title: The joint association of self-rated health and diabetes status on 14-year mortality in elderly men and women.
abstract: Low self-rated health (SRH) has been found to be associated with increased risk of type 2 diabetes (T2D) and with mortality. We examined the possible interaction between SRH and diabetic state on all-cause mortality in a large cohort of elderly subjects, followed for 14 years.
  
  
  
  During the years 2000-2004, survivors of the nationwide longitudinal Israel Study of Glucose Intolerance, Obesity and Hypertension were interviewed and examined for the third follow-up. The 1037 participants (mean age 72.4 ± 7.2 years) were asked to rate their health as: excellent, good, fair, poor, or very poor. Glucose categories were as follows: Normoglycemic, Prediabetes, T2D and Undiagnosed diabetes. Survival time was defined as the time from interview to date of death or date of last vital status follow-up (August 1, 2013). Multivariate Cox proportional hazards models were performed in order to assess whether SRH interacts with glycemic state in the association with mortality.
  
  
  
  A better SRH was reported by those with undiagnosed than known diabetes, and best for normoglycemic and prediabetic individuals. While all individuals with fair or poor/very poor SRH were at increased risk of mortality compared to those with excellent/good SRH, in the known diabetic individuals a greater hazard was observed in the excellent/good SRH (HR 3.32, 95 % CI 1.71-6.47) than in those with fair or poor/very poor SRH (HR 2.19, 95 % CI 1.25-3.86), after adjusting for age, sex, ethnic origin, marital status, education, BMI, physical activity, CVD, tumors, and creatinine level (p for interaction = 0.01).
  
  
  
  Self-rated health is not a sensitive tool for predicting mortality in elderly men and women with known T2D.
authors.affiliation: Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Tel Hashomer, Israel. racheld@gertner.health.gov.il.|Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, 61390, Ramat Aviv, Tel Aviv, Israel. racheld@gertner.health.gov.il.|Patient Oriented Research, The Feinstein Institute for Medical Research, Manhasset, North Shore, NY, 11030, USA. racheld@gertner.health.gov.il.
authors.forename: R
authors.initials: R
authors.lastname: Dankner
authors.affiliation: Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Tel Hashomer, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Olmer
authors.affiliation: Psychosocial Aspects of Health, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Tel Hashomer, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Kaplan
authors.affiliation: Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 52621, Tel Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Chetrit
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011788:Quality of Life; D018434:Sickness Impact Profile; D013997:Time Factors
keywords: Cohort; Diabetes; Elderly; Glycemic state; Joint association; Mortality; Predictor; Self-rated health