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The Relationship Between Self-Rated Health and Mortality in Older Black and White Americans

Authors

  • Sei J. Lee MD, MAS,

    1. From the *Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of GeriatricsDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
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  • Sandra Y. Moody-Ayers MD,

    1. From the *Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of GeriatricsDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
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  • C. Seth Landefeld MD,

    1. From the *Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of GeriatricsDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
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  • Louise C. Walter MD,

    1. From the *Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of GeriatricsDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
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  • Karla Lindquist MS,

    1. From the *Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of GeriatricsDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
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  • Mark R. Segal PhD,

    1. From the *Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of GeriatricsDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
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  • Kenneth E. Covinsky MD, MPH

    1. From the *Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, California; and Division of GeriatricsDepartment of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
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  • This work was presented at the Society of General Internal Medicine (SGIM) California Regional Meeting in March 2005, SGIM National Meeting in April 2005 and the American Geriatrics Society National Meeting in May 2005.

Address correspondence to Sei J. Lee, MD, MAS, San Francisco VA Medical Ctr, Division of Geriatrics, Bldg 1, Rm 306, Box 181G, 4150 Clement Street, San Francisco, CA 94121. E-mail: seijlee@gmail.com

Abstract

OBJECTIVES: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship.

DESIGN: Prospective cohort.

SETTING: Communities in the United States.

PARTICIPANTS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older.

MEASUREMENTS: Subjects were asked to self-identify their race and their overall health by answering the question, “Would you say your health is excellent, very good, good, fair, or poor?” Death was determined according to the National Death Index.

RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0–13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5–5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH.

CONCLUSION: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.

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