Self-rated health and probability of death among middle-aged Kaunas population (20-year follow-up)]

The aim of this study was to examine the self-rated health differences in relation with risk factors among middle-aged men and women and to assess the probability of death from all causes, from cardiovascular diseases and from ischemic heart disease in the self-rated health groups during the 20-year follow-up. In the framework of the World Health Organization MONICA-1 survey (1983-1984) random samples of Kaunas men and women aged 35-64 and stratified by age and gender (response rate 70.2%) were examined using standard epidemiological methods. Self-rated health was divided into five levels based on information from questionnaire: excellent, very good, good, fair, or ill. The participants of the survey were followed-up in terms of the end points reached, from the beginning of each study until December 31, 2001. The study population was followed-up through the death register: among women there were 197 deaths (94 deaths from cardiovascular diseases and 44 deaths from ischemic heart disease) and among men there were 303 deaths (154 deaths from cardiovascular diseases and 98 from ischemic heart disease). Among dead men and women the prevalence of fair and ill self-rated health was higher as compared to alive ones (respectively, 71.0% and 54.9%, p<0.001; 84.3% and 76.7%, p<0.05). Among dead women with hypercholesterolemia (> or =5.0 mmol/l), overweight (body mass index > or =25.0 kg/m2), nonsmoking and sufficient physical activity the prevalence of "fair and ill" self-rated health was higher as compared to alive; the prevalence of "fair and ill" self-rated health in men with hypercholesterolemia (> or =5.0 mmol/l) and sufficient physical activity was higher among dead as compared to alive. During the 20 year follow-up the probability of death from all causes, cardiovascular and ischemic heart disease among men with self-rated health as "ill and fair" as compared to "excellent and very good", showed statistically significant difference (log rank=18.5, p<0.001, log rank=10.8 p<0.01, log rank=8.9, p<0.01, respectively); among women there were no significant differences. The results of this study suggest that special attention and care should be directed to persons with reporting self-rated health as "fair and ill".