Self-Rated Health in Middle Age and Risk of Hospitalizations and Death: Recurrent Event Analysis of the ARIC Study

Scott Z Mu; Caitlin W Hicks; Natalie R Daya; Randi E Foraker; Anna M Kucharska-Newton; Pamela L Lutsey; Josef Coresh; Elizabeth Selvin

doi:10.1007/s11606-024-08748-0

Self-Rated Health in Middle Age and Risk of Hospitalizations and Death: Recurrent Event Analysis of the ARIC Study

J Gen Intern Med. 2024 Apr 10. doi: 10.1007/s11606-024-08748-0. Online ahead of print.

Authors

Scott Z Mu^{1

2}, Caitlin W Hicks³, Natalie R Daya⁴, Randi E Foraker⁵, Anna M Kucharska-Newton^{6

7}, Pamela L Lutsey⁸, Josef Coresh⁴, Elizabeth Selvin⁴

Affiliations

¹ Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. scott.mu@rutgers.edu.
² Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA. scott.mu@rutgers.edu.
³ Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Division of General Medical Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
⁶ Department of Epidemiology, the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Department of Epidemiology, University of Kentucky, Lexington, KY, USA.
⁸ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

PMID: 38598038
DOI: 10.1007/s11606-024-08748-0

Abstract

Background: Self-rated health is a simple measure that may identify individuals who are at a higher risk for hospitalization or death.

Objective: To quantify the association between a single measure of self-rated health and future risk of recurrent hospitalizations or death.

Participants: Atherosclerosis Risk in Communities (ARIC) study, a community-based prospective cohort study of middle-aged men and women with follow-up beginning from 1987 to 1989.

Main measures: We quantified the associations between initial self-rated health with risk of recurrent hospitalizations and of death using a recurrent events survival model that allowed for dependency between the rates of hospitalization and hazards of death, adjusted for demographic and clinical factors.

Key results: Of the 14,937 ARIC cohort individuals with available self-rated health and covariate information, 34% of individuals reported "excellent" health, 47% "good," 16% "fair," and 3% "poor" at study baseline. After a median follow-up of 27.7 years, 1955 (39%), 3569 (51%), 1626 (67%), and 402 (83%) individuals with "excellent," "good," "fair," and "poor" health, respectively, had died. After adjusting for demographic factors and medical history, a less favorable self-rated health status was associated with increased rates of hospitalization and death. As compared to those reporting "excellent" health, adults with "good," "fair," and "poor" health had 1.22 (1.07 to 1.40), 2.01 (1.63 to 2.47), and 3.13 (2.39 to 4.09) times the rate of hospitalizations, respectively. The hazards of death also increased with worsening categories of self-rated health, with "good," "fair," and "poor" health individuals experiencing 1.30 (1.12 to 1.51), 2.15 (1.71 to 2.69), and 3.40 (2.54 to 4.56) times the hazard of death compared to "excellent," respectively.

Conclusions: Even after adjusting for demographic and clinical factors, having a less favorable response on a single measure of self-rated health taken in middle age is a potent marker of future hospitalizations and death.

Keywords: epidemiology; hospitalizations; recurrent events; self-rated health; survival analysis.

Abstract

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