title: Trajectories of self-rated health in the last 15 years of life by cause of death.
abstract: Poor self-rated health is associated with increased risk of mortality, but no previous study has examined how long-term trajectories of self-rated health differ among people at risk of subsequent death compared to those who survive. Data were drawn from French occupational cohort (the GAZEL study, 1989-2010). This nested case-control study included 915 deceased men and women and 2578 controls matched for sex, baseline age, occupational grade and marital status. Self-rated health was measured annually and dichotomized into good versus poor health. Trajectories of poor self-rated health up to 15 years were compared among people who subsequently died to those who survived. Participants contributed to an average 10.3 repeated assessments of self-rated health. Repeated-measures log-binomial regression analysis with generalized estimating equations showed an increased prevalence of poor self-rated health in cases 13-15 years prior to death from ischemic and other cardiovascular disease [multivariable-adjusted risk ratio 2.06, 95 % confidence interval (CI) 1.55-2.75], non-smoking-related cancers (1.57, 95 % CI 1.30-1.89), and suicide (1.78, 95 % CI 1.00-3.16). Prior to death from ischemic and other cardiovascular disease, increased rates of poor self-rated health were evident even among persons who were free of cardiovascular diseases (2.05, 95 % CI 1.50-2.78). In conclusion, perceptions of health diverged between the surviving controls and the deceased already 15 years prior to death. For cardiovascular mortality, decline in self-rated health started before diagnosis of the disease leading to death. The findings suggest that declining self-rated health might capture pathological changes before and beyond the disease diagnosis.
authors.affiliation: Department of Public Health, University of Turku, 20014, Turku, Finland. sari.stenholm@utu.fi.|School of Health Sciences and the Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland. sari.stenholm@utu.fi.
authors.forename: Sari
authors.initials: S
authors.lastname: Stenholm
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.|Finnish Institute of Occupational Health, Helsinki, Finland.|Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: School of Health Sciences and the Gerontology Research Center (GEREC), University of Tampere, Tampere, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Jylhä
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: University of Stockholm, Stockholm, Sweden.
authors.forename: Hugo
authors.initials: H
authors.lastname: Westerlund
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.affiliation: INSERM, UMS 011, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Goldberg
authors.affiliation: INSERM, UMS 011, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Zins
authors.affiliation: Department of Public Health, University of Turku, 20014, Turku, Finland.|Finnish Institute of Occupational Health, Helsinki, Finland.|Turku University Hospital, Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D009369:Neoplasms / Q000401:mortality*; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data
keywords: Cause-specific mortality; Cohort study; Self-rated health; Trajectory