title: Self-rated health and cardiovascular disease incidence: results from a longitudinal population-based cohort in Norfolk, UK.
abstract: BACKGROUND
  Self-rated health (SRH) predicts chronic disease morbidity including cardiovascular disease (CVD). In a population-based cohort, we examined the association between SRH and incident CVD and whether this association was independent of socio-demographic, clinical and behavioural participant characteristics.
  
  
  METHODS
  Population-based prospective cohort study (European Prospective Investigation of Cancer-Norfolk). 20,941 men and women aged 39-74 years without prevalent CVD attended a baseline health examination (1993-1998) and were followed for CVD events/death until March 2007 (mean 11 years). We used a Cox proportional hazards model to quantify the association between baseline SRH (reported on a four point scale--excellent, good, fair, poor) and risk of developing CVD at follow-up after adjusting for socio-demographic, clinical and behavioural risk factors.
  
  
  RESULTS
  Baseline SRH was reported as excellent by 17.8% participants, good by 65.1%, fair by 16.0% and poor by 1.2%. During 225,508 person-years of follow-up, there were 55 (21.2%) CVD events in the poor SRH group and 259 (7.0%) in the excellent SRH group (HR 3.7, 95% CI 2.8-4.9). The HR remained significant after adjustment for behavioural risk factors (HR 2.6, 95% CI 1.9-3.5) and after adjustment for all socio-demographic, clinical and behavioural risk factors (HR 3.3, 95% CI 2.4-4.4). Associations were strong for both fatal and non-fatal events and remained strong over time.
  
  
  CONCLUSIONS
  SRH is a strong predictor of incident fatal and non-fatal CVD events in this healthy, middle-aged population. Some of the association is explained by lifestyle behaviours, but SRH remains a strong predictor after adjustment for socio-demographic, clinical and behavioural risk factors and after a decade of follow-up. This easily accessible patient-centred measure of health status may be a useful indicator of individual and population health for those working in primary care and public health.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, United Kingdom. rmv23@medschl.cam.ac.uk
authors.forename: Rianne M
authors.initials: RM
authors.lastname: van der Linde
authors.forename: Nahal
authors.initials: N
authors.lastname: Mavaddat
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Simmons
authors.forename: Kay Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Kinmonth
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D059026:Diagnostic Self Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology