title: Self-rated health and mortality in individuals with diabetes mellitus: prospective cohort study.
abstract: OBJECTIVE
  To investigate whether low self-rated health (SRH) is associated with increased mortality in individuals with diabetes.
  
  
  METHODS
  Population-based prospective cohort study.
  
  
  METHODS
  Enrolment took place between 1992 and 2000 in four centres (Bilthoven, Heidelberg, Potsdam, Umeå) in a subcohort nested in the European Prospective Investigation into Cancer and Nutrition.
  
  
  METHODS
  3257 individuals (mean ± SD age was 55.8±7.6 years and 42% women) with confirmed diagnosis of diabetes mellitus.
  
  
  METHODS
  The authors used Cox proportional hazards modelling to estimate HRs for total mortality controlling for age, centre, sex, educational level, body mass index, physical inactivity, smoking, insulin treatment, hypertension, hyperlipidaemia and history of myocardial infarction, stroke or cancer.
  
  
  RESULTS
  During follow-up (mean follow-up ± SD was 8.6±2.3 years), 344 deaths (241 men/103 women) occurred. In a multivariate model, individuals with low SRH were at higher risk of mortality (HR 1.38, 95% CI 1.10 to 1.73) than those with high SRH. The association was mainly driven by increased 5-year mortality and was stronger among individuals with body mass index of <25 kg/m(2) than among obese individuals. In sex-specific analyses, the association was statistically significant in men only. There was no indication of heterogeneity across centres.
  
  
  CONCLUSIONS
  Low SRH was associated with increased mortality in individuals with diabetes after controlling for established risk factors. In patients with diabetes with low SRH, the physician should consider a more detailed consultation and intensified support.
authors.affiliation: Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden. wennberg@fammed.umu.se
authors.forename: Patrik
authors.initials: P
authors.lastname: Wennberg
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.forename: Lars
authors.initials: L
authors.lastname: Jerdén
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Diewertje
authors.initials: D
authors.lastname: Sluik
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Birgit
authors.initials: B
authors.lastname: Teucher
authors.forename: Annemieke
authors.initials: A
authors.lastname: Spijkerman
authors.forename: Bas
authors.initials: B
authors.lastname: Bueno de Mesquita
authors.forename: Claus
authors.initials: C
authors.lastname: Dethlefsen
authors.forename: Peter
authors.initials: P
authors.lastname: Nilsson
authors.forename: Ute
authors.initials: U
authors.lastname: Nöthlings