Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population

Abstract

IntroductionPoor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its’ relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke.MethodsMRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years.Results11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1–1.9)), but not stroke mortality (OR 1.2 (0.8–1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9–1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6–1.4)), stroke mortality (OR 1.1(0.5–2.5)), or survival (OR 1.1(0.6–2.1)).ConclusionsPoor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.

Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study

“…We also investigated the relations of SRH with fatal and non-fatal stroke. Our results of non-fatal stroke were similar with two previous studies [ 13 , 14 ]. No study has specifically examined the association between general SRH and fatal stroke, while some studies reported inconsistent findings with stroke mortality [ 6 , 14 , 24 ].…”

“…Our results of non-fatal stroke were similar with two previous studies [ 13 , 14 ]. No study has specifically examined the association between general SRH and fatal stroke, while some studies reported inconsistent findings with stroke mortality [ 6 , 14 , 24 ]. Two small studies in European populations did not find significant association between SRH and stroke mortality [ 6 , 14 ], while a large study in US adults (n=689,710) reported a significant association (HR, 2.12 comparing poor with excellent SRH; 95% CI, 1.76 to 2.56) [ 24 ].…”

“…However, they had relatively small sample size (ranged from 168 to 473 incident cases), and some studies combined the SRH measure into two categories (excellent/good vs. fair/poor). With regard to the association between SRH and recurrent stroke, two studies in UK populations did not find significant association [ 14 , 16 ], but the sample size was small: Mavaddat et al [ 14 ] identified 77 recurrent cases out of 434 stroke patients during 2 years’ follow-up and Hillen et al [ 16 ] identified 66 recurrent cases out of 561 stroke patients during 5 years’ follow-up. Therefore, our study is thus the largest prospective cohort study on this topic and the first of its kind in Asians.…”

“…No study has specifically examined the association between general SRH and fatal stroke, while some studies reported inconsistent findings with stroke mortality [ 6 , 14 , 24 ]. Two small studies in European populations did not find significant association between SRH and stroke mortality [ 6 , 14 ], while a large study in US adults (n=689,710) reported a significant association (HR, 2.12 comparing poor with excellent SRH; 95% CI, 1.76 to 2.56) [ 24 ]. The two European studies were also conducted in elderly populations (mean age, 74.1 and 76.2 years old) [ 6 , 14 ], while the US study24 and our study were done in much younger participants (mean age, 44.4 and 51.0 years old).…”

Self‐rated health in mothers of children hospitalised for severe illnesses and mothers of healthy children: cross‐sectional study

“…Poor SRH is associated with an increased incidence of diabetes (8), myocardial infarction (9) and stroke in patients without this disease in their medical history. Interestingly, poor SRH is not correlated with stroke-related mortality (10). At the same time, SRH does not seem to be associated with the incidence of such disease as breast, lung or intestine cancer (11).…”