Kaplan G A, Goldberg D E, Everson S A, Cohen R D, Salonen R, Tuomilehto J, Salonen J
Human Population Laboratory, California Department of Health Services, Berkeley, 94704-1011, USA.
Int J Epidemiol. 1996 Apr;25(2):259-65. doi: 10.1093/ije/25.2.259.
Previous studies have reported an increased risk of death in those who report their health is poor, however, the role of underlying and subclinical disease in this association has not been carefully studied.
The associations between perceived health status and mortality from all causes and cardiovascular disease, incidence of myocardial infarction, carotid atherosclerosis, forced expiratory volume, and maximal exercise capacity were studied in the Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based study of 2682 men, aged 42-60, in eastern Finland.
There were strong, statistically significant, age-adjusted associations between level of perceived health and mortality from all causes (RH(bad versus good) = 3.67), cardiovascular causes (RH(bad versus good) = 6.64), and incidence of myocardial infarction (RH(bad versus good) = 3.87). Perceived health levels were strongly associated with risk factors and disease indicators. The associations with mortality and myocardial infarction outcomes were considerably weakened with progressive adjustment for eight risk factors and prevalent disease. Higher levels of perceived health were associated with less carotid atherosclerosis, and greater forced expiratory volume and maximal exercise capacity. Associations between level of perceived health and these indicators were considerably stronger in those with prevalent diseases than in those who were healthy.
The overall pattern of results suggests that perceived health levels mainly reflect underlying disease burden.
既往研究报告称，自述健康状况较差者的死亡风险增加，然而，潜在疾病和亚临床疾病在这种关联中的作用尚未得到仔细研究。
在库奥皮奥缺血性心脏病危险因素研究中，研究了自我感知健康状况与全因死亡率、心血管疾病死亡率、心肌梗死发病率、颈动脉粥样硬化、用力呼气量和最大运动能力之间的关联。该研究是一项基于人群的研究，对芬兰东部2682名年龄在42至60岁之间的男性进行了调查。
在经过年龄调整后，自我感知健康水平与全因死亡率（相对危险度[差与好相比]=3.67）、心血管疾病死亡率（相对危险度[差与好相比]=6.64）以及心肌梗死发病率（相对危险度[差与好相比]=3.87）之间存在强烈的、具有统计学意义的关联。自我感知健康水平与危险因素和疾病指标密切相关。随着对八个危险因素和现患疾病进行逐步调整，与死亡率和心肌梗死结局的关联显著减弱。自我感知健康水平较高与较少的颈动脉粥样硬化、更大的用力呼气量和最大运动能力相关。在患有现患疾病的人群中，自我感知健康水平与这些指标之间的关联比在健康人群中要强得多。
总体结果模式表明，自我感知健康水平主要反映潜在的疾病负担。
