title: Self-rated health trajectories in the African American health cohort.
abstract: BACKGROUND
  Self-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans.
  
  
  METHODS
  Data on 998 African American men and women aged 50-64 years old were taken from a probability-based community sample that was first assessed in 2000-2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later. Using an innovative approach for including decedents in the analysis, semi-parametric group-based mixture models were used to identify person-centered group trajectories of self-rated health over time. Multivariable multinomial logistic regression analysis was then used to differentiate the characteristics of AAH participants classified into the different group trajectories.
  
  
  RESULTS
  Four self-rated health group trajectories were identified: persistently good health, good but declining health, persistently fair health, and fair but declining health. The main characteristics that differentiated the self-rated health trajectory groups from each other were age, education, smoking, morbidity (angina, congestive heart failure, diabetes, and kidney disease), having been hospitalized in the year prior to baseline, depressive symptoms, mobility limitations, and initial self-rated health.
  
  
  CONCLUSIONS
  This is the first study to examine self-rated health trajectories separately among African Americans. Four qualitatively distinct self-rated health group trajectories were identified that call into question the accuracy of prior reports that a single, average self-rated health trajectory for African Americans adequately captures their within-group heterogeneity.
authors.affiliation: Department of Health Management and Policy, the University of Iowa, Iowa City, Iowa United States of America.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Ayyagari
authors.forename: Fred
authors.initials: F
authors.lastname: Ullrich
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Malmstrom
authors.forename: Elena M
authors.initials: EM
authors.lastname: Andresen
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: J Philip
authors.initials: JP
authors.lastname: Miller
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Miller
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
mesh_terms: D001741:Black or African American; D015331:Cohort Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D057566:Self Report