Abstract
IntroductionSelf-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). In a population-based cohort, we examined the association between SRH and incident CVD and whether this association was independent of socio-demographic, clinical and behavioural participant characteristics.MethodsPopulation-based prospective cohort study (European Prospective Investigation of Cancer-Norfolk). 20,941 men and women aged 39–74 years without prevalent CVD attended a baseline health examination (1993–1998) and were followed for CVD events/death until March 2007 (mean 11 years). We used a Cox proportional hazards model to quantify the association between baseline SRH (reported on a four point scale – excellent, good, fair, poor) and risk of developing CVD at follow-up after adjusting for socio-demographic, clinical and behavioural risk factors.ResultsBaseline SRH was reported as excellent by 17.8% participants, good by 65.1%, fair by 16.0% and poor by 1.2%. During 225,508 person-years of follow-up, there were 55 (21.2%) CVD events in the poor SRH group and 259 (7.0%) in the excellent SRH group (HR 3.7, 95% CI 2.8–4.9). The HR remained significant after adjustment for behavioural risk factors (HR 2.6, 95% CI 1.9–3.5) and after adjustment for all socio-demographic, clinical and behavioural risk factors (HR 3.3, 95% CI 2.4–4.4). Associations were strong for both fatal and non-fatal events and remained strong over time.ConclusionsSRH is a strong predictor of incident fatal and non-fatal CVD events in this healthy, middle-aged population. Some of the association is explained by lifestyle behaviours, but SRH remains a strong predictor after adjustment for socio-demographic, clinical and behavioural risk factors and after a decade of follow-up. This easily accessible patient-centred measure of health status may be a useful indicator of individual and population health for those working in primary care and public health.
Highlights
Self-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD)
We hypothesised that SRH will be strongly and robustly related to incident cardiovascular disease (CVD) events in a population without prevalent disease, that the relationship will remain strong over time, and that the relationship will be at least partially explained by health-related behaviours including smoking, physical activity and diet [8,9]
We report incidence of first CVD event by self-rated health status over a mean of 11 years in a populationbased cohort of healthy 39 to 74 year olds without prevalent CVD recruited from general practices in Eastern England
Summary
Self-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). Self-rated health (SRH), assessed through a single question, is strongly and consistently associated with all-cause mortality [1] and with mortality and morbidity due to a range of chronic diseases including diabetes, heart disease, stroke and cancer [2,3,4,5,6,7]. Interpretation of this finding has been hampered by the possibility of reverse causation and residual confounding due to poor characterisation of the populations studied, both in terms of prevalent disease status and of hypothesised mediators including health related behaviours [8]. We hypothesised that SRH will be strongly and robustly related to incident cardiovascular disease (CVD) events in a population without prevalent disease, that the relationship will remain strong over time, and that the relationship will be at least partially explained by health-related behaviours including smoking, physical activity and diet [8,9].
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