Self-rated Health Compared With Objectively Measured Health
Self-rated Health Compared With Objectively Measured Health
Interest in self-rated health (SRH) as a tool for use in disease and mortality risk screening is increasing. The authors assessed the discriminatory ability of baseline SRH to predict 10-year mortality rates compared with objectively measured health status. Principal component analysis was used to create a health score that included systolic blood pressure, presence of diabetes mellitus, body mass index, electrocardiographic parameters, B-type natriuretic peptide, and other biochemical and hematologic measures. From 1997 to 2007, a total of 474 of the 1,388 baseline participants died and 81 were lost to follow-up, yielding 11,833 person-years of observation. The adjusted hazard ratio for death was 1.74 (95% confidence interval (CI): 1.32, 2.29) for persons reporting poor health versus those reporting good health. When combined with age and sex, SRH had a C statistic to predict death equal to 0.69 (95% CI: 0.67, 0.71), which was comparable to that of the inclusive health score (C = 0.69, 95% CI: 0.67, 0.72). The addition of other parameters, such as lifestyle, physical functioning, mental symptoms, and physical symptoms, had little effect on these 2 predictive models (C = 0.71 (95% CI: 0.69, 0.73) and C = 0.71 (95% CI: 0.69, 0.74), respectively). The abilities of the SRH and the health score models to predict death decreased in parallel fashion over time. These results suggest that older adults who report poor health warrant particular attention as persons who have accumulated biologic markers of disease.
Self-rated health (SRH) is an expression of social, psychological, and biologic dimensions. It is one of the most widely used yet poorly understood measures of health. There have been several studies in which the association between SRH and mortality has been studied, and the results have been fairly consistent. In a meta-analysis of 22 community-based cohort studies, DeSalvo et al. found that individuals who reported poor health had a 2-fold increased risk of death compared with individuals who reported excellent health. This association was attenuated but remained significant after adjustment for self-reported or objectively measured diseases.
With heightened interest in predictive health measures has come interest in using SRH as a tool for disease and mortality risk screening. The discriminatory ability of SRH alone or in addition to other variables (such as health conditions and health behaviors) to predict the outcome is generally assessed by estimating the areas under the receiver operating characteristic curve (C statistics) of different predictive models. To our knowledge, previous studies on this subject were limited to self-reported health conditions. A study conducted in a clinic-based Veterans Affairs population in the United States showed that the discriminatory ability of SRH to predict death within 12 months was comparable to that of the physical health components of the Short Form 36 Health Survey Update and of the Seattle Index of Comorbidity, which is based on self-reported chronic conditions, age, and tobacco use. Other studies have shown that SRH adds value to conventional risk factors for predicting stroke and other cardiovascular outcomes.
We used data from a community-based cohort study of aging to compare the discriminatory ability of baseline SRH to predict 10-year subsequent deaths with that of an inclusive health score based on 10 objectively measured parameters. An additional objective of the present study was to examine the stability of these measures in predicting the outcome over time.
Abstract and Introduction
Abstract
Interest in self-rated health (SRH) as a tool for use in disease and mortality risk screening is increasing. The authors assessed the discriminatory ability of baseline SRH to predict 10-year mortality rates compared with objectively measured health status. Principal component analysis was used to create a health score that included systolic blood pressure, presence of diabetes mellitus, body mass index, electrocardiographic parameters, B-type natriuretic peptide, and other biochemical and hematologic measures. From 1997 to 2007, a total of 474 of the 1,388 baseline participants died and 81 were lost to follow-up, yielding 11,833 person-years of observation. The adjusted hazard ratio for death was 1.74 (95% confidence interval (CI): 1.32, 2.29) for persons reporting poor health versus those reporting good health. When combined with age and sex, SRH had a C statistic to predict death equal to 0.69 (95% CI: 0.67, 0.71), which was comparable to that of the inclusive health score (C = 0.69, 95% CI: 0.67, 0.72). The addition of other parameters, such as lifestyle, physical functioning, mental symptoms, and physical symptoms, had little effect on these 2 predictive models (C = 0.71 (95% CI: 0.69, 0.73) and C = 0.71 (95% CI: 0.69, 0.74), respectively). The abilities of the SRH and the health score models to predict death decreased in parallel fashion over time. These results suggest that older adults who report poor health warrant particular attention as persons who have accumulated biologic markers of disease.
Introduction
Self-rated health (SRH) is an expression of social, psychological, and biologic dimensions. It is one of the most widely used yet poorly understood measures of health. There have been several studies in which the association between SRH and mortality has been studied, and the results have been fairly consistent. In a meta-analysis of 22 community-based cohort studies, DeSalvo et al. found that individuals who reported poor health had a 2-fold increased risk of death compared with individuals who reported excellent health. This association was attenuated but remained significant after adjustment for self-reported or objectively measured diseases.
With heightened interest in predictive health measures has come interest in using SRH as a tool for disease and mortality risk screening. The discriminatory ability of SRH alone or in addition to other variables (such as health conditions and health behaviors) to predict the outcome is generally assessed by estimating the areas under the receiver operating characteristic curve (C statistics) of different predictive models. To our knowledge, previous studies on this subject were limited to self-reported health conditions. A study conducted in a clinic-based Veterans Affairs population in the United States showed that the discriminatory ability of SRH to predict death within 12 months was comparable to that of the physical health components of the Short Form 36 Health Survey Update and of the Seattle Index of Comorbidity, which is based on self-reported chronic conditions, age, and tobacco use. Other studies have shown that SRH adds value to conventional risk factors for predicting stroke and other cardiovascular outcomes.
We used data from a community-based cohort study of aging to compare the discriminatory ability of baseline SRH to predict 10-year subsequent deaths with that of an inclusive health score based on 10 objectively measured parameters. An additional objective of the present study was to examine the stability of these measures in predicting the outcome over time.
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