title: Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population.
abstract: BACKGROUND
  Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke.
  
  
  METHODS
  MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years.
  
  
  RESULTS
  11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)).
  
  
  CONCLUSIONS
  Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN.
authors.forename: Nahal
authors.initials: N
authors.lastname: Mavaddat
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, United Kingdom, CB2 0SR.
authors.forename: Rianne
authors.initials: R
authors.lastname: van der Linde
authors.affiliation: Health Services Research Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Parker
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom, NR4 7TJ.
authors.forename: George
authors.initials: G
authors.lastname: Savva
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN.
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Kinmonth
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, United Kingdom, CB2 0SR.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
mesh_terms: D000368:Aged; D000375:Aging; D003071:Cognition; D005260:Female; D006304:Health Status; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D057566:Self Report; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis