Elsevier

Public Health

Volume 127, Issue 12, December 2013, Pages 1097-1104
Public Health

Original Research
Self-rated health and mortality: a follow-up study of a Spanish population

https://doi.org/10.1016/j.puhe.2013.09.003Get rights and content

Abstract

Objectives

Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population.

Study design

Longitudinal study.

Methods

A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations.

Results

Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability.

Conclusions

SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

Introduction

Self-rated health (SRH) is commonly used in epidemiological research. This measure provides a complete overview of the health status of a population, allowing dynamic and continuous assessment to reflect judgements about the trajectory of health and not just the current level of health.1, 2 SRH has been described as a complex measure that joins multiple dimensions of health, and is used as a complementary indicator of objective measures.2 Moreover, SRH may be useful as a global screening tool to establish people's health status, adding a predictive value to the known risk factors. In a clinical context, SRH is a sensitive measure to complement specific measures, detects different clinical states, predicts functional impairment, and may be an indicator in risk assessments and clinical practice.3

In Europe, SRH has been included in many surveys and questionnaires to monitor health due to international recommendations (World Health Organization Europe and European Commission).4, 5, 6 Several transverse and longitudinal studies have shown the validity and reliability of this subjective measure as an overall health indicator, as it has been related to different objective measures such as functional capacity, morbidity, use of health services and mortality.3, 7, 8, 9

Although comparison of SRH between countries is very complex, some studies have found large differences in distribution.10, 11, 12, 13, 14, 15, 16 In Europe, a north–south gradient has been described, with individuals living in Scandinavian countries having healthier perceptions than individuals living in countries in southern Europe.11, 13, 15 Other differences have been identified between people of Eastern and Western Europe, being generally worse in former communist countries than in Western European countries.10 These disparities may be explained, in part, by the true state of health, but also by differences in the standard of health thresholds;13 the style of reporting; the variability across different cultures;3, 15, 16, 17 the wording, language and scale of response;18, 19 or even the version of the instrument used in the survey.20, 21, 22, 23, 24

In 2007, 34% of a European Community population (EU-25) reported poor SRH.16 The factors that best explained this result, in order of importance, included: chronic diseases, limitation of activity, increasing age, being outside the labour market (unemployed, retired or inactive), country of residence, low educational level, low income level and sex.16 Another study in 11 European countries described differences between the determinants of SRH in an elderly population, and reported that education, depression, chronic conditions, mobility difficulties, somatic symptoms and levels of physical activity were important components of SRH.15

Overall, between 1980 and 1990, poor SRH decreased in several European countries.12 However, in Spain, the percentage of people who reported poor SRH increased from 27.0% in 1993 to 30.2% in 2006 (24.9% in men and 35.0% in women).25

Moreover, the association of SRH with mortality has been established by several authors.7, 8, 17, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36 This association is often weaker in women than in men.7, 17, 34 Regarding the ability of SRH to predict mortality, taking into account differences between socio-economic groups, several studies have found discrepant results, including stronger associations in subjects with high socio-economic status,30, 34, 37 stronger associations in subjects with low socio-economic status28, 33 and no association.32, 35

In Spain, although some studies have evaluated the association between SRH and mortality, they have all been conducted in populations over 60 years of age,37, 38, 39, 40 and have reported differing results.

Given the lack of studies in Spain to establish the association between SRH and mortality, the predictive role of SRH for mortality in the general population, and the discrepancies in the findings in elderly populations, the aims of this study were: to describe and analyse the associations of health status, socio-economic and demographic characteristics with SRH, and the associations between SRH and mortality by follow-up of a cohort of subjects representative of the general population.

Section snippets

Methods

This longitudinal study monitored a cohort of subjects who were part of the sample for the 2005 Health Interview Survey of the Valencian Community (HISVC). The questionnaire normally used in health surveys was used in this study. The variables included in the questionnaire dealt with lifestyle, sociodemographic characteristics, SRH, health status and the use of health services.

Details about the survey methodology (sample design, sample size, sampling procedure, consent, ethics, etc.) have been

Results

After four years of follow-up, there were 188 deaths (3.6%) among the 5275 individuals in the cohort [99 men (52.9%) and 89 women (47.1%)]. The frequencies and percentages of deaths at the end of the follow-up period, by sex and for the total population, for each of the categories of the explanatory variables are shown in Table 1. In both men and women, there were more deaths in individuals who reported poor SRH, older age, unemployment, primary or no education, self-perceived low income, born

Discussion

This article reports the results of the first longitudinal study on the associations and predictive role of SRH. This study is based on the follow-up of a general population of Spanish adults (age ≥21 years), through data from a health interview survey and mortality results obtained from the local mortality register. This study found that all the variables studied were significantly associated with SRH, both in men and women, except country of birth. Thus, according to the results, the

Ethical approval

Not required as this study used secondary data derived from a survey undertaken by the Office of Health Plan (Conselleria de Sanitat of the Valencian Autonomous Government) which is the highest authority on health statistics in this region. Ethical considerations were taken into account by this authority.

Funding

This study was supported, in part, by the Dirección General de Salud Pública (Conselleria de Sanitat of the Generalitat Valenciana). The funding source had no involvement in the process of

References (49)

  • A. de Bruin et al.

    Health interview surveys: towards international harmonization of methods and instruments

    (1996)
  • Eurostat

    Guidelines for the collection of data on 18 HIS items

    (2004)
  • E.L. Idler et al.

    Self-rated health and mortality: a review of twenty-seven community studies

    J Health Soc Behav

    (1997)
  • Y. Benyamini et al.

    Community studies reporting association between self-rated health and mortality

    Res Aging

    (1999)
  • K.B. DeSalvo et al.

    Mortality prediction with a single general self-rated health question

    J Gen Intern Med

    (2006)
  • C. Bardage et al.

    Self-rated health among older adults: a cross-national comparison

    Eur J Ageing

    (2005)
  • A.E. Kunst et al.

    Trends in socioeconomic inequalities in self-assessed health in 10 European countries

    Int J Epidemiol

    (2005)
  • H. Jürges

    True health vs response styles: exploring cross-country differences in self-reported health

    Health Econ

    (2007)
  • J.P. Mackenbach et al.

    Socioeconomic inequalities in health in 22 European countries

    N Engl J Med

    (2008)
  • G. Verropoulou

    Key elements composing self-rated health in older adults: a comparative study of 11 European countries

    Eur J Ageing

    (2009)
  • K. Baert et al.

    Perception of health and access to health care in the EU-25 in 2007

    (2009)
  • M. Jylhä et al.

    Is self-rated health comparable across cultures and genders?

    J Gerontol B Psychol Sci Soc Sci

    (1998)
  • H. Jürges et al.

    How comparable are different measures of self-rated health? Evidence from five European countries

    (2007)
  • Cited by (54)

    • What influences individual perception of health? Using machine learning to disentangle self-perceived health

      2021, SSM - Population Health
      Citation Excerpt :

      In the academic community, there is, and has been, considerable interest in evaluating its actual capacity for approximating the objective health profile of a population. Indeed, while subjective health seems to predict the short- and medium-term survival of individuals in both adult (Singh-Manoux et al., 2006; Tamayo-Fonseca et al., 2013) and old ages (Quesnel–Vallée, 2007), a number of studies conducted on populations at more advanced ages have shown that the association between these two indicators decreases with increasing age (Franks et al., 2003; Zajacova & Woo, 2016), thus weakening the general belief that self-perceived health and mortality show parallel patterns across all age groups. Self-perceived health, therefore, constitutes a black box precisely because of its subjective nature and the fact that it summarizes all the health conditions of an individual in a single indicator.

    • Correlates of quality of life in mothers of children with diagnosed epilepsy

      2019, Epilepsy and Behavior
      Citation Excerpt :

      Self-rated health emerged as a significant predictor of physical, psychological, and environmental QoL domains. This finding is consistent with previous studies, which found that patients' SRH provides health professionals with valuable clinical information regarding inflammatory status (even in healthy individuals) [35], burden of care [36], health services utilization [37], mortality [38], and morbidity [39]. There is no doubt that parenting children with epilepsy poses great challenges [19,20].

    • Self-Rated Health as a Predictor of Mortality in Older Adults: A Systematic Review

      2023, International Journal of Environmental Research and Public Health
    View all citing articles on Scopus
    View full text