title: The impact of changes in self-rated general health on 28-year mortality among middle-aged Danes.
abstract: OBJECTIVE
  Self-rated general health (SRH) predicts future mortality. SRH may change, and these changes may alter the mortality risk. All-cause mortality until the age of 68 and its association with changes in SRH from the age of 40-45, 45-51, and 51-60 years was examined in a cohort of Danes.
  
  
  METHODS
  Prospective population study started in 1976 with follow-up in 1981, 1987, and 1996.
  
  
  METHODS
  Suburban area of Copenhagen.
  
  
  METHODS
  A total of 1198 individuals born in 1936.
  
  
  METHODS
  All-cause mortality.
  
  
  RESULTS
  Among participants with two consecutive SRH ratings the mortality rate per 1000 observation years was 7.6 (95% CI 6.4; 8.9), 8.5 (95% CI 7.1; 10.2), and 8.9 (95% CI 6.4; 10.3) after the 45-, 51-, and 60-year examination. Decline in SRH between two time-points was in bivariate Cox regression analyses associated with an increased mortality risk, the association increasing as participants grew older. Multivariate analysis of the effect of changes of SRH on mortality gave similar results: hazard ratios for declined SRH were (reference: "unchanged good") 1.55 (95% CI 0.93-2.58), 1.96 (95% CI 1.09-3.53), and 2.22 (95% CI 0.97-5.09) at the 40-45, 45-51, and 51-60-year intervals. However, unchanged poor and improved SRH (at the 40-45-year interval) were also associated with an increase, and additional analyses showed that just rating SRH as poor at one rating was associated with increased risk.
  
  
  CONCLUSIONS
  Changes in SRH are associated with higher mortality risks than unchanged good SRH.
authors.affiliation: The 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: Svend
authors.initials: S
authors.lastname: Kreiner
authors.forename: Line Conradsen
authors.initials: LC
authors.lastname: Hiort
authors.forename: Thomas
authors.initials: T
authors.lastname: Drivsholm
authors.forename: Lene Falgaard
authors.initials: LF
authors.lastname: Eplov
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; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D012307:Risk Factors; D012649:Self Concept; D011795:Surveys and Questionnaires