Original articleSelf-rated health, chronic diseases, and symptoms among middle-aged and elderly men and women
Introduction
Self-rated health has been found to be a strong predictor of morbidity and mortality 1, 2, 3, 4, 5. A large part of this effect is mediated through disease and disability, but self-reported health remains a significant predictor of mortality even after controlling for present disease or dysfunction 4, 5, 6. Furthermore, self-rated health is an indicator of well-being, quality of life 7, 8, and a significant predictor of utilization of health care services 9, 10.
It has been found that different people have different interpretations of self-rated health. Some people think about specific health problems when asked to rate their health, whereas others think in terms of either general physical functioning or health behaviors [11]. The interpretations of self-rated health also vary by age and gender 11, 12, 13.
Many physiological and psychosocial determinants of self-rated health have been described in the literature, but the main determinant of self-rated health is physical health 4, 14, 15, 16. Several studies have considered the effect of chronic diseases and symptoms on self-rated health, but the results vary depending on what conditions have been taken into consideration and on the composition of the study population 8, 17, 18, 19, 20. In addition, most of the studies have only looked at the association at the individual level. From a public health perspective it is, however, also important to get insight into the impact of chronic diseases and symptoms on self-rated health at the population level. While results at the patient level express which diseases and symptoms are most important for individual patients, results at the population level express which part of the total burden of poor self-rated health could be prevented if certain diseases and symptoms could be eliminated. This can be done by calculating population-attributable risks which are based both on the strength of association between a specific condition and poor self-rated health, and the prevalence of the condition in the general population.
We wanted to study the association between chronic diseases, symptoms, and poor self-rated health, and to identify the conditions with the largest contributions to ill health in the general adult population using a wide range of diseases and symptoms. This was done both at individual and population levels. We also investigated whether the associations between chronic diseases/symptoms and self-rated health vary by gender and age group.
Section snippets
Methods
The study population comprised 6,061 men and women aged 35–79 years, a representative sample of the adult population in Värmland County in western Sweden. The data was gathered using a postal survey questionnaire. The data collection was done in March–May 2000. The overall response rate was 74%.
Self-rated health was measured using the following question: “How would you rate your general state of health?” with the response options: “Very good,” “Good,” “Neither good or bad,” “Poor,” and “Very
Results
Table 1 shows the number of respondents by gender and age group, response rates, and prevalence of poor self-rated health and self-reported diseases and symptoms. Self-reported health deteriorated with age (P < 0.001) and the prevalence of diseases, but not symptoms, increased. The most frequent symptoms were pains in the musculoskeletal system. The most prevalent disease among the elderly (65–79 years) was cardiovascular disease (CVD), while among the middle-aged (35–64 years) no disease in
Discussion
Many chronic diseases have a strong association with poor self-rated health in the individual, but they may be rare in the total population, especially among younger adults. Therefore their contribution to the total burden of poor self-rated health may be limited. In our population of middle-aged and elderly men and women, tiredness/weakness had the strongest association with self-rated health at population level. The contribution of depression and musculoskeletal pains to the burden of poor
Acknowledgements
The population survey in Värmland was financed by the Värmland County Council.
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