title: Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance.
abstract: BACKGROUND
  The Study on Global Ageing and Adult Health (SAGE) aims to improve empirical understanding of health and well-being of adults in developing countries. We examine the role of self-rated health (SRH) in predicting mortality and assess how socio-demographic and other disability measures influence this association.
  
  
  METHODS
  In 2007, a shortened SAGE questionnaire was administered to 5087 adults aged ≥50 years under the Health Demographic Surveillance System in rural Pune district, India. Respondents rated their own health with a single global question on SRH. Disability and well-being were assessed using the WHO Disability Assessment Schedule Index, Health State Score and quality-of-life score. Respondents were followed up every 6 months till June 2011. Any change in spousal support, migration or death during follow-up was updated in the SAGE dataset.
  
  
  RESULTS
  In all, 410 respondents (8%) died in the 3-year follow-up period. Mortality risk was higher with bad/very bad SRH [hazard ratio (HR) in men: 3.06, 95% confidence interval (CI): 1.93-4.87; HR in women: 1.64, 95% CI: 0.94-2.86], independent of age, disability and other covariates. Disability measure (WHO Disability Assessment Schedule Index) and absence of spousal support were also associated with increased mortality risk.
  
  
  CONCLUSIONS
  Our findings confirm an association between bad/very bad SRH and mortality for men, independent of age, socio-demographic factors and other disability measures, in a rural Indian population. This association loses significance in women when adjusted for disability. Our study highlights the strength of nesting cross-sectional surveys within the context of the Health Demographic Surveillance System in studying the role of SRH and mortality.
authors.affiliation: Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
authors.forename: Siddhivinayak
authors.initials: S
authors.lastname: Hirve
authors.forename: Sanjay
authors.initials: S
authors.lastname: Juvekar
authors.forename: Somnath
authors.initials: S
authors.lastname: Sambhudas
authors.forename: Pallavi
authors.initials: P
authors.lastname: Lele
authors.forename: Yulia
authors.initials: Y
authors.lastname: Blomstedt
authors.forename: Stig
authors.initials: S
authors.lastname: Wall
authors.forename: Lisa
authors.initials: L
authors.lastname: Berkman
authors.forename: Steve
authors.initials: S
authors.lastname: Tollman
authors.forename: Nawi
authors.initials: N
authors.lastname: Ng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D012737:Sex Factors; D012959:Socioeconomic Factors