Do self-assessments of health predict future mortality in rural South Africa? The case of KwaZulu-Natal in the era of antiretroviral treatment.
Do self-assessments of health predict future mortality in rural South Africa? The case of KwaZulu-Natal in the era of antiretroviral treatment.
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健康自我评估能否预测南非农村地区未来的死亡率？
DOI：
10.1111/j.1365-3156.2012.03012.x
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Newell,Marie-Louise
中科院分区：
文献类型：
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作者：
Olgiati,Analia;Bärnighausen,Till;Newell,Marie-Louise
虽然健康自我评估（SAH）广泛应用于流行病学研究，但大多数关于SAH预测未来死亡率的证据来自发达国家。由于艾滋病毒大流行主要影响壮年人群，因此先前工作中得出的SAH与死亡率之间的强相关性可能与抗逆转录病毒治疗时代艾滋病毒流行率高的国家中的年轻高危人群无关。我们使用来自三个来源的相关数据，研究了SAH在HIV高流行率和抗逆转录病毒治疗（ART）覆盖率社区中预测死亡率的能力：纵向人口监测，非洲最大的，纵向的，基于人口的艾滋病毒监测之一，方法我们使用考克斯比例风险规范来检验SAH是否显著预测死亡风险样本由9217名15-54岁成年人组成，对他们的死亡率进行了8年的随访 。结果健康自我评估强烈预测死亡率（随访4年内 ），调整后的风险比（aHR）相对于“优秀”自我评估健康状况的基线，并控制年龄、性别、婚姻状况、社会经济状况（SES）、变量教育、就业、家庭支出和家庭资产，HIV状态和ART摄取：“非常好”的自我评估健康状况（SAHS）为1.40（95% CI 0.99-1.96）;“良好”的SAHS为2.10（95% CI 1.52-2.90）;“一般”的SAHS为3.12（95% CI 2.18-4.45）;“差”的SAHS为4.64（95% CI 2.93-7.35）。虽然在长期死亡率（随访4-8年内）的未调整分析中仍然存在类似的相关性，但一旦控制了HIV状态，ART摄取和性别，年龄，婚姻状况和SES，SAH的风险比在预测死亡率方面并不显著。HIV感染状况和ART项目参与是长期mortality.ConclusionsOur的研究结果验证SAH作为一个变量，显着预测短期死亡率在撒哈拉以南非洲地区的社区高艾滋病毒感染率，发病率和死亡率的大和高度显着的预测。然而，在预测长期死亡率时，了解一个人的艾滋病毒状况和ART计划参与比SAH更重要。
ObjectivesWhile self‐assessments of health (SAH) are widely employed in epidemiological studies, most of the evidence on the power of SAH to predict future mortality originates in the developed world. With the HIV pandemic affecting largely prime age individuals, the strong association between SAH and mortality derived from previous work might not be relevant for the younger at‐risk groups in countries with high HIV prevalence in the era of antiretroviral treatment. We investigate the power of SAH to predict mortality in a community with high HIV prevalence and antiretroviral treatment (ART) coverage using linked data from three sources: a longitudinal demographic surveillance, one of Africa’s largest, longitudinal, population‐based HIV surveillances, and a decentralised rural HIV treatment and care programme.MethodsWe used a Cox proportional hazards specification to examine whether SAH significantly predicts mortality hazard in a sample composed of 9217 adults aged 15–54, who were followed up for mortality for 8 years.ResultsSelf‐assessments of health strongly predicted mortality (within 4 years of follow‐up), with a clear gradient of the adjusted hazard ratios (aHRs), relative to the baseline of ‘excellent’ self‐assessed health status and controlling for age, gender, marital status, the socio‐economic status (SES), variables education, employment, household expenditures and household assets, and HIV status and ART uptake: 1.40 (95% CI 0.99–1.96) for ‘very good’ self‐assessed health status (SAHS); 2.10 (95% CI 1.52–2.90) for ‘good’ SAHS; 3.12 (95% CI 2.18–4.45) for ‘fair’ SAHS; and 4.64 (95% CI 2.93–7.35) for ‘poor’ SAHS. While a similar association remained in the unadjusted analysis of long‐term mortality (within 4–8 years of follow‐up) the hazard ratios capturing SAH are jointly insignificant in predicting of mortality once HIV status, ART uptake and gender, age, marital status and SES were controlled for. HIV status and ART programme participation were large and highly significant predictors of long‐term mortality.ConclusionsOur findings validate SAH as a variable that significantly predicts short‐term mortality in a community in sub‐Saharan Africa with high HIV prevalence, morbidity and mortality. When predicting long‐term mortality, however, it is much more important to know a person's HIV status and ART programme participation than SAH.