Self-rated health and cardiovascular disease incidence: results from a longitudinal population-based cohort in Norfolk, UK

• Published in: PloS one Vol. 8; no. 6; p. e65290
• Main Authors: van der Linde, Rianne M, Mavaddat, Nahal, Luben, Robert, Brayne, Carol, Simmons, Rebecca K, Khaw, Kay Tee, Kinmonth, Ann Louise
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.06.2013; Public Library of Science (PLoS)
• Subjects: Adjustment; Adult; Age; Aged; Alcohol; Alcohol use; Biology; Cancer; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases - psychology; Cholesterol; Chronic illnesses; Demographics; Development and progression; Diabetes; Diagnosis; Diagnostic Self Evaluation; Family medical history; Female; Hazards; Health care; Health risk assessment; Health risks; Health screening; Health services; Health Status; Heart; Humans; Incidence; Longitudinal Studies; Male; Medicine; Mens health; Methods; Middle Aged; Morbidity; Mortality; Nutrition research; Population; Population studies; Primary care; Proportional Hazards Models; Prospective Studies; Public health; Risk analysis; Risk Factors; Smoking; Social Class; Social classes; Sociodemographics; Statistical models; Studies; Survival Analysis; United Kingdom - epidemiology; Womens health; United Kingdom; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0065290

Self-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). In a population-based cohort, we examined the association between SRH and incident CVD and whether this association was independent of socio-demographic, clinical and behavioural participant characteristics. Population-based prospective cohort study (European Prospective Investigation of Cancer-Norfolk). 20,941 men and women aged 39-74 years without prevalent CVD attended a baseline health examination (1993-1998) and were followed for CVD events/death until March 2007 (mean 11 years). We used a Cox proportional hazards model to quantify the association between baseline SRH (reported on a four point scale--excellent, good, fair, poor) and risk of developing CVD at follow-up after adjusting for socio-demographic, clinical and behavioural risk factors. Baseline SRH was reported as excellent by 17.8% participants, good by 65.1%, fair by 16.0% and poor by 1.2%. During 225,508 person-years of follow-up, there were 55 (21.2%) CVD events in the poor SRH group and 259 (7.0%) in the excellent SRH group (HR 3.7, 95% CI 2.8-4.9). The HR remained significant after adjustment for behavioural risk factors (HR 2.6, 95% CI 1.9-3.5) and after adjustment for all socio-demographic, clinical and behavioural risk factors (HR 3.3, 95% CI 2.4-4.4). Associations were strong for both fatal and non-fatal events and remained strong over time. SRH is a strong predictor of incident fatal and non-fatal CVD events in this healthy, middle-aged population. Some of the association is explained by lifestyle behaviours, but SRH remains a strong predictor after adjustment for socio-demographic, clinical and behavioural risk factors and after a decade of follow-up. This easily accessible patient-centred measure of health status may be a useful indicator of individual and population health for those working in primary care and public health.