title: The relationship between self-rated health and mortality in older black and white Americans.
abstract: OBJECTIVE
  To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Communities in the United States.
  
  
  METHODS
  Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older.
  
  
  METHODS
  Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index.
  
  
  RESULTS
  SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH.
  
  
  CONCLUSIONS
  This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.
authors: Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA. seijlee@gmail.com
authors: Sei J
authors: SJ
authors: Lee
authors: Sandra Y
authors: SY
authors: Moody-Ayers
authors: C Seth
authors: CS
authors: Landefeld
authors: Louise C
authors: LC
authors: Walter
authors: Karla
authors: K
authors: Lindquist
authors: Mark R
authors: MR
authors: Segal
authors: Kenneth E
authors: KE
authors: Covinsky
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012650:Self Disclosure; D017678:Sex Distribution; D014481:United States; D044465:White People; D001741:Black or African American