Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
PLoS One. 2012;7(2):e30795. doi: 10.1371/journal.pone.0030795. Epub 2012 Feb 9.
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.
自我评估健康状况较差（SRH）与死亡率增加有关。然而，大多数研究仅调整了少数健康风险因素，或者没有分析这种关联是否也适用于 SRH 的中间类别以及超过 5-10 年的随访期。本研究检验了当调整广泛的已知临床、行为和社会人口学风险因素时，SRH 与死亡率之间的关联在评估后 30 年内是否仍然显著。
我们随访了 8251 名年龄≥16 岁的男性和女性，他们于 1977-79 年参加了一项基于社区的健康研究，并在 2008 年底之前匿名链接到瑞士国家队列（SNC）。协变量在基线时进行测量，包括教育程度、婚姻状况、吸烟、病史、用药、血糖和血压。
8251 名原始研究参与者中有 92.8%能够与 SNC 的人口普查、死亡率或移民记录相联系。1980-2000 年的失访率为 5.8%。即使经过 30 年的随访，并调整了所有协变量，SRH 与全因死亡率之间的关联仍然很强，估计值几乎呈线性增加，从“优秀”（参考：风险比，HR 1）到“良好”（男性：HR 1.07，95%置信区间 0.92-1.24，女性：1.22，1.01-1.46）到“一般”（1.41，1.18-1.68；1.39，1.14-1.70）到“差”（1.61，1.15-2.25；1.49，1.07-2.06）到“非常差”（2.85，1.25-6.51；1.30，0.18-9.35）。回答 SRH 问题为“不知道”的人（1.87，1.21-2.88；1.26，0.87-1.83）也有较高的死亡风险；这种风险在男性和随访的最初几年更为明显。
SRH 是死亡率的一个强有力的“剂量依赖性”预测指标。这种关联在很大程度上独立于协变量，并且在几十年后仍然显著。这表明，SRH 提供了比传统风险因素或病史更相关和持续的健康信息，反映了健康促进而不是发病机制的途径。
