Nielsen Anni Brit Sternhagen, Siersma Volkert, Hiort Line Conradsen, Drivsholm Thomas, Kreiner Svend, Hollnagel Hanne
Research Unit and Department of General Practice, University of Copenhagen, Copenhagen, Denmark.
Scand J Public Health. 2008 Jan;36(1):3-11. doi: 10.1177/1403494807085242.
Self-rated general health (SRH) predicts future mortality. We examined all-cause mortality at 10, 20, and 29 years' follow-up and its association with SRH measured at the age of 40 years in a cohort of 1,198 healthy Danes born in 1936 and who were residents in suburban Copenhagen.
The association between SRH (dichotomized into good versus poor) and all-cause mortality was estimated in standard time-homogenous Cox regression models adjusting for covariates related to mortality, and in time-heterogeneous Cox regression models without covariate adjustment, where time-heterogeneity features as a separate risk assessment for each of the three follow-up periods defined by the follow-up examinations.
At the age of 40 years, 153 (14.6%) of 1,045 participants reported poor and 85.4% good SRH. Dead participants totalled 36 at the 10-year, 96 at the 20-year, and 207 at the 29-year follow-up. For poor SRH, mortality hazard ratios (multivariate analysis) were persistently significant, but slowly declining with follow-up time. The time-heterogeneous models explain this feature: increased mortality risk was significant only in the first decade after assessment: 2.30 (95% CI 1.11-4.78) vs. 0.91 (95% CI 0.36-2.31) and 0.73 (95% CI 0.34-1.55).
The association between poor SRH and mortality emphasizes the importance of health personnel taking account of people's health rating, particularly when a recent assessment has been made. SRH is related to death, even when controlling for known covariates, but it is not a long-term effect.
自我评定的总体健康状况（SRH）可预测未来死亡率。我们在一个由1936年出生、居住在哥本哈根郊区的1198名健康丹麦人组成的队列中，研究了随访10年、20年和29年时的全因死亡率及其与40岁时测量的SRH之间的关联。
在调整了与死亡率相关的协变量的标准时间齐性Cox回归模型中，以及在未进行协变量调整的时间非齐性Cox回归模型中，估计SRH（分为良好与不良）与全因死亡率之间的关联，其中时间非齐性作为由随访检查定义的三个随访期各自的单独风险评估。
在40岁时，1045名参与者中有153人（14.6%）报告SRH不良，85.4%报告良好。在10年随访时有36人死亡，20年随访时有96人死亡，29年随访时有207人死亡。对于不良SRH，死亡率风险比（多变量分析）一直显著，但随随访时间缓慢下降。时间非齐性模型解释了这一特征：死亡率风险增加仅在评估后的第一个十年显著：2.30（95%置信区间1.11 - 4.78），而在随后分别为0.91（95%置信区间0.36 - 2.31）和0.73（95%置信区间0.34 - 1.55）。
不良SRH与死亡率之间的关联强调了卫生人员考虑人们健康评级的重要性，特别是在最近进行评估时。即使控制了已知的协变量，SRH仍与死亡相关，但这不是一种长期影响。
