Rambukwella Roshan, Westbury Leo D, Cooper Cyrus, Harvey Nicholas C, Dennison Elaine M
MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
J Med Surg Public Health. 2024 Apr;2:None. doi: 10.1016/j.glmedi.2024.100085.
Poor self-rated health (SRH) has been shown to predict adverse health outcomes among older people, however these associations have traditionally only been considered at one point in the lifecourse, usually midlife or later. Here we examined lifecourse correlates of SRH in early, mid and later life, relating these to subsequent risk of mortality in a community-dwelling cohort.
2989 men and women from the Hertfordshire Cohort Study (HCS) were included in this study. The HCS was initially retrospective and linked contemporary health outcome data to early life data available from health ledgers but investigations from baseline (1998-2004, aged 59-73) onwards have been prospective. At baseline, participants completed an initial clinic visit, which included questionnaire assessment of SRH, reported as 'excellent', 'very good', 'good', 'fair', or 'poor'. Socioeconomic, lifestyle, mental health and demographic information was also collected. Deaths were recorded from baseline to 31/12/2018. Baseline characteristics in relation to SRH were examined using sex-stratified ordinal logistic regression; these factors were examined in relation to mortality using sex-stratified Cox regression. Statistically significant exposures were then included in sex-stratified mutually-adjusted models.
In mutually-adjusted analysis, numerous contemporaneous correlates of poorer SRH in the seventh decade were identified and included obesity, lower physical activity, greater comorbidity and higher levels of depression among men and women. For example, odds ratios for being in a lower category of SRH were as follows: obese (BMI≥30) vs underweight/healthy (BMI<25) (men 1.60 (1.21, 2.11), women 1.65 (1.25, 2.17)) and per additional system medicated (men 1.62 (1.47, 1.77), women 1.53 (1.41, 1.66)). By contrast, factors earlier in the lifecourse (early growth, age left full-time education) were not associated with SRH in late adulthood. 36% of men and 26% of women died during follow-up. Hazard ratios (95% CI) for mortality per lower category of SRH were 1.22 (1.10,1.36) among men and 1.17 (1.01,1.35) among women after adjustment for age, BMI, smoking, physical activity, diet quality, education, home ownership status, comorbidity level and depression levels, suggesting residual confounding by other unrecorded factors that are related to SRH.
Poorer SRH in the seventh decade was a risk factor for mortality. Importantly modifiable adverse health behaviours in the seventh decade, such as low physical activity, were associated with poorer SRH and later mortality after adjustment for socioeconomic factors and comorbidity level. By contrast early growth and education were not related to later SRH. These data suggest that attention to lifestyle in late midlife may be associated with better SRH and subsequent health outcomes, highlighting the value of intervention at this stage of the lifecourse.
自我健康评价差（SRH）已被证明可预测老年人的不良健康结局，然而传统上这些关联仅在生命历程中的某一点进行考量，通常是中年或更晚阶段。在此，我们研究了生命早期、中期和晚期SRH的生命历程相关因素，并将其与社区居住队列中随后的死亡风险相关联。
本研究纳入了来自赫特福德郡队列研究（HCS）的2989名男性和女性。HCS最初是回顾性研究，并将当代健康结局数据与健康账本中的早期生命数据相联系，但从基线（1998 - 2004年，年龄59 - 73岁）起的调查是前瞻性的。在基线时，参与者完成了首次门诊就诊，其中包括对SRH的问卷调查评估，结果报告为“优秀”“非常好”“好”“一般”或“差”。还收集了社会经济、生活方式、心理健康和人口统计学信息。记录了从基线到2018年12月31日的死亡情况。使用按性别分层的有序逻辑回归分析与SRH相关的基线特征；使用按性别分层的Cox回归分析这些因素与死亡率的关系。然后将具有统计学显著意义的暴露因素纳入按性别分层的相互调整模型。
在相互调整分析中，确定了许多与七十多岁时较差SRH同时存在的相关因素，包括肥胖、身体活动较少、合并症较多以及男性和女性中较高水平的抑郁。例如，处于较低SRH类别的比值比如下：肥胖（BMI≥30）与体重过轻/健康（BMI<25）相比（男性1.60（1.21，2.11），女性1.65（1.25，2.17））以及每增加一个用药系统（男性1.62（1.47，1.77），女性1.53（1.41，1.66））。相比之下，生命历程早期的因素（早期生长、离开全日制教育的年龄）与成年后期的SRH无关。在随访期间，36%的男性和26%的女性死亡。在调整年龄、BMI、吸烟、身体活动、饮食质量、教育、房屋所有权状况、合并症水平和抑郁水平后，男性中每降低一个SRH类别死亡率的风险比（95%CI）为1.22（1.10，1.36），女性为1.17（1.01，1.35），这表明存在与SRH相关的其他未记录因素导致的残余混杂。
七十多岁时较差的SRH是死亡的一个风险因素。重要的是，七十多岁时可改变的不良健康行为，如身体活动少，在调整社会经济因素和合并症水平后，与较差的SRH和随后的死亡率相关。相比之下，早期生长和教育与后期的SRH无关。这些数据表明，关注中年后期的生活方式可能与更好的SRH和随后的健康结局相关，突出了在生命历程这一阶段进行干预的价值。
