Self-rated health and all-cause and cause-specific mortality of older adults: Individual data meta-analysis of prospective cohort studies in the CHANCES Consortium

Bamia C 1 , Orfanos P 2 , Juerges H 3 , Schöttker B 4 , Brenner H 5 , Lorbeer R 6 Show all authors , Aadahl M 7 , Matthews CE 8 , Klinaki E 9 , Katsoulis M 9 , Lagiou P 10 , Bueno-de-Mesquita HBA 11 , Eriksson S 12 , Mons U 4 , Saum KU 4 , Kubinova R 13 , Pajak A 14 , Tamosiunas A 15 , Malyutina S 16 , Gardiner J 17 , Peasey A 17 , de Groot LC 18 , Wilsgaard T 19 , Boffetta P 20 , Trichopoulou A 2 , Trichopoulos D 21

Affiliations 

  • 1 National and Kapodistrian University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, 115 27 Athens, Greece; Hellenic Health Foundation, 115 27, Athens, Greece. Electronic address: cbamia@med.uoa.gr
  • 2 National and Kapodistrian University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, 115 27 Athens, Greece; Hellenic Health Foundation, 115 27, Athens, Greece
  • 3 University of Wuppertal, 42119, Wuppertal, Germany
  • 4 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
  • 5 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany; Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
  • 6 Institute for Community Medicine, University Medicine, Ernst Moritz Arndt University Greifswald, 17475 Greifswald, Germany; Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, 80336 Munich, Germany
  • 7 Research Centre for Prevention and Health, Center for Health, The Capital Region of Denmark, 2600 Glostrup, Denmark
  • 8 National Cancer Institute, Division of Cancer Epidemiology and Genetics, Nutritional Epidemiology Branch, Bethesda, MD, 20892-9704, USA
  • 9 Hellenic Health Foundation, 115 27, Athens, Greece
  • 10 National and Kapodistrian University of Athens, Medical School, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, 115 27 Athens, Greece; Hellenic Health Foundation, 115 27, Athens, Greece; Department of Epidmiology, Harvard School of Public Health, Boston, MA 02115, USA
  • 11 Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, 3508 GA Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, W2 1 PG London, United Kingdom; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
  • 12 Umeå University, Department of Geriatrics, SE 90185 Umeå, Sweden
  • 13 National Institute of Public Health, Šrobarova 48, 10042 Prague 10, Czech Republic
  • 14 Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Faculty of Health Sciences, 31-137 Krakow, Poland
  • 15 Institute of Cardiology, Lithuanian University of Health Sciences, Sukilėlių av. 17, Kaunas LT-50161, Lithuania
  • 16 Institute of Internal and Preventive Medicine, 630089, Novosibirsk, Russia; Novosibirsk State Medical University, 630091, Novosibirsk, Russia
  • 17 Department of Epidemiology and Public Health, University College London, WC1E 6BT, UK
  • 18 Division of Human Nutrition, Wageningen University, P.O. Box 8129, NL-6700 EV Wageningen, The Netherlands
  • 19 Department of Community Medicine, UiT The Arctic University of Norway, 9037 Tromsø, Norway
  • 20 Hellenic Health Foundation, 115 27, Athens, Greece; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
  • 21 Hellenic Health Foundation, 115 27, Athens, Greece; Department of Epidmiology, Harvard School of Public Health, Boston, MA 02115, USA; Bureau of Epidemiologic Research, Academy of Athens, 115 27Athens, Greece
Maturitas, 2017 Sep;103:37-44.
PMID: 28778331 DOI: 10.1016/j.maturitas.2017.06.023

Abstract

OBJECTIVES: To evaluate, among the elderly, the association of self-rated health (SRH) with mortality, and to identify determinants of self-rating health as "at-least-good".

STUDY DESIGN: Individual data on SRH and important covariates were obtained for 424,791 European and United States residents, ≥60 years at recruitment (1982-2008), in eight prospective studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios, HRs) in relation to SRH were calculated and subsequently combined with random-effect meta-analyses.

MAIN OUTCOME MEASURES: All-cause, cardiovascular and cancer mortality.

RESULTS: Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH "fair" or "poor" vs. "at-least-good" was associated with increased mortality: HRs 1.46 (95% CI 1·23-1.74) and 2.31 (1.79-2.99), respectively. These associations were evident: for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently, for medical history explained only a modest amount of the unadjusted associations. Factors favourably associated with SRH were: sex (males), age (younger-old), education (high), marital status (married/cohabiting), physical activity (active), body mass index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence).

CONCLUSION: SRH provides a quick and simple tool for assessing health and identifying groups of elders at risk of early mortality that may be useful also in clinical settings. Modifying determinants of favourably rating health, e.g. by increasing physical activity and/or by eliminating obesity, may be important for older adults to "feel healthy" and "be healthy".

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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