Health perceptions and survival: do global evaluations of health status really predict mortality?

Abstract

Self-evaluations of health status have been shown to predict mortality, above and beyond the contribution to prediction made by indices based on the presence of health problems, physical disability, and biological or life-style risk factors. Several possible reasons for this association are discussed: (a) methodological shortcomings of previous studies render the association spurious; (b) other psychosocial influences on mortality are involved and explain the association; and (c) self-evaluations of health status have a direct and independent effect of their own. Four-year follow-up mortality data from the Yale Health and Aging Project (N = 2812) are used to explore these possibilities. The analysis controls for the contribution of numerous indicators of health problems, disability and risk factors, and also makes adjustments of standard errors for the complex sample design. The findings favor the third possibility, an independent effect, to the extent that the particular set of psychosocial factors examined did not explain the basic association, and to the extent that the control variables were an adequately comprehensive set.

PIP: Researchers evaluated data from a prospective study begun in 1982 of the health of 2812 elderly people in New Haven, Connecticut to determine the extent self perceptions of health have on predicting mortality. The results demonstrated that men who rated their health as bad or poor were 6.75 times at risk of death than those who rated it as excellent. In addition, women who reported their health as bad or poor were 3.12 times more likely to die than those who claimed to be in excellent health. Both of these results were statistically significant. Nevertheless age was the best predictor of mortality for both sexes. For men, self assessed health followed age then the Roscow score (a health scale for the aged), smoking, and diabetes. For women, diabetes followed age then self assessed health, the Roscow score, body mass index, and smoking. Further poor and fair self assessed health statuses correctly predicted both early and late deaths for both sexes. Additional analyses showed that the association between self assessed health and mortality existed only for women living in the community and not for those in public or private housing for the elderly. Moreover this analysis indicated an excess number of expected deaths among women living in public housing who claimed to be in excellent health. Medical care utilization, presence of external social resources (e.g., close friends), and presence of internal emotional resources (e.g. religiosity) had little to no direct effect on mortality. These results indicated that self rated health has a unique, predictive, and, at the present time, inexplicable association with mortality. Further research on possible contributing variables is needed.