Abstract
Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. We examined the association between SRH and mortality and how this is affected by time and health measurements in a prospective cohort study using repeated measurements and physical examinations of 11652 men and 12684 women in Tromsø, Norway. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death for SRH, controlling for pathology, biometrics, smoking, sex and age. SRH predicted mortality independently of other, more objective health measures. Higher SRH was strongly associated with lower mortality risk. Poor SRH had HR 2.51 (CI: 2.19, 2.88). SRH is affected by disease, mental health and other risk factors, but these factors had little impact on HRs (Poor SRH: HR 1.99; CI: 1.72, 2.31). SRH predicted mortality, but with a time-dependent effect. Time strongly affected the hazard ratio for mortality, especially after ten-year follow-up (Poor SRH HR 3.63 at 0–5 years decreased to HR 1.58 at 15–21 years). SRH has both methodological and clinical value. It should not be uncritically utilised as a replacement instrument when measures of physical illness and other objective health measures are lacking.
Highlights
Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s
SRH is a dynamic instrument likely to change during a life span, but we find no studies that examine the effect of observation time on its ability to predict mortality
We aim to determine the strength of association between different levels of SRH and mortality risk, how this is affected by other measurements of health, and whether these associations remain stable over time
Summary
Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. Time strongly affected the hazard ratio for mortality, especially after ten-year follow-up (Poor SRH HR 3.63 at 0–5 years decreased to HR 1.58 at 15–21 years). SRH has both methodological and clinical value It should not be uncritically utilised as a replacement instrument when measures of physical illness and other objective health measures are lacking. SRH is a dynamic instrument likely to change during a life span, but we find no studies that examine the effect of observation time on its ability to predict mortality. Studies of SRH and mortality often lack comprehensive health measures, are based on limited samples (e.g. patient populations) or have limited follow-up time. We aim to determine the strength of association between different levels of SRH and mortality risk, how this is affected by other measurements of health, and whether these associations remain stable over time
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