SELF-RATED HEALTH AND ADVERSE HEALTH OUTCOMES - AN EXPLORATION AND REFINEMENT OF THE TRAJECTORY HYPOTHESIS

Objectives. To examine the hypothesis that the relationship between po or self-rated health and adverse health outcomes simply reflects self- assessments of declining health trajectories rather than current healt h status. Methods. A 12-month follow-up of 786 disadvantaged adults ag ed 50-99 years old was conducted. Baseline markers of poor self-rated health and declining health trajectory were used to predict 12-month f ollow-up reports of the expectations of being hospitalized within one year, being placed in a nursing home within Eve years, and dying withi n ten years. Hierarchical multivariable logistic regression was used w ith poor self-rated health entered first, standard epidemiologic covar iates entered next, and declining health trajectory entered last. Resu lts. Poor sell-rated health was not independently associated with expe ctations for being hospitalized, but declining health trajectory indep endently increased the risk of such expectations by 65-88%. Neither po or self-rated health nor declining health trajectory were independentl y associated with expectations for being placed in a nursing home, but both were independently associated with expectations for dying, incre asing such expectations by 70-105%. Discussion. The relationship betwe en poor self-rated health and adverse outcomes is not a simple reflect ion of unmeasured self-assessments of impending decline or doom. Rathe r, the effects of poor self-rated health and declining health trajecto ry appear to be independent and complementary.