Large variation in predictors of mortality by levels of self-rated health: Results from an 18-year follow-up study

- As a valid predictor of mortality, self-rated health (SRH) presents a clear gradation in terms of mortality risk.
- SRH is driven by 'health component' but the determinants of positive and negative SRH evaluations are different.
- The SRH-mortality association is mediated by a range of demographic and socioeconomic variables.
- The baseline SRH presented a graded mortality risk with predictors of mortality varying by the levels of SRH.
- Illness-related limitations, older age and being never married increased the mortality risk in respondents with poor SRH.
- Socioeconomic and health-behavior covariates predicted mortality risk in respondents with good and average SRH.
- These findings contribute to research on the conceptual differences between positive and negative health assessments.

ObjectivesTo analyze the variation in factors associated with mortality risk at different levels of self-rated health (SRH).Study designRetrospective cohort study.MethodsCox regression analysis was used to examine the association between mortality and demographic, socioeconomic and health-related predictors for respondents with good, average, and poor SRH in a longitudinal data set from Estonia with up to 18 years of follow-up time.ResultsIn respondents with good SRH, male sex, older age, lower income, manual occupation, ever smoking, and heavy alcohol consumption predicted higher mortality. These covariates, together with marital status, illness-related limitations, and underweight predicted mortality in respondents with average SRH. For poor SRH, only being never married and having illness-related limitations predicted mortality risk in addition to older age and male sex.ConclusionsThe predictors of all-cause mortality are not universal but depend on the level of SRH. The higher mortality of respondents with poor SRH could to a large extent be attributed to health problems, whereas in the case of average or good SRH, factors other than the presence of illness explained outcome mortality.