Schnittker Jason, Bacak Valerio
University of Pennsylvania, Department of Sociology, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2014 Jan 22;9(1):e84933. doi: 10.1371/journal.pone.0084933. eCollection 2014.
Using the 1980 to 2002 General Social Survey, a repeated cross-sectional study that has been linked to the National Death Index through 2008, this study examines the changing relationship between self-rated health and mortality. Research has established that self-rated health has exceptional predictive validity with respect to mortality, but this validity may be deteriorating in light of the rapid medicalization of seemingly superficial conditions and increasingly high expectations for good health. Yet the current study shows the validity of self-rated health is increasing over time. Individuals are apparently better at assessing their health in 2002 than they were in 1980 and, for this reason, the relationship between self-rated health and mortality is considerably stronger across all levels of self-rated health. Several potential mechanisms for this increase are explored. More schooling and more cognitive ability increase the predictive validity of self-rated health, but neither of these influences explains the growing association between self-rated health and mortality. The association is also invariant to changing causes of death, including a decline in accidental deaths, which are, by definition, unanticipated by the individual. Using data from the final two waves of data, we find suggestive evidence that exposure to more health information is the driving force, but we also show that the source of information is very important. For example, the relationship between self-rated health and mortality is smaller among those who use the internet to find health information than among those who do not.
本研究利用1980年至2002年的综合社会调查（一项重复横断面研究，截至2008年已与国家死亡指数相关联），考察自评健康与死亡率之间不断变化的关系。研究已证实，自评健康在预测死亡率方面具有卓越的有效性，但鉴于看似表面的状况迅速医学化以及对健康的期望越来越高，这种有效性可能正在下降。然而，当前研究表明自评健康的有效性随时间推移在增加。2002年的个体显然比1980年的个体更善于评估自己的健康状况，因此，在所有自评健康水平上，自评健康与死亡率之间的关系都显著更强。本文探讨了这种增加的几种潜在机制。受教育程度更高和认知能力更强会提高自评健康的预测有效性，但这两种影响都无法解释自评健康与死亡率之间日益增强的关联。这种关联对于不断变化的死亡原因也具有不变性，包括意外死亡的减少，从定义上讲，意外死亡是个体无法预料的。利用最后两轮数据，我们发现有暗示性证据表明接触更多健康信息是驱动力，但我们也表明信息来源非常重要。例如，在使用互联网查找健康信息的人群中，自评健康与死亡率之间的关系比不使用互联网的人群要小。
