Grant M D, Piotrowski Z H, Chappell R
Department of Geriatrics, La Grange Memorial Hospital, IL.
J Clin Epidemiol. 1995 Mar;48(3):375-87. doi: 10.1016/0895-4356(94)00143-e.
Changing and often declining health among elderly individuals makes interpreting the long-standing association between self-reported health (SRH) and mortality potentially problematic. This analysis of the Longitudinal Study of Aging from 1984 through 1986 explores changes over time in the association between a single self-report of health and survival among 4380 noninstitutionalized individuals aged 70 and older. Health was reported as excellent or very good (excellent/very good), good, fair or poor. The association between SRH and survival was modeled controlling for age, race, education, marital status, body mass index, difficulty performing activities of daily living, social contacts, self-reported stroke, heart disease, cancer, diabetes and recent hospitalization. Among women, SRH and survival were associated in a nonproportional model, with relative hazard declining over time. Women with poor vs excellent/very good SRH had adjusted relative hazards at 5, 14, 23 and 32 months of 3.8 [95% confidence interval (CI) 2.0-7.1], 2.7 (95% CI: 1.8-4.1), 2.0 (95% CI: 1.3-3.0), and 1.4 (95% CI: 0.7-2.7). The declining relative hazard was due to an increasing mortality rate over time among women initially reporting excellent/very good health. SRH was associated with survival among men in a proportional model (constant relative hazard over time). Men with poor vs excellent/very good SRH had an adjusted relative hazard of 1.7 (95% CI: 1.1-2.6) over the entire follow-up. The relative hazard of lesser magnitude among men reflects the weaker SRH-survival association, possibly too weak for any interaction with time to be detected. The constant relative hazard is also consistent with a rapid decline in health before death among men. The diminishing SRH-survival association among women is consistent with their longer period of declining health before death.
老年人健康状况不断变化且往往趋于下降，这使得解读自我报告健康状况（SRH）与死亡率之间长期存在的关联可能存在问题。这项对1984年至1986年老年纵向研究的分析，探讨了4380名70岁及以上非机构化个体中，单次健康自我报告与生存之间的关联随时间的变化。健康状况报告为极佳或非常好（极佳/非常好）、良好、一般或较差。对SRH与生存之间的关联进行建模时，控制了年龄、种族、教育程度、婚姻状况、体重指数、日常生活活动困难程度、社交接触、自我报告的中风、心脏病、癌症、糖尿病以及近期住院情况。在女性中，SRH与生存之间存在非比例模型关联，相对风险随时间下降。自我报告健康状况较差与极佳/非常好的女性，在5、14、23和32个月时的调整后相对风险分别为3.8[95%置信区间（CI）2.0 - 7.1]、2.7（95%CI：1.8 - 4.1）、2.0（95%CI：1.3 - 3.0）和1.4（95%CI：0.7 - 2.7）。相对风险下降是由于最初报告健康状况极佳/非常好的女性随时间死亡率上升。在男性中，SRH与生存之间存在比例模型关联（相对风险随时间恒定）。自我报告健康状况较差与极佳/非常好的男性在整个随访期间的调整后相对风险为1.7（95%CI：1.1 - 2.6）。男性中相对风险较小反映了SRH与生存之间的关联较弱，可能弱到无法检测到与时间的任何相互作用。恒定的相对风险也与男性在死亡前健康状况迅速下降一致。女性中SRH与生存之间关联的减弱与她们在死亡前健康状况下降的时间较长一致。
