title: Is self-rated health an independent index for mortality among older people in Indonesia?
abstract: BACKGROUND
  Empirical studies on the association between self-rated health (SRH) and subsequent mortality are generally lacking in low- and middle-income countries. The evidence on whether socio-economic status and education modify this association is inconsistent. This study aims to fill these gaps using longitudinal data from a Health and Demographic Surveillance System (HDSS) site in Indonesia.
  
  
  METHODS
  In 2010, we assessed the mortality status of 11,753 men and women aged 50+ who lived in Purworejo HDSS and participated in the INDEPTH WHO SAGE baseline in 2007. Information on self-rated health, socio-demographic indicators, disability and chronic disease were collected through face-to-face interview at baseline. We used Cox-proportional hazards regression for mortality and included all variables measured at baseline, including interaction terms between SRH and both education and socio-economic status (SES).
  
  
  RESULTS
  During an average of 36 months follow-up, 11% of men and 9.5% of women died, resulting in death rates of 3.1 and 2.6 per 1,000 person-months, respectively. The age-adjusted Hazard Ratio (HR) for mortality was 17% higher in men than women (HR = 1.17; 95% CI = 1.04-1.31). After adjustment for covariates, the hazard ratios for mortality in men and women reporting bad health were 3.0 (95% CI = 2.0-4.4) and 4.9 (95% CI = 3.2-7.4), respectively. Education and SES did not modify this association for either sex.
  
  
  CONCLUSIONS
  This study supports the predictive power of bad self-rated health for subsequent mortality in rural Indonesian men and women 50 years old and over. In these analyses, education and household socio-economic status do not modify the relationship between SRH and mortality. This means that older people who rate their own health poorly should be an important target group for health service interventions.
authors.affiliation: Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
authors.forename: Nawi
authors.initials: N
authors.lastname: Ng
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hakimi
authors.forename: Ailiana
authors.initials: A
authors.lastname: Santosa
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
authors.forename: Siswanto Agus
authors.initials: SA
authors.lastname: Wilopo
authors.forename: Stig
authors.initials: S
authors.lastname: Wall
mesh_terms: D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012424:Rural Population; D012649:Self Concept; D012959:Socioeconomic Factors