title: Self-rated health and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition-InterAct study: a case-cohort study.
abstract: OBJECTIVE
  To investigate the association between self-rated health and risk of type 2 diabetes and whether the strength of this association is consistent across five European centres.
  
  
  METHODS
  Population-based prospective case-cohort study.
  
  
  METHODS
  Enrolment took place between 1992 and 2000 in five European centres (Bilthoven, Cambridge, Heidelberg, Potsdam and Umeå).
  
  
  METHODS
  Self-rated health was assessed by a baseline questionnaire in 3399 incident type 2 diabetic case participants and a centre-stratified subcohort of 4619 individuals from the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study which was drawn from a total cohort of 340 234 participants in the EPIC.
  
  
  METHODS
  Prentice-weighted Cox regression was used to estimate centre-specific HRs and 95% CIs for incident type 2 diabetes controlling for age, sex, centre, education, body mass index (BMI), smoking, alcohol consumption, energy intake, physical activity and hypertension. The centre-specific HRs were pooled across centres by random effects meta-analysis.
  
  
  RESULTS
  Low self-rated health was associated with a higher hazard of type 2 diabetes after adjusting for age and sex (pooled HR 1.67, 95% CI 1.48 to 1.88). After additional adjustment for health-related variables including BMI, the association was attenuated but remained statistically significant (pooled HR 1.29, 95% CI 1.09 to 1.53). I(2) index for heterogeneity across centres was 13.3% (p=0.33).
  
  
  CONCLUSIONS
  Low self-rated health was associated with a higher risk of type 2 diabetes. The association could be only partly explained by other health-related variables, of which obesity was the strongest. We found no indication of heterogeneity in the association between self-rated health and type 2 diabetes mellitus across the European centres.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Wennberg
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.forename: Daphne L
authors.initials: DL
authors.lastname: van der A
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Silke
authors.initials: S
authors.lastname: Feller
authors.forename: Manuela M
authors.initials: MM
authors.lastname: Bergmann
authors.forename: Claudia
authors.initials: C
authors.lastname: Langenberg
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Sharp
authors.forename: Nita
authors.initials: N
authors.lastname: Forouhi
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wareham