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.
- SELF-RATED HEALTH
- PUBLIC HEALTH
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.
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