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Subjective measures of health and all-cause mortality – the Rotterdam Study

Published online by Cambridge University Press:  13 March 2017

A. Sajjad ,
R. L. Freak-Poli ,
A. Hofman ,
S. J. Roza ,
M. A. Ikram  and
H. Tiemeier
A. Sajjad
Affiliation:
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
R. L. Freak-Poli
Affiliation:
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Preventive Medicine, Monash University, Melbourne, Australia
A. Hofman
Affiliation:
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
S. J. Roza
Affiliation:
Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
M. A. Ikram
Affiliation:
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
H. Tiemeier*
Affiliation:
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
*
*Address for correspondence: H. Tiemeier M.D., Ph.D., Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. (Email: h.tiemeier@erasmusmc.nl)
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Abstract

Background

Subjectively assessed health is related to mortality. Various subjective indicators of health have been studied, but it is unclear whether perceived physical functioning or mental health best accounts for the relation with mortality.

Method

We studied the relation of subjective measures of health with all-cause mortality in 5538 participants of age 55 to 96 years at baseline from the Rotterdam Study. Various instruments of subjectively assessed health were used, that included basic activities of daily living (BADL), instrumental activities of daily living (IADL), quality of life (QoL), positive affect, somatic symptoms and negative affect. All participants completed questionnaires for each subjective measure of health and were followed for mortality for a mean of 12.2 (s.e. = 0.09) years. Cox regression analysis was conducted in the total sample.

Results

In this cohort, 2021 persons died during 48 534 person-years of follow-up. All measures of subjective health were related to mortality after adjusting for age, gender, education, cognition, prevalent chronic diseases and cardiovascular risk [BADL hazard ratio (HR, calculated per Z-score) = 1.35, 95% confidence interval (CI) 1.29–1.41; IADL HR = 1.27, 95% CI 1.22–1.32; QoL HR = 0.85, 95% CI 0.81–0.89; positive affect HR = 0.92, 95% CI 0.88–0.96; somatic symptoms HR = 1.11, 95% CI 1.06–1.16; and negative affect HR = 1.05, 95% CI 1.01–1.10]. In the mutually adjusted model, only BADL (HR = 1.24, 95% CI 1.16–1.32) and IADL (HR = 1.10, 95% CI 1.04–1.17) remained independently associated with mortality.

Conclusions

Measures of subjectively assessed health are important indicators of mortality. Our study shows that of the different measures of subjective health, perceived physical health predicts mortality over and above mental health. Conversely, the association between mental health and mortality may partly be explained by poor perceived physical health.

Keywords

Activities of daily livingmental healthmortalityphysical functioningquality of life
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 11 , August 2017 , pp. 1971 - 1980
Copyright
Copyright © Cambridge University Press 2017 

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