Bosworth H B, Siegler I C, Brummett B H, Barefoot J C, Williams R B, Clapp-Channing N E, Mark D B
Health Services Research and Development, Durham Veterans Affairs Medical Center, North Carolina 27705, USA.
Med Care. 1999 Dec;37(12):1226-36. doi: 10.1097/00005650-199912000-00006.
The relationship between self-rated health and mortality after adjustment for sociodemographic variables, physician-rated comorbidities, disease severity, health-related quality of life (HRQOL), and psychosocial measures (depression, social support, and functional ability) was examined in the Mediators of Social Support (MOSS) study.
The sample consisted of 2,885 individuals (mean age, 62.5 years) who had significant heart disease based upon heart catheterization. RESULTS. Using Cox proportional survival analysis, individuals who rated their health as "fair" or "poor" had a significantly greater likelihood of all-cause mortality (OR = 2.13; CI = 1.40-3.23; OR = 4.92; CI = 3.24-7.46, respectively) across follow-up (mean, 3.5 years) than those who rated their health as "very good" after considering sociodemographic factors. After adjustment for comorbidities, disease severity, HRQOL, psychosocial factors, and demographic variables, only those who rated their health as poor had a significant greater risk of mortality (OR = 2.96, CI = 1.80-4.85). A similar pattern was observed for coronary artery disease (CAD)-related mortality; increased adjustment of variables weakened the relationship between self-rated health and mortality. Individuals who rated their health as poor had a significantly greater risk of CAD-related mortality than did those who rated their health as very good (poor vs. very good OR = 3.58, CI = 2.13-6.02) after adjustment for all available mortality risk factors.
This study indicates that it is important to include self-rated health when studying risk factors for mortality. Not adjusting for relevant factors may provide an overestimation of the effects of self-rated health on mortality in a sample of CAD patients.
在社会支持中介（MOSS）研究中，研究了在调整社会人口统计学变量、医生评定的合并症、疾病严重程度、健康相关生活质量（HRQOL）以及心理社会指标（抑郁、社会支持和功能能力）后，自评健康与死亡率之间的关系。
样本包括2885名个体（平均年龄62.5岁），这些个体经心导管检查确诊患有严重心脏病。结果：使用Cox比例生存分析，在考虑社会人口统计学因素后，在整个随访期（平均3.5年）内，将自己的健康状况评为“一般”或“差”的个体全因死亡率显著高于将自己的健康状况评为“非常好”的个体（OR分别为2.13；CI = 1.40 - 3.23；OR为4.92；CI = 3.24 - 7.46）。在调整合并症、疾病严重程度、HRQOL、心理社会因素和人口统计学变量后，只有将自己的健康状况评为差的个体有显著更高的死亡风险（OR = 2.96，CI = 1.80 - 4.85）。在冠状动脉疾病（CAD）相关死亡率方面也观察到类似模式；变量调整得越多，自评健康与死亡率之间的关系越弱。在调整所有可用的死亡风险因素后，将自己的健康状况评为差的个体CAD相关死亡率显著高于将自己的健康状况评为非常好的个体（差 vs. 非常好，OR = 3.58，CI = 2.13 - 6.02）。
本研究表明，在研究死亡率风险因素时纳入自评健康很重要。在CAD患者样本中，不调整相关因素可能会高估自评健康对死亡率的影响。
