title: The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australian longitudinal study of ageing.
abstract: BACKGROUND
  Self-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults. Whilst the robust relationship between SRH and mortality is well established, it is not known how comparable different SRH items are in their relationship to mortality over time. We used a dynamic evaluation model to investigate the sensitivity of time-varying SRH measures with different reference points to predict mortality in older adults over time.
  
  
  METHODS
  We used seven waves of data from the Australian Longitudinal Study of Ageing (1992 to 2004; N = 1733, 52.6% males). Cox regression analysis was used to evaluate the relationship between three time-varying SRH measures (global, age-comparative and self-comparative reference point) with mortality in older adults (65+ years).
  
  
  RESULTS
  After accounting for other mortality risk factors, poor global SRH ratings increased mortality risk by 2.83 times compared to excellent ratings. In contrast, the mortality relationship with age-comparative and self-comparative SRH was moderated by age, revealing that these comparative SRH measures did not independently predict mortality for adults over 75 years of age in adjusted models.
  
  
  CONCLUSIONS
  We found that a global measure of SRH not referenced to age or self is the best predictor of mortality, and is the most reliable measure of self-perceived health for longitudinal research and population health estimates of healthy life expectancy in older adults. Findings emphasize that the SRH measures are not equivalent measures of health status.
authors.affiliation: Ageing Research Unit, Centre for Mental Health Research, Australian National University, Canberra, Australia. Kerry.Sargent-Cox@anu.edu.au
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Sargent-Cox
authors.forename: Kaarin J
authors.initials: KJ
authors.lastname: Anstey
authors.forename: Mary A
authors.initials: MA
authors.lastname: Luszcz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D002755:Choice Behavior; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality / Q000639:trends*; D011237:Predictive Value of Tests; D012649:Self Concept
references.citation: Arch Gerontol Geriatr. 2009 Jan-Feb;48(1):14-8
references.pmid: 17950481
references.citation: Gerontologist. 2005 Apr;45(2):216-21
references.pmid: 15799986
references.citation: J Health Soc Behav. 1997 Mar;38(1):21-37
references.pmid: 9097506
references.citation: Soc Sci Med. 2009 Aug;69(3):307-16
references.pmid: 19520474
references.citation: Aging Clin Exp Res. 2006 Jun;18(3):211-7
references.pmid: 16804367
references.citation: Am J Psychiatry. 1997 Nov;154(11):1593-8
references.pmid: 9356570
references.citation: J Am Geriatr Soc. 1992 Sep;40(9):922-35
references.pmid: 1512391
references.citation: Cancer. 1998 Jun 1;82(11):2123-34
references.pmid: 9610691
references.citation: Arch Gerontol Geriatr. 1996 Jul-Aug;23(1):47-60
references.pmid: 15374166
references.citation: J Aging Health. 2004;16(4):517-38
references.pmid: 15271268
references.citation: J Aging Health. 2008 Sep;20(6):739-61
references.pmid: 18625760
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Psychol Methods. 2002 Jun;7(2):147-77
references.pmid: 12090408
references.citation: Gerontologist. 2003 Jun;43(3):387-95; discussion 372-5
references.pmid: 12810903
references.citation: Eur J Public Health. 2003 Sep;13(3 Suppl):6-14
references.pmid: 14533742
references.citation: J Epidemiol Community Health. 2005 Jul;59(7):574-9
references.pmid: 15965141
references.citation: Age Ageing. 1998 Jan;27(1):23-33
references.pmid: 9504363
references.citation: J Clin Epidemiol. 2005 Jul;58(7):680-7
references.pmid: 15939219
references.citation: Am J Public Health. 1993 Jun;83(6):896-8
references.pmid: 8498632
references.citation: WHO Reg Publ Eur Ser. 1996;58:i-xiii, 1-161
references.pmid: 8857196
references.citation: Kidney Int. 2008 Oct;74(8):994-7
references.pmid: 18633346
references.citation: Scand J Prim Health Care Suppl. 1990;1:55-60
references.pmid: 2100366
references.citation: Int J Epidemiol. 2001 Apr;30(2):326-33
references.pmid: 11369738
references.citation: J Health Soc Behav. 1993 Jun;34(2):105-21
references.pmid: 8277124
references.citation: Soc Sci Med. 2003 Apr;56(7):1447-52
references.pmid: 12614696
references.citation: Health Psychol. 2004 Nov;23(6):651-5
references.pmid: 15546234
references.citation: J Gerontol B Psychol Sci Soc Sci. 2001 Jul;56(4):S195-205
references.pmid: 11445612
references.citation: Gerontologist. 2003 Jun;43(3):376-86; discussion 372-5
references.pmid: 12810902
references.citation: J Gerontol B Psychol Sci Soc Sci. 2001 May;56(3):S171-8
references.pmid: 11316842
references.citation: Soc Sci Med. 2003 Jun;56(12):2505-14
references.pmid: 12742613