Abstract
BackgroundSelf-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults. Whilst the robust relationship between SRH and mortality is well established, it is not known how comparable different SRH items are in their relationship to mortality over time. We used a dynamic evaluation model to investigate the sensitivity of time-varying SRH measures with different reference points to predict mortality in older adults over time.MethodsWe used seven waves of data from the Australian Longitudinal Study of Ageing (1992 to 2004; N = 1733, 52.6% males). Cox regression analysis was used to evaluate the relationship between three time-varying SRH measures (global, age-comparative and self-comparative reference point) with mortality in older adults (65+ years).ResultsAfter accounting for other mortality risk factors, poor global SRH ratings increased mortality risk by 2.83 times compared to excellent ratings. In contrast, the mortality relationship with age-comparative and self-comparative SRH was moderated by age, revealing that these comparative SRH measures did not independently predict mortality for adults over 75 years of age in adjusted models.ConclusionsWe found that a global measure of SRH not referenced to age or self is the best predictor of mortality, and is the most reliable measure of self-perceived health for longitudinal research and population health estimates of healthy life expectancy in older adults. Findings emphasize that the SRH measures are not equivalent measures of health status.
Highlights
Self-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults
Manderbacka, Kareholt, Martikainen and Lundberg [5] found the predictive quality of global and age-comparative SRH items was dependent on gender, with the age-comparative item being a better predictor of mortality for males than females in simultaneous models
Prior to the Cox regression models the relationship between the three SRH measures was investigated
Summary
Self-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults. A comparative reference point is often used to anchor the assessment, such as comparing current health to previous health (self-comparative), or same-aged peers (age-comparative) All these forms of the SRH item are in use in health surveys around the world as an indicator of older adults' years lived in good health [e.g. Extensive use, and the robust relationship between poor ratings of SRH and major health outcomes, there is scant research that has compared how these SRH measures perform in older adult populations; in particular it has not been established how the SRH measures compare in their relationship with mortality. Bath [7] found that a global SRH item was more robust in predicting mortality than a self-comparative measure that asked older adults to compare their present health to health five years previously. In a study that compared a global, age-comparative and self-comparative (10 years previous) SRH items it was found that the predictive quality of the self-comparative item became less robust for males after longer follow up periods, whereas none of the SRH items were predictive of mortality in adjusted models for females after 3 and 7.5 year follow-ups [8]
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