Health risk or resource? Gradual and independent association between self-rated health and mortality persists over 30 years
Poor self-rated health (SRH) is associated with increased mortality. However, most studies only adjust for few health risk factors and/or do not analyse whether this association is consistent also for intermediate categories of SRH and for follow-up periods exceeding 5-10 years. This study examined...
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| description | Poor self-rated health (SRH) is associated with increased mortality. However, most studies only adjust for few health risk factors and/or do not analyse whether this association is consistent also for intermediate categories of SRH and for follow-up periods exceeding 5-10 years. This study examined whether the SRH-mortality association remained significant 30 years after assessment when adjusting for a wide range of known clinical, behavioural and socio-demographic risk factors.
We followed-up 8,251 men and women aged ≥ 16 years who participated 1977-79 in a community based health study and were anonymously linked with the Swiss National Cohort (SNC) until the end of 2008. Covariates were measured at baseline and included education, marital status, smoking, medical history, medication, blood glucose and pressure.
92.8% of the original study participants could be linked to a census, mortality or emigration record of the SNC. Loss to follow-up 1980-2000 was 5.8%. Even after 30 years of follow-up and after adjustment for all covariates, the association between SRH and all-cause mortality remained strong and estimates almost linearly increased from "excellent" (reference: hazard ratio, HR 1) to "good" (men: HR 1.07 95% confidence interval 0.92-1.24, women: 1.22, 1.01-1.46) to "fair" (1.41, 1.18-1.68; 1.39, 1.14-1.70) to "poor"(1.61, 1.15-2.25; 1.49, 1.07-2.06) to "very poor" (2.85, 1.25-6.51; 1.30, 0.18-9.35). Persons answering the SRH question with "don't know" (1.87, 1.21-2.88; 1.26, 0.87-1.83) had also an increased mortality risk; this was pronounced in men and in the first years of follow-up.
SRH is a strong and "dose-dependent" predictor of mortality. The association was largely independent from covariates and remained significant after decades. This suggests that SRH provides relevant and sustained health information beyond classical risk factors or medical history and reflects salutogenetic rather than pathogenetic pathways. |
| doi_str_mv | 10.1371/journal.pone.0030795 |
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We followed-up 8,251 men and women aged ≥ 16 years who participated 1977-79 in a community based health study and were anonymously linked with the Swiss National Cohort (SNC) until the end of 2008. Covariates were measured at baseline and included education, marital status, smoking, medical history, medication, blood glucose and pressure.
92.8% of the original study participants could be linked to a census, mortality or emigration record of the SNC. Loss to follow-up 1980-2000 was 5.8%. Even after 30 years of follow-up and after adjustment for all covariates, the association between SRH and all-cause mortality remained strong and estimates almost linearly increased from "excellent" (reference: hazard ratio, HR 1) to "good" (men: HR 1.07 95% confidence interval 0.92-1.24, women: 1.22, 1.01-1.46) to "fair" (1.41, 1.18-1.68; 1.39, 1.14-1.70) to "poor"(1.61, 1.15-2.25; 1.49, 1.07-2.06) to "very poor" (2.85, 1.25-6.51; 1.30, 0.18-9.35). Persons answering the SRH question with "don't know" (1.87, 1.21-2.88; 1.26, 0.87-1.83) had also an increased mortality risk; this was pronounced in men and in the first years of follow-up.
SRH is a strong and "dose-dependent" predictor of mortality. The association was largely independent from covariates and remained significant after decades. This suggests that SRH provides relevant and sustained health information beyond classical risk factors or medical history and reflects salutogenetic rather than pathogenetic pathways.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0030795</identifier><identifier>PMID: 22347405</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Blood glucose ; Blood pressure ; Community participation ; Confidence intervals ; Data Collection ; Demographics ; Diagnostic Self Evaluation ; Drugs ; Emigration ; Female ; Follow-Up Studies ; Health aspects ; Health risks ; Health Status ; Humans ; Life Expectancy ; Male ; Medical research ; Medicine ; Men ; Middle Aged ; Mortality ; Predictive Value of Tests ; Prevention ; Preventive medicine ; Risk analysis ; Risk Factors ; Smoking ; Studies ; Switzerland - epidemiology ; Young Adult</subject><ispartof>PloS one, 2012-02, Vol.7 (2), p.e30795-e30795</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Bopp et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Bopp et al. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c757t-2ac263e8e6b9fd31fe4f7101aefa32f0709d39e5974c831f4297ee8ea6ceca9e3</citedby><cites>FETCH-LOGICAL-c757t-2ac263e8e6b9fd31fe4f7101aefa32f0709d39e5974c831f4297ee8ea6ceca9e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276505/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276505/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22347405$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bopp, Matthias</creatorcontrib><creatorcontrib>Braun, Julia</creatorcontrib><creatorcontrib>Gutzwiller, Felix</creatorcontrib><creatorcontrib>Faeh, David</creatorcontrib><creatorcontrib>Swiss National Cohort Study Group</creatorcontrib><creatorcontrib>for the Swiss National Cohort Study Group</creatorcontrib><title>Health risk or resource? Gradual and independent association between self-rated health and mortality persists over 30 years</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Poor self-rated health (SRH) is associated with increased mortality. However, most studies only adjust for few health risk factors and/or do not analyse whether this association is consistent also for intermediate categories of SRH and for follow-up periods exceeding 5-10 years. This study examined whether the SRH-mortality association remained significant 30 years after assessment when adjusting for a wide range of known clinical, behavioural and socio-demographic risk factors.
We followed-up 8,251 men and women aged ≥ 16 years who participated 1977-79 in a community based health study and were anonymously linked with the Swiss National Cohort (SNC) until the end of 2008. Covariates were measured at baseline and included education, marital status, smoking, medical history, medication, blood glucose and pressure.
92.8% of the original study participants could be linked to a census, mortality or emigration record of the SNC. Loss to follow-up 1980-2000 was 5.8%. Even after 30 years of follow-up and after adjustment for all covariates, the association between SRH and all-cause mortality remained strong and estimates almost linearly increased from "excellent" (reference: hazard ratio, HR 1) to "good" (men: HR 1.07 95% confidence interval 0.92-1.24, women: 1.22, 1.01-1.46) to "fair" (1.41, 1.18-1.68; 1.39, 1.14-1.70) to "poor"(1.61, 1.15-2.25; 1.49, 1.07-2.06) to "very poor" (2.85, 1.25-6.51; 1.30, 0.18-9.35). Persons answering the SRH question with "don't know" (1.87, 1.21-2.88; 1.26, 0.87-1.83) had also an increased mortality risk; this was pronounced in men and in the first years of follow-up.
SRH is a strong and "dose-dependent" predictor of mortality. The association was largely independent from covariates and remained significant after decades. This suggests that SRH provides relevant and sustained health information beyond classical risk factors or medical history and reflects salutogenetic rather than pathogenetic pathways.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Blood glucose</subject><subject>Blood pressure</subject><subject>Community participation</subject><subject>Confidence intervals</subject><subject>Data Collection</subject><subject>Demographics</subject><subject>Diagnostic Self Evaluation</subject><subject>Drugs</subject><subject>Emigration</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Health Status</subject><subject>Humans</subject><subject>Life Expectancy</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Men</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Predictive Value of Tests</subject><subject>Prevention</subject><subject>Preventive medicine</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Smoking</subject><subject>Studies</subject><subject>Switzerland - epidemiology</subject><subject>Young Adult</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11rFDEUhgdRbK3-A9GAoHixaz5mJpMbpRRtFwoFv27D2cyZ3ayzk22SqS7-eTPutOxKLySQhOR53yQn52TZc0anTEj2buV630E73bgOp5QKKlXxIDtmSvBJyal4uDc_yp6EsKK0EFVZPs6OOBe5zGlxnP2-QGjjkngbfhDniceQfA1-IOce6h5aAl1NbFfjBlPXRQIhOGMhWteROcafiB0J2DYTDxFrstz5Daq18xFaG7dkgz7YEANxN-iJoGSL4MPT7FEDbcBn43iSffv08evZxeTy6nx2dno5MbKQccLB8FJgheVcNbVgDeaNZJQBNiB4QyVVtVBYKJmbKm3nXElMOJQGDSgUJ9nLne-mdUGPcQuaCS6KoipKlYjZjqgdrPTG2zX4rXZg9d8F5xcafLSmRa0qLljNJVN5ndPcAJVcSlNIScW84kXyej-e1s_XWJsUMw_tgenhTmeXeuFutOCyLOhg8GY08O66xxD12gaDbQsduj5oVQimmJTDtV_9Q97_uJFaQLq_7RqXjjWDpz7NpWQlU2WVqOk9VGo1rq1JOdbYtH4geHsgSEzEX3EBfQh69uXz_7NX3w_Z13vsLp2Ca_sh4cIhmO9A410IHpu7GDOqhxK5jYYeSkSPJZJkL_b_5050WxPiD0EADLc</recordid><startdate>20120209</startdate><enddate>20120209</enddate><creator>Bopp, Matthias</creator><creator>Braun, Julia</creator><creator>Gutzwiller, Felix</creator><creator>Faeh, David</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20120209</creationdate><title>Health risk or resource? Gradual and independent association between self-rated health and mortality persists over 30 years</title><author>Bopp, Matthias ; Braun, Julia ; Gutzwiller, Felix ; Faeh, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c757t-2ac263e8e6b9fd31fe4f7101aefa32f0709d39e5974c831f4297ee8ea6ceca9e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Blood glucose</topic><topic>Blood pressure</topic><topic>Community participation</topic><topic>Confidence intervals</topic><topic>Data Collection</topic><topic>Demographics</topic><topic>Diagnostic Self Evaluation</topic><topic>Drugs</topic><topic>Emigration</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health aspects</topic><topic>Health risks</topic><topic>Health Status</topic><topic>Humans</topic><topic>Life Expectancy</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Men</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Predictive Value of Tests</topic><topic>Prevention</topic><topic>Preventive medicine</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Smoking</topic><topic>Studies</topic><topic>Switzerland - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bopp, Matthias</au><au>Braun, Julia</au><au>Gutzwiller, Felix</au><au>Faeh, David</au><aucorp>Swiss National Cohort Study Group</aucorp><aucorp>for the Swiss National Cohort Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Health risk or resource? Gradual and independent association between self-rated health and mortality persists over 30 years</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2012-02-09</date><risdate>2012</risdate><volume>7</volume><issue>2</issue><spage>e30795</spage><epage>e30795</epage><pages>e30795-e30795</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Poor self-rated health (SRH) is associated with increased mortality. However, most studies only adjust for few health risk factors and/or do not analyse whether this association is consistent also for intermediate categories of SRH and for follow-up periods exceeding 5-10 years. This study examined whether the SRH-mortality association remained significant 30 years after assessment when adjusting for a wide range of known clinical, behavioural and socio-demographic risk factors.
We followed-up 8,251 men and women aged ≥ 16 years who participated 1977-79 in a community based health study and were anonymously linked with the Swiss National Cohort (SNC) until the end of 2008. Covariates were measured at baseline and included education, marital status, smoking, medical history, medication, blood glucose and pressure.
92.8% of the original study participants could be linked to a census, mortality or emigration record of the SNC. Loss to follow-up 1980-2000 was 5.8%. Even after 30 years of follow-up and after adjustment for all covariates, the association between SRH and all-cause mortality remained strong and estimates almost linearly increased from "excellent" (reference: hazard ratio, HR 1) to "good" (men: HR 1.07 95% confidence interval 0.92-1.24, women: 1.22, 1.01-1.46) to "fair" (1.41, 1.18-1.68; 1.39, 1.14-1.70) to "poor"(1.61, 1.15-2.25; 1.49, 1.07-2.06) to "very poor" (2.85, 1.25-6.51; 1.30, 0.18-9.35). Persons answering the SRH question with "don't know" (1.87, 1.21-2.88; 1.26, 0.87-1.83) had also an increased mortality risk; this was pronounced in men and in the first years of follow-up.
SRH is a strong and "dose-dependent" predictor of mortality. The association was largely independent from covariates and remained significant after decades. This suggests that SRH provides relevant and sustained health information beyond classical risk factors or medical history and reflects salutogenetic rather than pathogenetic pathways.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22347405</pmid><doi>10.1371/journal.pone.0030795</doi><tpages>e30795</tpages><oa>free_for_read</oa></addata></record> |
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| source | Electronic Journals Library; Public Library of Science (PLoS) Journals Open Access; Open Access: PubMed Central; MEDLINE; DOAJ Directory of Open Access Journals; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adult Aged Blood glucose Blood pressure Community participation Confidence intervals Data Collection Demographics Diagnostic Self Evaluation Drugs Emigration Female Follow-Up Studies Health aspects Health risks Health Status Humans Life Expectancy Male Medical research Medicine Men Middle Aged Mortality Predictive Value of Tests Prevention Preventive medicine Risk analysis Risk Factors Smoking Studies Switzerland - epidemiology Young Adult |
| title | Health risk or resource? Gradual and independent association between self-rated health and mortality persists over 30 years |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T07%3A59%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Health%20risk%20or%20resource?%20Gradual%20and%20independent%20association%20between%20self-rated%20health%20and%20mortality%20persists%20over%2030%20years&rft.jtitle=PloS%20one&rft.au=Bopp,%20Matthias&rft.aucorp=Swiss%20National%20Cohort%20Study%20Group&rft.date=2012-02-09&rft.volume=7&rft.issue=2&rft.spage=e30795&rft.epage=e30795&rft.pages=e30795-e30795&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0030795&rft_dat=%3Cgale_plos_%3EA477161968%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1323558569&rft_id=info:pmid/22347405&rft_galeid=A477161968&rft_doaj_id=oai_doaj_org_article_98231d27194d404ca07277c57703b825&rfr_iscdi=true |