title: Self-rated general health among 40-year-old Danes and its association with all-cause mortality at 10-, 20-, and 29 years' follow-up.
abstract: OBJECTIVE
  Self-rated general health (SRH) predicts future mortality. We examined all-cause mortality at 10, 20, and 29 years' follow-up and its association with SRH measured at the age of 40 years in a cohort of 1,198 healthy Danes born in 1936 and who were residents in suburban Copenhagen.
  
  
  METHODS
  The association between SRH (dichotomized into good versus poor) and all-cause mortality was estimated in standard time-homogenous Cox regression models adjusting for covariates related to mortality, and in time-heterogeneous Cox regression models without covariate adjustment, where time-heterogeneity features as a separate risk assessment for each of the three follow-up periods defined by the follow-up examinations.
  
  
  RESULTS
  At the age of 40 years, 153 (14.6%) of 1,045 participants reported poor and 85.4% good SRH. Dead participants totalled 36 at the 10-year, 96 at the 20-year, and 207 at the 29-year follow-up. For poor SRH, mortality hazard ratios (multivariate analysis) were persistently significant, but slowly declining with follow-up time. The time-heterogeneous models explain this feature: increased mortality risk was significant only in the first decade after assessment: 2.30 (95% CI 1.11-4.78) vs. 0.91 (95% CI 0.36-2.31) and 0.73 (95% CI 0.34-1.55).
  
  
  CONCLUSIONS
  The association between poor SRH and mortality emphasizes the importance of health personnel taking account of people's health rating, particularly when a recent assessment has been made. SRH is related to death, even when controlling for known covariates, but it is not a long-term effect.
authors.affiliation: Research Unit and Department of General Practice, University of Copenhagen, Copenhagen, Denmark. a.nielsen@gpract.ku.dk
authors.forename: Anni Brit Sternhagen
authors.initials: AB
authors.lastname: Nielsen
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.forename: Line Conradsen
authors.initials: LC
authors.lastname: Hiort
authors.forename: Thomas
authors.initials: T
authors.lastname: Drivsholm
authors.forename: Svend
authors.initials: S
authors.lastname: Kreiner
authors.forename: Hanne
authors.initials: H
authors.lastname: Hollnagel
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D010808:Physical Examination; D012307:Risk Factors; D012649:Self Concept; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires