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Self-rated general health among 40-year-old Danes and its association with all-cause mortality at 10-, 20-, and 29 years' follow-up

Research Unit and Department of General Practice, University of Copenhagen, Copenhagen, Denmark, a.nielsen{at}gpract.ku.dk

Volkert Siersma

Research Unit and Department of General Practice, University of Copenhagen, Copenhagen, Denmark, Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

Line Conradsen Hiort

Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

Thomas Drivsholm

Research Unit and Department of General Practice, University of Copenhagen, Copenhagen, Denmark, Copenhagen County Research Centre for Prevention and Health, Glostrup University Hospital, Copenhagen, Denmark

Svend Kreiner

Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

Hanne Hollnagel

Research Unit and Department of General Practice, University of Copenhagen, Copenhagen, Denmark, Copenhagen County Research Centre for Prevention and Health, Glostrup University Hospital, Copenhagen, Denmark

Aims: Self-rated general health (SRH) predicts future mortality. We examined all-cause mortality at 10, 20, and 29 years' follow-up and its association with SRH measured at the age of 40 years in a cohort of 1,198 healthy Danes born in 1936 and who were residents in suburban Copenhagen. Methods: The association between SRH (dichotomized into good versus poor) and all-cause mortality was estimated in standard time-homogenous Cox regression models adjusting for covariates related to mortality, and in time-heterogeneous Cox regression models without covariate adjustment, where time-heterogeneity features as a separate risk assessment for each of the three follow-up periods defined by the follow-up examinations. Results: At the age of 40 years, 153 (14.6%) of 1,045 participants reported poor and 85.4% good SRH. Dead participants totalled 36 at the 10-year, 96 at the 20-year, and 207 at the 29-year follow-up. For poor SRH, mortality hazard ratios (multivariate analysis) were persistently significant, but slowly declining with follow-up time. The time-heterogeneous models explain this feature: increased mortality risk was significant only in the first decade after assessment: 2.30 (95% CI 1.11-4.78) vs. 0.91 (95% CI 0.36-2.31) and 0.73 (95% CI 0.34-1.55). Conclusions: The association between poor SRH and mortality emphasizes the importance of health personnel taking account of people's health rating, particularly when a recent assessment has been made. SRH is related to death, even when controlling for known covariates, but it is not a long-term effect.

Key Words: Denmark • follow-up studies • health status • longitudinal studies • mortality • self-rated health

Scandinavian Journal of Public Health, Vol. 36, No. 1, 3-11 (2008)
DOI: 10.1177/1403494807085242


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