Predictive capacity of self-rated health on all-cause mortality in Spain: differences across sex, age and educational level

Author:

Suso-Palau Daniel,López-Cuadrado Teresa,Duque-León Daniela,Ortiz Cristina,Galán IñakiORCID

Abstract

BackgroundPublished evidence on self-rated health’s capacity to predict mortality and its variability across subpopulations lacks consistency. Our objective is to evaluate this predictive association and whether/how it varies by sex, age and educational attainment at the population level in Spain.MethodsData came from a prospective longitudinal study based on 42 645 individuals aged ≥15 years who participated in the 2011–2012 and 2014 Spanish Health Surveys. Median follow-up time for mortality was 5.4 years. Cox proportional hazards models adjusted for sociodemographic, lifestyle and chronic disease variables were used to estimate the predictive capacity of self-rated health on mortality.ResultsSelf-rated health was associated with mortality with a dose–response effect (p value for linear trend <0.001). Compared with respondents who rated their health as very good, those rating it as very poor presented an HR of 3.33 (95% CI 2.50 to 4.44). Suboptimal self-rated health was a stronger predictor of mortality among 15–44 year-olds (HR 2.87; 95% CI 1.59 to 5.18), compared with the estimate for 45–64 year-olds (HR 1.86; 95% CI 1.45 to 2.39) (p value for interaction=0.001) and for those 65 and older (HR 1.51; 95% CI 1.36 to 1.68) (p value for interaction <0.001). Regarding educational attainment, the association was stronger for individuals with university studies (HR 2.51; 95% CI 1.67 to 3.76) than for those with only primary or no studies (HR 1.31; 95% CI 1.17 to 1.48) (p value for interaction=0.010). No statistically significant differences were observed between men and women.ConclusionsSelf-rated health may be considered a good predictor of all-cause mortality in the population of Spain, although the magnitude of this predictive association varies by age and educational level.

Funder

Instituto de Salud Carlos III

Publisher

BMJ

Subject

Public Health, Environmental and Occupational Health,Epidemiology

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