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.