Background Most previous studies of self-rated health (SRH) and mortality are in western populations and use global SRH. Conceptualisations of health and the cause-composition of mortality may be context specific; we examined the association of SRH with all-cause and cause-specific mortality in a developed non-western population.
Methods We used multivariable Cox regression to examine, in 64 189 Chinese people aged 65+ years enrolled at 18 Elderly Health Centres from 1998 to 2001, the adjusted associations of age-comparative and self-comparative SRH with mortality and whether the associations varied by follow-up duration, sex, age or socio-economic position.
Results After a mean follow-up of 8.2 years, there were 12 350 deaths. Worse age-comparative SRH was associated with higher mortality (HR 1.73, 95% CI 1.62 to 1.85) than better SRH, adjusted for sex, age, education, housing, monthly expenditure, smoking, alcohol use, body mass index and physical activity. The associations varied by sex in the short term and weakened with age. Age-comparative SRH was more strongly associated with mortality from circulatory diseases (HR 1.93, 95% CI 1.70 to 2.18) and respiratory diseases (HR 2.08, 95% 1.79 to 2.42) than from cancer (HR 1.27, 95% CI 1.13 to 1.43). Worse self-comparative SRH was not associated with higher mortality.
Conclusion Age-comparative SRH is a good predictor of mortality in older people from a non-western setting but self-comparative SRH is not. However, the association was less marked than in western settings possibly because of contextually specific assessments of health or a different pattern of mortality.