Self-Rated Health in Middle Age and Risk of Hospitalizations and Death: Recurrent Event Analysis of the ARIC Study

Abstract

Background Self-rated health is a simple measure that may identify individuals who are at a higher risk for hospitalization or death. Objective To quantify the association between a single measure of self-rated health and future risk of recurrent hospitalizations or death. Participants Atherosclerosis Risk in Communities (ARIC) study, a community-based prospective cohort study of middle-aged men and women with follow-up beginning from 1987 to 1989. Main Measures We quantified the associations between initial self-rated health with risk of recurrent hospitalizations and of death using a recurrent events survival model that allowed for dependency between the rates of hospitalization and hazards of death, adjusted for demographic and clinical factors. Key Results Of the 14,937 ARIC cohort individuals with available self-rated health and covariate information, 34% of individuals reported “excellent” health, 47% “good,” 16% “fair,” and 3% “poor” at study baseline. After a median follow-up of 27.7 years, 1955 (39%), 3569 (51%), 1626 (67%), and 402 (83%) individuals with “excellent,” “good,” “fair,” and “poor” health, respectively, had died. After adjusting for demographic factors and medical history, a less favorable self-rated health status was associated with increased rates of hospitalization and death. As compared to those reporting “excellent” health, adults with “good,” “fair,” and “poor” health had 1.22 (1.07 to 1.40), 2.01 (1.63 to 2.47), and 3.13 (2.39 to 4.09) times the rate of hospitalizations, respectively. The hazards of death also increased with worsening categories of self-rated health, with “good,” “fair,” and “poor” health individuals experiencing 1.30 (1.12 to 1.51), 2.15 (1.71 to 2.69), and 3.40 (2.54 to 4.56) times the hazard of death compared to “excellent,” respectively. Conclusions Even after adjusting for demographic and clinical factors, having a less favorable response on a single measure of self-rated health taken in middle age is a potent marker of future hospitalizations and death.