Pijls L T, Feskens E J, Kromhout D
Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands.
Am J Epidemiol. 1993 Nov 15;138(10):840-8. doi: 10.1093/oxfordjournals.aje.a116787.
The value of self-rated health in predicting mortality and the incidence of chronic diseases was studied in a cohort of 783 elderly Dutch men in the Zutphen Study. In 1985, 48% of the men felt "healthy," while 12% felt "moderately healthy" or "not healthy." As of 1990, 23% of the 783 men had died. Survival analysis showed that self-rated health was highly predictive of subsequent 5-year mortality from all causes (p < 0.001). When adjusted for the presence of major chronic diseases, age, medication use, smoking, alcohol consumption, physical activity, body mass index, systolic blood pressure, serum cholesterol, education, marital status, and family history of chronic diseases, the relative risk for "moderately healthy" or "not healthy" men compared with "healthy" men was 2.7 (95% confidence interval (CI) 1.8-4.3). Analysis of cause-specific mortality revealed that self-rated health was associated with cardiovascular mortality (crude relative risk (RR) = 2.7), but this finding resulted mainly from confounding by baseline prevalence of cardiovascular diseases (adjusted RR = 1.9, 95% CI 0.9-3.8). However, self-rated health was an independent risk factor for cancer mortality (adjusted RR = 4.2, 95% CI 1.9-9.4) and mortality due to other causes (adjusted RR = 3.0, 95% CI 1.2-7.8). Self-rated health did not independently predict the incidence of chronic diseases. This suggests that self-rated health especially affects fatality from chronic diseases rather than their onset, and this issue should be pursued further.
在祖特芬研究中，对783名荷兰老年男性队列进行了自我评估健康状况在预测死亡率和慢性病发病率方面价值的研究。1985年，48%的男性感觉“健康”，而12%感觉“一般健康”或“不健康”。截至1990年，783名男性中有23%已死亡。生存分析表明，自我评估健康状况对随后5年全因死亡率具有高度预测性（p<0.001）。在对主要慢性病的存在、年龄、用药情况、吸烟、饮酒、身体活动、体重指数、收缩压、血清胆固醇、教育程度、婚姻状况和慢性病家族史进行调整后，“一般健康”或“不健康”男性与“健康”男性相比的相对风险为2.7（95%置信区间（CI）1.8 - 4.3）。对特定病因死亡率的分析显示，自我评估健康状况与心血管疾病死亡率相关（粗相对风险（RR）=2.7），但这一发现主要是由于心血管疾病基线患病率的混杂作用（调整后RR = 1.9，95%CI 0.9 - 3.8）。然而，自我评估健康状况是癌症死亡率（调整后RR = 4.2，95%CI 1.9 - 9.4）和其他原因导致的死亡率（调整后RR = 3.0，95%CI 1.2 - 7.8）的独立危险因素。自我评估健康状况不能独立预测慢性病的发病率。这表明自我评估健康状况尤其影响慢性病的死亡率而非其发病，这一问题应进一步探讨。
