The Association Between Self-Rated Health and Mortality in... : Medical Care (original) (raw)

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The Association Between Self-Rated Health and Mortality in a Well-Characterized Sample of Coronary Artery Disease Patients

Bosworth, Hayden B. PhD*†‡; Siegler, Ilene C. MPH, PhD†§; Brummett, Beverly H. PhD§; Barefoot, John C. PhD§; Williams, Redford B. PhD§; Clapp-Channing, Nancy E. RN, MPH#; Mark, Daniel B. PhD#

*From the Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina.

†From the Center for Aging and Human Development, Duke University, Durham, North Carolina.

‡From the Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina.

§From the Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.

#From the Department of Medicine, Division of Cardiology, Duke University, Durham, North Carolina.

This research is supported by Grants RO1 HL45702; RO1 HL45720, RO1 HL36587, from the National Institute of Heart, Lung, and Blood and a RO1 AG12458 from the National Institute of Aging, and B2 MH19109 from National Institute of Mental Health. Partial support for the preparation of this manuscript was from a postdoctoral fellowship training grant (5 T32 MH19109-5) from the National Institute of Mental Health and, in part, by the Department of Veterans Affairs, Veterans Health Administration, HSR&D Service, Program 824 Funds to the first author.

Address correspondence to: Hayden B. Bosworth, Health Services Research and Development, Building 16, Room 70, Veterans Affairs Medical Center (152), 508 Fulton St., Durham, NC 27705. E-mail: [email protected]

Received January 7, 1999; initial review completed March 8, 1999; accepted June 11, 1999.

Abstract

Background.

The relationship between self-rated health and mortality after adjustment for sociodemographic variables, physician-rated comorbidities, disease severity, health-related quality of life (HRQOL), and psychosocial measures (depression, social support, and functional ability) was examined in the Mediators of Social Support (MOSS) study.

Subjects.

The sample consisted of 2,885 individuals (mean age, 62.5 years) who had significant heart disease based upon heart catheterization.

Results.

Using Cox proportional survival analysis, individuals who rated their health as "fair" or "poor" had a significantly greater likelihood of all-cause mortality (OR = 2.13; CI = 1.40-3.23; OR = 4.92; CI = 3.24-7.46, respectively) across follow-up (mean, 3.5 years) than those who rated their health as "very good" after considering sociodemographic factors. After adjustment for comorbidities, disease severity, HRQOL, psychosocial factors, and demographic variables, only those who rated their health as poor had a significant greater risk of mortality (OR = 2.96, CI = 1.80-4.85). A similar pattern was observed for coronary artery disease (CAD)-related mortality; increased adjustment of variables weakened the relationship between self-rated health and mortality. Individuals who rated their health as poor had a significantly greater risk of CAD-related mortality than did those who rated their health as very good (poor vs. very good OR = 3.58, CI = 2.13-6.02) after adjustment for all available mortality risk factors.

Conclusions.

This study indicates that it is important to include self-rated health when studying risk factors for mortality. Not adjusting for relevant factors may provide an overestimation of the effects of self-rated health on mortality in a sample of CAD patients.