysis.

RESULTS

Over a median follow-up of 3.3 years, 118 (27%) participants died and 138 (31%) had progression of kidney disease. Fair-to-poor self-rated health status was associated with significantly greater risks of mortality (fully adjusted hazard ratio [HR] for relative to good-to-excellent self-rated health, 2.76; 95% confidence interval [95% CI], 1.28 to 5.89), kidney disease progression (HR, 1.94; 95% CI, 1.49 to 2.56), and the combined end point (HR, 2.21; 95% CI, 1.66 to 2.96). For 3-year mortality prediction, the self-rated health model (AUC, 0.80; 95% CI, 0.76 to 0.85) had significantly higher AUCs than the base model (AUC, 0.71; 95% CI, 0.66 to 0.76) and the multibiomarker panel model (AUC, 0.74; 95% CI, 0.68 to 0.80) (P=0.03 and P=0.04, respectively).

CONCLUSIONS

A single, easily obtained measure of self-rated health helps identify patients with CKD at high risk of mortality and kidney disease progression. Routine evaluation of self-rated health may help target individuals who might benefit from more intensive monitoring strategies.

Self-rated health and mortality in a prospective Chinese elderly cohort study in Hong Kong

OBJECTIVES

In the West, self-rated health reliably predicts death, but conceptualizations of health and cause-composition of mortality may be contextually specific. Little is known as to how self-rated health predicts death in non-Western settings.

METHODS

Multivariable Cox regression analysis was used to assess the adjusted associations of age-comparative and self-comparative self-rated health with death from all- and specific-causes using a population-based cohort of 66,820 Chinese (65+years) enrolled from 1998 to 2001 at 18 Elderly Health Centers in Hong Kong, and followed until May 31, 2012.

RESULTS

During an average of 10.9 years follow-up, 19,845 deaths occurred with 6336 from cancer. Worse age-comparative self-rated health, compared with better, was positively associated with death from all-causes (hazard ratio 1.68, 95% confidence interval 1.59, 1.77), cardiovascular disease (hazard ratio 1.83, 95% confidence interval 1.66, 2.02), stroke (hazard ratio 1.93, 95% confidence interval 1.63, 2.29), ischemic heart disease (hazard ratio 1.77, 95% confidence interval 1.51, 2.08), cancer (hazard ratio 1.17, 95% confidence interval 1.06, 1.30) and respiratory disease (hazard ratio 2.25, 95% confidence interval 2.01, 2.52), adjusted for age and sex. Self-comparative self-rated health was not associated with higher mortality.

CONCLUSION

Age-comparative self-rated health predicted death in older people from a non-Western setting although the association was less marked than in Western settings.

Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: a systematic review and meta-analysis

Background

People who rate their health as poor experience higher all-cause mortality. Study of disease-specific association with self-rated health might increase understanding of why this association exists.

Objectives

To estimate the strength of association between self-rated health and fatal and non-fatal cardiovascular disease.

Methods

A comprehensive search of PubMed MEDLINE, EMBASE, CINAHL, BIOSIS, PsycINFO, DARE, Cochrane Library, and Web of Science was undertaken during June 2013. Two reviewers independently searched databases and selected studies. Inclusion criteria were prospective cohort studies or cohort analyses of randomised trials with baseline measurement of self-rated health with fatal or non-fatal cardiovascular outcomes. 20 studies were pooled quantitatively in different meta-analyses. Study quality was assessed using Newcastle-Ottawa scales.

Results

‘Poor’ relative to ‘excellent’ self-rated health (defined by most extreme categories in each study, most often’ poor’ or ‘very poor’ and ‘excellent’ or ‘good’) was associated over a follow-up of 2.3–23 years with cardiovascular mortality in studies: where varying degrees of adjustments had been made for cardiovascular disease risk (HR 1.79 (95% CI 1.50 to 2.14); 15 studies, I2 = 71.24%), and in studies reporting outcomes in people with pre-existing cardiovascular disease or ischaemic heart disease symptoms (HR 2.42 (95% CI 1.32 to 4.44); 3 studies; I2 = 71.83%). ‘Poor’ relative to ‘excellent’ self rated health was also associated with the combined outcome of fatal and non-fatal cardiovascular events (HR 1.90 (95% CI 1.26 to 2.87); 5 studies; I² = 68.61%), Self-rated health was not significantly associated with non-fatal cardiovascular disease outcomes (HR 1.66 (95% CI 0.96 to 2.87); 5 studies; I2 = 83.60%).

Conclusions

Poor self rated health is associated with cardiovascular mortality in populations with and without prior cardiovascular disease. Those with current poor self-rated health may warrant additional input from health services to identify and address reasons for their low subjective health.