Self-assessment of Health Status and Mortality in Middle-aged British Men

In a prospective study of 7725 middle-aged British men, 357 of whom died in an average follow-up period of four years, self-assessment of health status was strongly associated with mortality. Men who reported poor health had an eight-fold increase in total mortality compared with those reporting excellent health. Those perceiving fair or poor health were older, more likely to be manual workers and cigarette smokers, more likely to be thin and to be heavy drinkers or to have given up drinking in the past five years. They were also more likely to recall multiple diagnoses and to be on regular medication. Half of those with poor perceived health had chest pain on exertion (angina), one-third had experienced severe chest pain (possible myocardial infarction) half were breathless on exertion and 80% had been off work for more than a month in recent years. At all age levels between 45 and 64 years, and in both manual and non-manual workers, mortality was twice as high in men reporting fair or poor health than in men reporting excellent or good health. In both men with and without recall of at least one major diagnosis, fair or poor perceived health was associated with a two fold increase in age-adjusted mortality rate. In both groups this increased mortality was to a large extent accounted for by the increase in the prevalence of adverse characteristics such as regular medication, chest pain, breathlessness and current smoking. Self-assessment of health status appears to be a good measure of current physical health and risk of death. It could be useful in both clinical and epidemiological situations.