Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study

Abstract

BackgroundThe prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine the strength of association of single and multimorbid physical chronic diseases with self-rated health in a middle-aged and older population in England, and to determine whether any association is mediated by depression and other psychosocial factors.Methods25 268 individuals aged 39 to 79 years recruited from general practice registers in the European Prospective Investigation of Cancer (EPIC-Norfolk) study, completed a survey including self-rated health, psychosocial function and presence of common physical chronic conditions (cancer, stroke, heart attack, diabetes, asthma/bronchitis and arthritis). Logistic regression models determined odds of “moderate/poor” compared to “good/excellent” health by condition and number of conditions adjusting for psychosocial measures.ResultsOne-third (8252) reported one, around 7.5% (1899) two, and around 1% (194) three or more conditions. Odds of “moderate/poor” self-rated health worsened with increasing number of conditions (one (OR = 1.3(1.2–1.4)) versus three or more (OR = 3.4(2.3–5.1)), and were highest where there was comorbidity with stroke (OR = 8.7(4.6–16.7)) or heart attack (OR = 8.5(5.3–13.6)). Psychosocial measures did not explain the association between chronic diseases and multimorbidity with self-rated health.The relationship of multimorbidity with self-rated health was particularly strong in men compared to women (three or more conditions: men (OR = 5.2(3.0–8.9)), women OR = 2.1(1.1–3.9)).ConclusionsSelf-rated health provides a simple, integrative patient-centred assessment for evaluation of illness in the context of multiple chronic disease diagnoses. Those registering in general practice in particular men with three or more diseases or those with cardiovascular comorbidities and with poorer self-rated health may warrant further assessment and intervention to improve their physical and subjective health.

U.S. General Population Estimate for “Excellent” to “Poor” Self-Rated Health Item

“…5,20 It may also be useful for identifying patients for targeted interventions 20 and as part of the evaluation and planning of care for patients in clinical practice. 21 The item has been used as part of behavioral change strategies by comparing responses to it with health-related behaviors and clinical measures. 22 In summary, the excellent to poor self-rated health item is useful for population-level monitoring.…”

Ageing and mental health: changes in self-reported health due to physical illness and mental health status with consecutive cross-sectional analyses

“…The prevalence of coexisting chronic conditions is rising as life expectancy increases in contemporary Western society 18. The age-specific decline could mean that the increasing level of pathology due to age explains this specific decline of SRH and not ageing by itself.…”

Research in and Prospects for the Measurement of Health Using Self-Rated Health

“…*Address correspondence to Dana Garbarski, Department of Sociology, Loyola University Chicago, 1032 W. Sheridan Road, 440 Coffey Hall, Chicago, IL 60660, USA; e-mail: dgarbarski@luc.edu. a summary indicator to monitor the health of populations (OECD 2015) and patients in clinical settings (Mavaddat et al 2014). Its popularity stems in part from its association with multiple domains of health and subsequent mortality (Idler and Benyamini 1997;Jylhä 2009;DeSalvo et al 2006).…”