Self-rated health and adverse health outcomes: An exploration and refinement of the trajectory hypothesis
Self-rated health and adverse health outcomes: An exploration and refinement of the trajectory hypothesis
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DOI：
10.1093/geronb/53b.6.s336
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发表时间：
1998-11-01
影响因子：
6.2
通讯作者：
Tierney, WM
中科院分区：
文献类型：
--
作者：
Wolinsky, FD;Tierney, WM
目标。检验以下假设：较差的自评健康状况与不良健康结果之间的关系仅反映了对健康轨迹下降的自我评估，而不是当前的健康状况。方法。对 786 名 50-99 岁的弱势成年人进行了为期 12 个月的随访。自评健康状况不佳和健康轨迹下降的基线标记被用来预测 12 个月的随访报告，其中包括一年内住院、几年内被安置在疗养院以及十年内死亡的预期。使用分层多变量逻辑回归，首先输入较差的自评健康状况，其次输入标准流行病学协变量，最后输入健康状况下降轨迹。结果。糟糕的健康状况评价与住院预期并不独立相关，但健康轨迹的下降独立地将这种预期的风险增加了 65-88%。较差的自评健康状况和下降的健康轨迹都与被安置在疗养院的期望独立相关，但两者都与死亡的期望独立相关，使这种期望增加了 70-105%。讨论。不良的自我评价健康状况与不良结果之间的关系并不是简单地反映了对即将到来的衰退或厄运的未经衡量的自我评估。相反，自评健康状况不佳和健康轨迹下降的影响似乎是独立且互补的。
Objectives. To examine the hypothesis that the relationship between poor self-rated health and adverse health outcomes simply reflects self-assessments of declining health trajectories rather than current health status.Methods. A 12-month follow-up of 786 disadvantaged adults aged 50-99 years old was conducted. Baseline markers of poor self-rated health and declining health trajectory were used to predict 12-month follow-up reports of the expectations of being hospitalized within one year, being placed in a nursing home within Eve years, and dying within ten years. Hierarchical multivariable logistic regression was used with poor self-rated health entered first, standard epidemiologic covariates entered next, and declining health trajectory entered last.Results. Poor sell-rated health was not independently associated with expectations for being hospitalized, but declining health trajectory independently increased the risk of such expectations by 65-88%. Neither poor self-rated health nor declining health trajectory were independently associated with expectations for being placed in a nursing home, but both were independently associated with expectations for dying, increasing such expectations by 70-105%.Discussion. The relationship between poor self-rated health and adverse outcomes is not a simple reflection of unmeasured self-assessments of impending decline or doom. Rather, the effects of poor self-rated health and declining health trajectory appear to be independent and complementary.