Background: Self-rated health (SRH), a subjective measure of health, is strongly predictive of mortality, independently of objective measures of health status and existing known disease. There is also a strong social gradient in SRH. We ask whether SRH can explain the well-known socioeconomic gradient in mortality.
Methods: We examine the effect of adjusting for SRH on the socioeconomic differential in mortality in a prospective study of 20,754 men and women aged 39–79 years, without prevalent disease, living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993-1997 and followed up for an average of 10 years.
Results: Mortality risk increased with decreasing social class in men and women. There was some attenuation after adjustment for covariates age, BMI, smoking, history of diabetes, systolic blood pressure, cholesterol level, alcohol consumption, physical activity and educational level, but a gradient remained. Further adjustment for SRH attenuated the association slightly more, but there was still some evidence of a socioeconomic differential in mortality, particularly in class V compared to class I (age and sex adjusted hazard ratio=1.57 (95%CI 1.19, 2.06).
Conclusions: SRH does not substantially explain the socioeconomic differential in mortality beyond that explained by health related covariates.