Abstract
BackgroundGeneral health perception as measured by self-rated health (SRH) is an individual's synthesis of personal overall health and has value in its own right. In addition, this subjective perspective has a unique predictive power of subsequent mortality and adds valuable information not captured by objective measures. We studied the relationship between SRH and subsequent mortality to demonstrate how simple self-ratings can enhance our understanding of health inequities. MethodsData from a population-based survey conducted in Finnmark 1987/1988 were linked to the Norwegian Cause of Death Registry for information on all deaths by the end of 2017. We used Cox proportional hazard regression modelling to estimate the relative effects of all-cause mortality separately for sex and age (30–49 and 50–62 years) with stepwise adjustment for socio-demographics and various other health status and behavioural measures. ResultsThe age-adjusted power of mortality prediction of SRH was strong (most pronounced in the youngest age-group) but markedly attenuated by other factors. Education inequality in mortality was most substantial in the youngest age-group, which might partly be due to a combination of selective mortality and historical changes in health inequality. In comparison, educational inequality in SRH was clearly pronounced regardless of age. Work disability pension appeared as the common key factor affecting the mortality prediction of SRH and educational inequity for both subsequent mortality and SRH. ConclusionSRH adds unique information to our understanding of health inequities. The consistency in shared predictors of educational inequity concerning both mortality and SRH underscores the correspondence of these measures. In addition to predicting the fatal effects of social selection mechanisms, SRH adds non-fatal effects and seems less prone to selective mortality. The results are relevant to approaches in health equity research and have important policy implications.
Highlights
General health perception or self-rated health (SRH) can be consid ered an individual’s synthesis of both subjective and more objective information about their health
The crude all-cause mortality rate for men was 18.36 and for women it was 12.07 per 1000 person-years
The ageadjusted mortality risk was 1.58 times higher in men compared with women
Summary
General health perception or self-rated health (SRH) can be consid ered an individual’s synthesis of both subjective and more objective information about their health. An extensive amount of previous research has shown that the simple question “How would you evaluate your health overall?” has a strong predictive ability concerning different future life events and behaviours, and in particular has the unique power to predict mortality (DeSalvo et al, 2006; Idler & Benyamini, 1997; Jylha, 2009). High predictability of SRH has been documented for a variety of other outcomes This includes subsequent health care use (DeSalvo et al, 2005; Miilunpalo et al, 1997) and prescribed medication in adulthood (Hetlevik et al, 2019; Vie et al, 2018). General health perception as measured by self-rated health (SRH) is an individual’s synthesis of personal overall health and has value in its own right This subjective perspective has a unique predictive power of subsequent mortality and adds valuable information not captured by objective measures. The results are relevant to approaches in health equity research and have important policy implications
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