Self-Rated Health and Cardiovascular Disease Incidence: Results from a Longitudinal Population-Based Cohort in Norfolk, UK

Abstract

IntroductionSelf-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). In a population-based cohort, we examined the association between SRH and incident CVD and whether this association was independent of socio-demographic, clinical and behavioural participant characteristics.MethodsPopulation-based prospective cohort study (European Prospective Investigation of Cancer-Norfolk). 20,941 men and women aged 39–74 years without prevalent CVD attended a baseline health examination (1993–1998) and were followed for CVD events/death until March 2007 (mean 11 years). We used a Cox proportional hazards model to quantify the association between baseline SRH (reported on a four point scale – excellent, good, fair, poor) and risk of developing CVD at follow-up after adjusting for socio-demographic, clinical and behavioural risk factors.ResultsBaseline SRH was reported as excellent by 17.8% participants, good by 65.1%, fair by 16.0% and poor by 1.2%. During 225,508 person-years of follow-up, there were 55 (21.2%) CVD events in the poor SRH group and 259 (7.0%) in the excellent SRH group (HR 3.7, 95% CI 2.8–4.9). The HR remained significant after adjustment for behavioural risk factors (HR 2.6, 95% CI 1.9–3.5) and after adjustment for all socio-demographic, clinical and behavioural risk factors (HR 3.3, 95% CI 2.4–4.4). Associations were strong for both fatal and non-fatal events and remained strong over time.ConclusionsSRH is a strong predictor of incident fatal and non-fatal CVD events in this healthy, middle-aged population. Some of the association is explained by lifestyle behaviours, but SRH remains a strong predictor after adjustment for socio-demographic, clinical and behavioural risk factors and after a decade of follow-up. This easily accessible patient-centred measure of health status may be a useful indicator of individual and population health for those working in primary care and public health.

Educational differences in trajectories of self-rated health before, during, and after entering or leaving paid employment in the European workforce

“…However, several studies have shown that self-rated suboptimum health is strongly and consistently associated with allcause mortality (43,44) and with mortality and morbidity due to a range of chronic diseases including diabetes, heart disease, stroke and cancer (45)(46)(47). It is also strongly predictive for entering and losing paid employment (48,49) and, hence, a suitable measure of health to study in trajectories over time in the workforce.…”

Clinical characteristics of asymptomatic left ventricular diastolic dysfunction and its association with self‐rated health and N‐terminal B‐type natriuretic peptide: a cross‐sectional study

“…The association between SRH and the incidence of cardiovascular disease has been discussed in previous studies 23. Benyamini et al showed that somatic sensations are possible manifestations of disease and powerful reminders of prior health risks, as well as potential indications of current and future health risks 24.…”

Association between self-reported health and sociodemographic characteristics with cardiovascular diseases in adults

“…Despite the infrequency of studies on this topic, we found that these findings corroborate those of other studies carried out in China, Athens, the United States and Sweden, which revealed a strong association between CVD and negative self-rated health (regular and poor) in adults (15,23) . A prospective study found that negative self-rated health is an indicative factor of the occurrence of CVD (24) . Thus, it is noteworthy that self-rated health is directly influenced by lifestyle behaviors, which in turn influence the health condition of the individual.…”

“…Along with being a measure centered on the patient, it is easy to obtain and provide real data representing a useful individual and population health indicator for those working in primary care and public health (24,28) . The results of this study show the importance of the health team recognizing the significance of the health problem for the individual who experiences it.…”