Self-rated health and physician-rated health as independent predictors of mortality in elderly men

• Published in: Age and ageing Vol. 41; no. 2; pp. 165 - 171
• Main Authors: Giltay, Erik J., Vollaard, Albert M., Kromhout, Daan
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-03-2012; Oxford Publishing Limited (England)
• Subjects: adults; Age; Age Factors; Aged; Aged men; Aged, 80 and over; Aging; Analysis of Variance; Cancer; cancer-patients; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cause of Death; Chi-Square Distribution; Doctors; elderly; Elderly men; Evaluation; Geriatric assessment; Geriatric Assessment - statistics & numerical data; Geriatrics; Health; Health status; Health Status Indicators; heart-disease; Historical account; Humans; Independent Living; inflammation; intensive-care-unit; Male; males; Medical examination; Men; Men's Health - statistics & numerical data; Mens health; Methods; Middle Aged; Mortality; Neoplasms - mortality; Netherlands - epidemiology; Older people; Proportional Hazards Models; Prospective Studies; Quality of life; risk; Risk Assessment; Risk Factors; Self Report; Sex Factors; survival; term; Time Factors; zutphen; Netherlands; health status; evaluation; risk assessment; epidemiology; elderly; survival; mortality; cohort studies
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afr161

Background: When assessing health status, physicians may focus on objective symptoms and diagnoses, whereas individuals may focus more on subjective symptoms, functional limitations and quality of life.
Methods: In the Zutphen Elderly Study, 710 community-living men (aged 64-84 years) were followed until death for 15 years. Self-rated health was assessed through a single-item question. Physician-rated health was estimated on a Likert scale by physicians after medical history assessment and physical examination. Both health ratings were categorised into three groups. All-cause, cardiovascular and cancer mortality rates were analysed in Cox proportional-hazards models.
Results: There were 352 (49.6%) men who felt healthy and 225 (31.7%) men with a good physician-rated health. During 15 years of follow-up 503 of 710 men (70.8%) died, of whom 229 (45.5%) from cardiovascular causes and 144 (28.6%) from cancer. Self-rated and physician-rated health both predicted independently all-cause mortality (hazard ratios [HR] for worst vs. best health category: 1.72; 95% confidence interval [CI]: 1.26-2.33, and 1.77; 95% CI: 1.36-2.29; respectively; P-values of <0.005). When self-rated and physician-rated health were discordant, mortality risk was highest when physicians had a less favourable view on the health status than the participant. Self-rated health predicted independently cancer mortality (HR 2.41), whereas physician-rated health cardiovascular mortality (HR 2.13).
Conclusion: Self-rated and physician-rated health status predicted both all-cause mortality, and showed a differential pattern for cancer and cardiovascular diseases mortality.