Abstract
BackgroundPeople who rate their health as poor experience higher all-cause mortality. Study of disease-specific association with self-rated health might increase understanding of why this association exists.ObjectivesTo estimate the strength of association between self-rated health and fatal and non-fatal cardiovascular disease.MethodsA comprehensive search of PubMed MEDLINE, EMBASE, CINAHL, BIOSIS, PsycINFO, DARE, Cochrane Library, and Web of Science was undertaken during June 2013. Two reviewers independently searched databases and selected studies. Inclusion criteria were prospective cohort studies or cohort analyses of randomised trials with baseline measurement of self-rated health with fatal or non-fatal cardiovascular outcomes. 20 studies were pooled quantitatively in different meta-analyses. Study quality was assessed using Newcastle-Ottawa scales.Results‘Poor’ relative to ‘excellent’ self-rated health (defined by most extreme categories in each study, most often’ poor’ or ‘very poor’ and ‘excellent’ or ‘good’) was associated over a follow-up of 2.3–23 years with cardiovascular mortality in studies: where varying degrees of adjustments had been made for cardiovascular disease risk (HR 1.79 (95% CI 1.50 to 2.14); 15 studies, I2 = 71.24%), and in studies reporting outcomes in people with pre-existing cardiovascular disease or ischaemic heart disease symptoms (HR 2.42 (95% CI 1.32 to 4.44); 3 studies; I2 = 71.83%). ‘Poor’ relative to ‘excellent’ self rated health was also associated with the combined outcome of fatal and non-fatal cardiovascular events (HR 1.90 (95% CI 1.26 to 2.87); 5 studies; I2 = 68.61%), Self-rated health was not significantly associated with non-fatal cardiovascular disease outcomes (HR 1.66 (95% CI 0.96 to 2.87); 5 studies; I2 = 83.60%).ConclusionsPoor self rated health is associated with cardiovascular mortality in populations with and without prior cardiovascular disease. Those with current poor self-rated health may warrant additional input from health services to identify and address reasons for their low subjective health.
Highlights
Self-rated health (SRH), a simple measure of subjective health status, strongly and consistently predicts all-cause mortality across varied populations even after adjustment for demographic, biophysical, and behavioural risk factors. [1,2] The reasons behind this are uncertain
Poor self rated health is associated with cardiovascular mortality in populations with and without prior cardiovascular disease
Other than three studies based on persons with pre-existing cardiovascular disease or ischaemic heart disease symptoms, [7,19,31] the focus was on populations without, or controlling for previous CVD events or risk
Summary
Self-rated health (SRH), a simple measure of subjective health status, strongly and consistently predicts all-cause mortality across varied populations even after adjustment for demographic, biophysical, and behavioural risk factors. [1,2] The reasons behind this are uncertain. Studies of SRH have primarily studied its’ relationship with allcause mortality.[1] All-cause mortality is objective, relatively easy to collect and comparable across populations. A further benefit of shifting the focus of SRH research to its relationship with specific disease incidence and disease outcomes is that better specification and measurement of relevant covariates may provide more precise estimates of any independent effect of SRH. Such information could be used to assess the potential use of SRH for risk prediction in specific diseases. Study of disease-specific association with self-rated health might increase understanding of why this association exists
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