Mortality prediction with a single general self-rated health question. A meta-analysis.
TL;DR: In this article, the authors conducted a systematic review of the association between a single item assessing general self-rated health (GSRH) and mortality and found that persons with poor self-reported health had a 2-fold higher mortality risk compared with persons with "excellent" health status, even after adjustment for key covariates such as functional status, depression, and co-morbidity.
Abstract: OBJECTIVE: Health planners and policy makers are increasingly asking for a feasible method to identify vulnerable persons with the greatest health needs. We conducted a systematic review of the association between a single item assessing general self-rated health (GSRH) and mortality. DATA SOURCES: Systematic MEDLINE and EMBASE database searches for studies published from January 1966 to September 2003. REVIEW METHODS: Two investigators independently searched English language prospective, community-based cohort studies that reported (1) all-cause mortality, (2) a question assessing GSRH; and (3) an adjusted relative risk or equivalent. The investigators searched the citations to determine inclusion eligibility and abstracted data by following a standarized protocol. Of the 163 relevant studies identified, 22 cohorts met the inclusion criteria. Using a random effects model, compared with persons reporting “excellent” health status, the relative risk (95% confidence interval) for all-cause mortality was 1.23 [1.09, 1.39], 1.44 [1.21, 1.71], and 1.92 [1.64, 2.25] for those reporting “good,” “fair,” and “poor” health status, respectively. This relationship was robust in sensitivity analyses, limited to studies that adjusted for comorbid illness, functional status, cognitive status, and depression, and across subgroups defined by gender and country of origin. CONCLUSIONS: Persons with “poor” self-rated health had a 2-fold higher mortality risk compared with persons with “excellent” self-rated health. Subjects’ responses to a simple, single-item GSRH question maintained a strong association with mortality even after adjustment for key covariates such as functional status, depression, and co-morbidity.
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TL;DR: A model describing the health assessment process is proposed to show how self-rated health can reflect the states of the human body and mind and the focus is on the social and biological pathways that mediate information from the human organism to individual consciousness.
1,938 citations
Journal Article•
TL;DR: The National Academy of Sciences founded The National Academies Press (NAP) with the goal of publishing reports of all four national academies as mentioned in this paper, which publishes more than 200 books from the fields of science, engineering and medicine and offers more than 4000 titles in PDF on its website.
Abstract: The National Academy of Sciences founded The National Academies Press (NAP) with the goal of publishing reports of all four national academies. Annually, NAP publishes more than 200 books from the fields of science, engineering and medicine and offers more than 4000 titles in PDF on its website (http://www.nap.edu/) free of charge.
1,241 citations
TL;DR: In the second year of expansion, Kentucky's Medicaid program and Arkansas's private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health.
Abstract: Importance Under the Affordable Care Act (ACA), more than 30 states have expanded Medicaid, with some states choosing to expand private insurance instead (the “private option”). In addition, while coverage gains from the ACA’s Medicaid expansion are well documented, impacts on utilization and health are unclear. Objective To assess changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA. Design, Setting, and Participants Differences-in-differences analysis of survey data from November 2013 through December 2015 of US citizens ages 19 to 64 years with incomes below 138% of the federal poverty level in Kentucky, Arkansas, and Texas (n = 8676). Data analysis was conducted between January and May 2016. Exposures Medicaid expansion in Kentucky and use of Medicaid funds to purchase private insurance for low-income adults in Arkansas (private option), compared with no expansion in Texas. Main Outcomes and Measures Self-reported access to primary care, specialty care, and medications; affordability of care; outpatient, inpatient, and emergency utilization; receiving glucose and cholesterol testing, annual check-up, and care for chronic conditions; quality of care, depression score, and overall health. Results Among the 3 states included in the study, Arkansas (n=2890), Kentucky (n=2898, and Texas (n=2888), there were no differences in sex, income, or marital status. Respondents from Texas were younger, more urban, and disproportionately Latino compared with those in Arkansas and Kentucky. Significant changes in coverage and access were more apparent in 2015 than in 2014. By 2015, expansion was associated with a 22.7 percentage-point reduction in the uninsured rate compared with nonexpansion ( P P P P = .02), reduced likelihood of emergency department visits (−6.0 percentage points, P = .04), and increased outpatient visits (0.69 visits per year; P = .04). Screening for diabetes (6.3 percentage points; P = .05), glucose testing among patients with diabetes (10.7 percentage points; P = .03), and regular care for chronic conditions (12.0 percentage points; P = .008) all increased significantly after expansion. Quality of care ratings improved significantly (−7.1 percentage points with “fair/poor quality of care”; P = .03), as did the share of adults reporting excellent health (4.8 percentage points; P = .04). Comparisons of Arkansas vs Kentucky showed increased private coverage in the former (21.7 percentage points; P P P = .04), but no other statistically significant differences. Conclusions and Relevance In the second year of expansion, Kentucky’s Medicaid program and Arkansas’s private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health. Aside from the type of coverage obtained, outcomes were similar for nearly all other outcomes between the 2 states using alternative approaches to expansion.
426 citations
TL;DR: Evidence of reliability; convergent, discriminant, and content validity assessments; and test-retest reliabilities at 1- and 3-month time lags for single-item measures using a multistage and multisource validation strategy are examined.
Abstract: The validity of organizational research relies on strong research methods, which include effective measurement of psychological constructs. The general consensus is that multiple item measures have better psychometric properties than single-item measures. However, due to practical constraints (e.g., survey length, respondent burden) there are situations in which certain single items may be useful for capturing information about constructs that might otherwise go unmeasured. We evaluated 37 items, including 18 newly developed items as well as 19 single items selected from existing multiple-item scales based on psychometric characteristics, to assess 18 constructs frequently measured in organizational and occupational health psychology research. We examined evidence of reliability; convergent, discriminant, and content validity assessments; and test-retest reliabilities at 1- and 3-month time lags for single-item measures using a multistage and multisource validation strategy across 3 studies, including data from N = 17 occupational health subject matter experts and N = 1,634 survey respondents across 2 samples. Items selected from existing scales generally demonstrated better internal consistency reliability and convergent validity, whereas these particular new items generally had higher levels of content validity. We offer recommendations regarding when use of single items may be more or less appropriate, as well as 11 items that seem acceptable, 14 items with mixed results that might be used with caution due to mixed results, and 12 items we do not recommend using as single-item measures. Although multiple-item measures are preferable from a psychometric standpoint, in some circumstances single-item measures can provide useful information.
426 citations
TL;DR: Multimorbidity was associated with an increase in risk of death and adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidities and mortality.
404 citations
References
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TL;DR: Funnel plots, plots of the trials' effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials.
Abstract: Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews . Main outcome measure: Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. Results: In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. Conclusions: A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution. Key messages Systematic reviews of randomised trials are the best strategy for appraising evidence; however, the findings of some meta-analyses were later contradicted by large trials Funnel plots, plots of the trials9 effect estimates against sample size, are skewed and asymmetrical in the presence of publication bias and other biases Funnel plot asymmetry, measured by regression analysis, predicts discordance of results when meta-analyses are compared with single large trials Funnel plot asymmetry was found in 38% of meta-analyses published in leading general medicine journals and in 13% of reviews from the Cochrane Database of Systematic Reviews Critical examination of systematic reviews for publication and related biases should be considered a routine procedure
37,989 citations
"Mortality prediction with a single ..." refers methods in this paper
...The potential for publication bias was first examined by constructing a funnel plot of the inverse of the standard error versus the effect size on a logarithmic scale, and statistically assessing asymmetry.(23) To assess the robustness of the relationship between GSRH and mortality, we performed subgroup and sensitivity analyses on studies reporting GSRH responses in multiple categories....
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TL;DR: This paper examines eight published reviews each reporting results from several related trials in order to evaluate the efficacy of a certain treatment for a specified medical condition and suggests a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
33,234 citations
"Mortality prediction with a single ..." refers result in this paper
...We tested for heterogeneity using fixed effects and the DerSimonian and Laird random-effects model to calculate the pooled relative risk by level of GSRH response.(21) Both models yielded similar findings, and so we present only the results from the random-effects model....
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TL;DR: This work examines the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples and suggests several approaches to the next stage of research in this field.
Abstract: We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.
7,940 citations
TL;DR: Empirical support is provided for the long held, but inadequately substantiated, belief that the way a person views his health is importantly related to subsequent health outcomes.
Abstract: Data from the Manitoba Longitudinal Study on Aging (MLSA) were used to test the hypothesis that self-rated health (SRH) is a predictor of mortality independent of "objective health status" (OHS). Subjects were a random sample of non-institutionalized residents of Manitoba aged 65+ in 1971 (n = 3,128). A single item measure of SRH was obtained during a survey conducted in 1971; a baseline measure of OHS was derived from physician and self-reported conditions and health service utilization data. Occurrence and date of death during the years 1971-1977 were known. Analyses of the data revealed that, controlling for OHS, age, sex, life satisfaction, income and urban/rural residence, the risk of early mortality (1971-1973) and late mortality (1974-1977) for persons whose SRH was poor was 2.92 and 2.77 times that of those whose SRH was excellent. This increased risk of death associated with poor self-rated health was greater than that associated with poor OHS, poor life satisfaction, low income and being male. These findings provide empirical support for the long held, but inadequately substantiated, belief that the way a person views his health is importantly related to subsequent health outcomes.
2,094 citations
TL;DR: The authors propose two methods that account for the correlations but require only the summary estimates and marginal data from the studies, which provide more efficient estimates of regression slope, more accurate variance estimates, and more valid heterogeneity tests than those previously available.
Abstract: Meta-analysis often requires pooling of correlated estimates to compute regression slopes (trends) across different exposure or treatment levels The authors propose two methods that account for the correlations but require only the summary estimates and marginal data from the studies These methods provide more efficient estimates of regression slope, more accurate variance estimates, and more valid heterogeneity tests than those previously available One method also allows estimation of nonlinear trend components, such as quadratic effects The authors illustrate these methods in a meta-analysis of alcohol use and breast cancer
2,052 citations
"Mortality prediction with a single ..." refers methods in this paper
...We performed a weighted meta-regression analysis with no intercept term to examine trends between progressively worse self-rated health and increasing risk of death using the ‘‘pool-first’’ method proposed by Greenland and Longnecker.22 The potential for publication bias was first examined by constructing a funnel plot of the inverse of the standard error versus the effect size on a logarithmic scale, and statistically assessing asymmetry.23 To assess the robustness of the relationship between GSRH and mortality, we performed subgroup and sensitivity analyses on studies reporting GSRH responses in multiple categories....
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...We performed a weighted meta-regression analysis with no intercept term to examine trends between progressively worse self-rated health and increasing risk of death using the ‘‘pool-first’’ method proposed by Greenland and Longnecker.(22) The potential for publication bias was first examined by constructing a funnel plot of the inverse of the standard error versus the effect size on a logarithmic scale, and statistically assessing asymmetry....
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