Self-rated health, chronic diseases, and symptoms among middle-aged and elderly men and women

Abstract

The objective was to study the association between chronic diseases, symptoms, and poor self-rated health among men and women and in different age groups, and to assess the contribution of chronic diseases and symptoms to the burden of poor self-rated health in the general population. Self-rated health and self-reported diseases and symptoms were investigated in a population sample of 6,061 men and women aged 35–79 years in Värmland County in Sweden. Odds ratios (OR) and population attributable risks (PAR) were calculated to quantify the contribution of chronic diseases and symptoms to poor self-rated health. Depression, neurological disease, rheumatoid arthritis, and tiredness/weakness had the largest contributions to poor self-rated health in individuals. Among the elderly (65–79 years), neurological disease and cancer had the largest contribution to self-rated health in men, and renal disease, rheumatoid arthritis, and cancer in women. Among the middle-aged (35–64 years), depression and tiredness/weakness were also important, especially in women. From a population perspective, tiredness/weakness explained the largest part of poor self-rated health due to its high prevalence in the population. Depression and musculoskeletal pains were also more important than other chronic diseases and symptoms at the population level. Even though many chronic diseases (such as neurological disease, rheumatoid arthritis, and cancer) are strongly associated with poor self-rated health in the individual, common symptoms (such as tiredness/weakness and musculoskeletal pains) as well as depression contribute more to the total burden of poor self-rated health in the population. More preventive measures should therefore be directed against these conditions, especially when they are not consequences of other diseases.

Introduction

Self-rated health has been found to be a strong predictor of morbidity and mortality 1, 2, 3, 4, 5. A large part of this effect is mediated through disease and disability, but self-reported health remains a significant predictor of mortality even after controlling for present disease or dysfunction 4, 5, 6. Furthermore, self-rated health is an indicator of well-being, quality of life 7, 8, and a significant predictor of utilization of health care services 9, 10.

It has been found that different people have different interpretations of self-rated health. Some people think about specific health problems when asked to rate their health, whereas others think in terms of either general physical functioning or health behaviors [11]. The interpretations of self-rated health also vary by age and gender 11, 12, 13.

Many physiological and psychosocial determinants of self-rated health have been described in the literature, but the main determinant of self-rated health is physical health 4, 14, 15, 16. Several studies have considered the effect of chronic diseases and symptoms on self-rated health, but the results vary depending on what conditions have been taken into consideration and on the composition of the study population 8, 17, 18, 19, 20. In addition, most of the studies have only looked at the association at the individual level. From a public health perspective it is, however, also important to get insight into the impact of chronic diseases and symptoms on self-rated health at the population level. While results at the patient level express which diseases and symptoms are most important for individual patients, results at the population level express which part of the total burden of poor self-rated health could be prevented if certain diseases and symptoms could be eliminated. This can be done by calculating population-attributable risks which are based both on the strength of association between a specific condition and poor self-rated health, and the prevalence of the condition in the general population.

We wanted to study the association between chronic diseases, symptoms, and poor self-rated health, and to identify the conditions with the largest contributions to ill health in the general adult population using a wide range of diseases and symptoms. This was done both at individual and population levels. We also investigated whether the associations between chronic diseases/symptoms and self-rated health vary by gender and age group.