Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: a systematic review and meta-analysis

Nahal Mavaddat; Richard A Parker; Simon Sanderson; Jonathan Mant; Ann Louise Kinmonth

doi:10.1371/journal.pone.0103509

Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: a systematic review and meta-analysis

PLoS One. 2014 Jul 30;9(7):e103509. doi: 10.1371/journal.pone.0103509. eCollection 2014.

Authors

Nahal Mavaddat¹, Richard A Parker², Simon Sanderson², Jonathan Mant¹, Ann Louise Kinmonth²

Affiliations

¹ Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, Cambridge, United Kingdom.
² Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.

Abstract

Background: People who rate their health as poor experience higher all-cause mortality. Study of disease-specific association with self-rated health might increase understanding of why this association exists.

Objectives: To estimate the strength of association between self-rated health and fatal and non-fatal cardiovascular disease.

Methods: A comprehensive search of PubMed MEDLINE, EMBASE, CINAHL, BIOSIS, PsycINFO, DARE, Cochrane Library, and Web of Science was undertaken during June 2013. Two reviewers independently searched databases and selected studies. Inclusion criteria were prospective cohort studies or cohort analyses of randomised trials with baseline measurement of self-rated health with fatal or non-fatal cardiovascular outcomes. 20 studies were pooled quantitatively in different meta-analyses. Study quality was assessed using Newcastle-Ottawa scales.

Results: 'Poor' relative to 'excellent' self-rated health (defined by most extreme categories in each study, most often' poor' or 'very poor' and 'excellent' or 'good') was associated over a follow-up of 2.3-23 years with cardiovascular mortality in studies: where varying degrees of adjustments had been made for cardiovascular disease risk (HR 1.79 (95% CI 1.50 to 2.14); 15 studies, I2 = 71.24%), and in studies reporting outcomes in people with pre-existing cardiovascular disease or ischaemic heart disease symptoms (HR 2.42 (95% CI 1.32 to 4.44); 3 studies; I2 = 71.83%). 'Poor' relative to 'excellent' self rated health was also associated with the combined outcome of fatal and non-fatal cardiovascular events (HR 1.90 (95% CI 1.26 to 2.87); 5 studies; I2 = 68.61%), Self-rated health was not significantly associated with non-fatal cardiovascular disease outcomes (HR 1.66 (95% CI 0.96 to 2.87); 5 studies; I2 = 83.60%).

Conclusions: Poor self rated health is associated with cardiovascular mortality in populations with and without prior cardiovascular disease. Those with current poor self-rated health may warrant additional input from health services to identify and address reasons for their low subjective health.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Cardiovascular Diseases / complications
Cardiovascular Diseases / mortality*
Cardiovascular Diseases / pathology
Databases, Factual
Depression / complications
Depression / diagnosis
Health Status
Humans
Proportional Hazards Models
Risk Factors
Severity of Illness Index
Social Class

Grants and funding

This report presents independent commissioned research by the National Institute for Health Research (NIHR) through the National School for Primary Care Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. NM was funded through an NIHR Walport Clinical Lectureship.