Self‐Rated Health Status and Risk of Ischemic Heart Disease in the China Kadoorie Biobank Study: A Population‐Based Cohort Study

Abstract

BackgroundSelf‐rated health (SRH) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease (IHD) have not been extensively explored, especially in a Chinese population.Methods and ResultsMore than 500 000 adults from 10 cities in China were followed from baseline (2004–2008) through December 31, 2013. Global and age‐comparative SRH were reported from baseline questionnaires. Incident IHD cases were identified through links to well‐established disease registry systems and the national health insurance system. During 3 423 542 person‐years of follow‐up, we identified 24 705 incident cases of IHD. In multivariable‐adjusted models, both global and age‐comparative SRH was significantly associated with incident IHD. Compared with excellent SRH, the hazard ratios for good, fair, and poor SRH were 1.02 (95% confidence interval [CI], 0.98–1.07), 1.32 (95% CI, 1.27–1.37), and 1.76 (95% CI, 1.68–1.85), respectively. Compared with better age‐comparative SRH, the hazard ratios for same and worse age‐comparative SRH were 1.23 (95% CI, 1.19–1.27) and 1.78 (95% CI, 1.70–1.86), respectively. The associations persisted in all subgroup analyses, although they were slightly modified by study location, education, and income levels.ConclusionsA simple questionnaire for self‐assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient tool for assessing future IHD risk.

Association Between Self-rated Health, Coronary Artery Calcium Scores, and Atherosclerotic Cardiovascular Disease Risk

“…First, similar to prior studies, our analysis showed that SRH is associated with incident CVD events and all-cause mortality. 6 , 7 , 8 However, our study extends prior knowledge by examining, for the first time, the predictive value of SRH in the context of existing risk tools such as the PCE and CAC score, seeking to assess combinations of SRH, PCE, and CAC score that may improve current clinical risk assessment or provide quick and less expensive strategies for risk prediction in selective screening programs, population health management, research, or other settings where decisions are made based on risk. Importantly, SRH can easily be assessed electronically inside or outside the health care setting; therefore, its applicability is broad.…”

“…Furthermore, participants’ responses may be influenced by their educational status or prior interactions with the clinical environment. 7 Validation studies are therefore needed using similar simple measures of SRH across different populations.…”

“… 3 Previous studies have shown SRH to be a reproducible measure 4 that is associated with cardiovascular risk factors and with cardiovascular and all-cause mortality. 3 , 5 , 6 , 7 , 8 …”

“…Several studies have assessed the utility of each of these measures for mortality and cardiovascular disease (CVD) risk prediction. 7 , 11 However, the association between SRH and the true burden of atherosclerosis, as estimated by CAC, and the interplay of these measures for risk estimation have not been explored. In addition, significant interest in formally assessing the incremental benefit of SRH in clinical cardiovascular risk prediction modeling has been indicated.…”

Self-rated Health Status and Associated Factors in Rural Workers

“…The self-rated health, a construct that involves physical, mental and social aspects of life through the individual's general perception of their health [9], has been widely used in epidemiological studies, since it is a simple, subjective, easy-to-evaluate and applicable measure [10,11]. It is also used to compare health services, resource needs according to geographic areas, calculation of morbidity and mortality indicators [12][13][14] and functional decline [15,16].…”