title: Effects of self-rated health on sick leave, disability pension, hospital admissions and mortality. A population-based longitudinal study of nearly 15,000 observations among Swedish women and men.
abstract: BACKGROUND
  Simple global self-ratings of health (SRH) have become increasingly used in national and international public health monitoring, and in recent decades recommended as a standard part of health surveys. Monitoring developments in population health requires identification and use of health measures, valid in relation to targets for population health. The aim of the present study was to investigate associations between SRH and sick leave, disability pension, hospital admissions, and mortality, adjusted for effects of significant covariates, in a large population-based cohort.
  
  
  METHODS
  The analyses were based on screening data from eight population-based cohorts in southern and central Sweden, and on official register data regarding sick-leave, disability pension, hospital admissions, and death, with little or no data loss. Sampling was performed 1973-2003. The study population consisted of 11,880 women and men, age 25-99 years, providing 14,470 observations. Information on SRH, socio-demographic data, lifestyle variables and somatic and psychological symptoms were obtained from questionnaires.
  
  
  RESULTS
  There was a significant negative association between SRH and sick leave (Beta -13.2, p<0.0001, and -9.5, p<0.01, in women and men, respectively), disability pension (Hazard ratio 0.77, p<0.0001 and 0.76, p<0.0001, in women and men, respectively), and mortality, adjusted for covariates. SRH was also significantly associated with hospital admissions in men (Hazard ratio 0.87, p<0.0001), but not in women (Hazard ratio 0.96, p0.20). Associations between SRH on the one hand, and sick leave, disability pension, hospital admission, and mortality, on the other, were robust during the follow-up period.
  
  
  CONCLUSIONS
  SRH had strong predictive validity in relation to use of social insurance facilities and health care services, and to mortality. Associations were strong and robust during follow-up.
authors.affiliation: Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden. christina.halford@pubcare.uu.se
authors.forename: Christina
authors.initials: C
authors.lastname: Halford
authors.forename: Thorne
authors.initials: T
authors.lastname: Wallman
authors.forename: Lennart
authors.initials: L
authors.lastname: Welin
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.forename: Annika
authors.initials: A
authors.lastname: Bardel
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.forename: Henry
authors.initials: H
authors.lastname: Eriksson
authors.forename: Ed
authors.initials: E
authors.lastname: Palmer
authors.forename: Lars
authors.initials: L
authors.lastname: Wilhelmsen
authors.forename: Kurt
authors.initials: K
authors.lastname: Svärdsudd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D018868:Insurance, Disability / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010415:Pensions / Q000706:statistics & numerical data*; D012042:Registries; D018582:Sick Leave / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology