title: Perceived health status and morbidity and mortality: evidence from the Kuopio ischaemic heart disease risk factor study.
abstract: BACKGROUND
  Previous studies have reported an increased risk of death in those who report their health is poor, however, the role of underlying and subclinical disease in this association has not been carefully studied.
  
  
  METHODS
  The associations between perceived health status and mortality from all causes and cardiovascular disease, incidence of myocardial infarction, carotid atherosclerosis, forced expiratory volume, and maximal exercise capacity were studied in the Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based study of 2682 men, aged 42-60, in eastern Finland.
  
  
  RESULTS
  There were strong, statistically significant, age-adjusted associations between level of perceived health and mortality from all causes (RH(bad versus good) = 3.67), cardiovascular causes (RH(bad versus good) = 6.64), and incidence of myocardial infarction (RH(bad versus good) = 3.87). Perceived health levels were strongly associated with risk factors and disease indicators. The associations with mortality and myocardial infarction outcomes were considerably weakened with progressive adjustment for eight risk factors and prevalent disease. Higher levels of perceived health were associated with less carotid atherosclerosis, and greater forced expiratory volume and maximal exercise capacity. Associations between level of perceived health and these indicators were considerably stronger in those with prevalent diseases than in those who were healthy.
  
  
  CONCLUSIONS
  The overall pattern of results suggests that perceived health levels mainly reflect underlying disease burden.
authors.affiliation: Human Population Laboratory, California Department of Health Services, Berkeley, 94704-1011, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Kaplan
authors.forename: D E
authors.initials: DE
authors.lastname: Goldberg
authors.forename: S A
authors.initials: SA
authors.lastname: Everson
authors.forename: R D
authors.initials: RD
authors.lastname: Cohen
authors.forename: R
authors.initials: R
authors.lastname: Salonen
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: J
authors.initials: J
authors.lastname: Salonen
mesh_terms: D000328:Adult; D002423:Cause of Death; D005080:Exercise Test; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D017202:Myocardial Ischemia / Q000401:mortality*; D011159:Population Surveillance; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires