Self rated health and mortality: a long term prospective study in eastern Finland

Study objective-To assess the relation between self rated health and mortal ity over a period of 23 years, taking into account medical history, cardiov ascular risk factors, and education at the beginning of the follow up. Design-A cohort of random population samples. The baseline studies included a self administered questionnaire and a health examination. Mortality data were collected from the national mortality register using personal identif ication numbers. Setting-The provinces of North Karelia and Kuopio in eastern Finland. Participants-Random samples of working age people (n = 21 302) from the pop ulation register. Main results-For self rated health, the age adjusted poor to good relative risk for all cause mortality was 2.36 (95% confidence intervals 2.10, 2.64) for men and 1.90 (1.63, 2.22) for women, and for cardiovascular mortality 2.29 (1.96, 2.68) for men and 2.34 (1.84, 2.96) for women. Adjusted for sel ected potentially fatal diseases from the subjects' medical histories, card iovascular disease risk factors, and education, the corresponding relative risks for all cause mortality were 1.66 (1.47, 1.88) for men and 1.50 (1.26 , 1.78) for women, and for cardiovascular mortality 1.54 (1.29, 1.82) for m en and 1.63 (1.26, 2.10) for women. The association between self rated heal th and mortality attributable to external causes was fairly strong. Conclusions-Poor self rated health is a strong predictor of mortality, and the association is only partly explained by medical history, cardiovascular disease risk factors, and education.