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Predictive capacity of self-rated health on all-cause mortality in Spain: differences across sex, age and educational level
  1. Daniel Suso-Palau1,2,
  2. Teresa López-Cuadrado1,3,
  3. Daniela Duque-León2,
  4. Cristina Ortiz3,
  5. Iñaki Galán1,3
  1. 1 Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain
  2. 2 Imbanaco Clinic - QuirónSalud Group, Cali, Colombia
  3. 3 Department of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Dr Iñaki Galán, Department of Chronic Diseases, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, 28029, Spain; igalan{at}


Background Published evidence on self-rated health’s capacity to predict mortality and its variability across subpopulations lacks consistency. Our objective is to evaluate this predictive association and whether/how it varies by sex, age and educational attainment at the population level in Spain.

Methods Data came from a prospective longitudinal study based on 42 645 individuals aged ≥15 years who participated in the 2011–2012 and 2014 Spanish Health Surveys. Median follow-up time for mortality was 5.4 years. Cox proportional hazards models adjusted for sociodemographic, lifestyle and chronic disease variables were used to estimate the predictive capacity of self-rated health on mortality.

Results Self-rated health was associated with mortality with a dose–response effect (p value for linear trend <0.001). Compared with respondents who rated their health as very good, those rating it as very poor presented an HR of 3.33 (95% CI 2.50 to 4.44). Suboptimal self-rated health was a stronger predictor of mortality among 15–44 year-olds (HR 2.87; 95% CI 1.59 to 5.18), compared with the estimate for 45–64 year-olds (HR 1.86; 95% CI 1.45 to 2.39) (p value for interaction=0.001) and for those 65 and older (HR 1.51; 95% CI 1.36 to 1.68) (p value for interaction <0.001). Regarding educational attainment, the association was stronger for individuals with university studies (HR 2.51; 95% CI 1.67 to 3.76) than for those with only primary or no studies (HR 1.31; 95% CI 1.17 to 1.48) (p value for interaction=0.010). No statistically significant differences were observed between men and women.

Conclusions Self-rated health may be considered a good predictor of all-cause mortality in the population of Spain, although the magnitude of this predictive association varies by age and educational level.


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Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • Contributors DS-P and IG were responsible for conception of the project. TL-C, DD-L and CO contributed to the design of the study. DS-P, TL-C, CO and IG performed the statistical analysis. DS-P and IG drafted the manuscript. All authors contributed to interpretation of data, revised the article critically for important intellectual content and approved the final version of the manuscript. IG is guarantor of this study.

  • Funding This work was supported by the Institute of Health Carlos III, Ministry of Science and Innovation (grant number: PI19CIII/00021).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.