老年学と老年医学の研究

概要

Self-rated Health and Medical Outcomes in the Women ’ s Health Initiative: The Aging Continuum, Health, Morbidity, Mortality

Robert Brunner, Marcia L. Stefanick, Aaron K. Aragaki, Shirley A.A. Beresford, F. Allan Hubbell, Andrea LaCroix, Dorothy S. Lane, Stephen R. Rapp, Monika M. Safford, Nazmus Saquib, Nelson B. Watts and Nancy Fugate Woods

Background: Self-rated health (SRH) predicts all-cause mortality in many studies; whereas, SRH has been inconsistently related to disease specific death, at least in part because often carefully documented cause of death is lacking. Methods: Physician-adjudicated cardiovascular disease (CVD), cancer, and other outcomes were evaluated in the Women’s Health Initiative (WHI) multi-ethnic Observational Study (OS) cohort of 93,6756 postmenopausal women, aged 50 to79 years. SRH was assessed by the RAND36 at baseline and three years later. Results: After adjusting for confounders, compared with women reporting excellent health, the risk of all-cause death among women reporting fair/poor health was significantly higher (HR=1.91, CI 1.68, 2.16) during a 7.6 year (1.6) follow-up, as were risks of death from CVD (HR=2.12, CI 1.65, 2.71) and from cancer (HR=1.40, CI, 1.15, 1.69) but not accidental death (HR=1.39, CI 0.69, 2.76). Compared with women whose scores did not change over the initial three years of follow-up, SRH that worsened significantly was associated with higher risk of all-cause (HR=2.06), CVD (HR=1.71) and cancer (HR=2.22) mortality; whereas, women with improved SRH had significantly lower all-cause, CVD and cancer mortality risks (HR: 0.78, 0.80, and 0.79, respectively). Conclusions: Low SRH and a decrease in SRH over three years were strongly associated with increased risks of all-cause, CVD, cancer and other cause mortality after more than 7 years of follow-up in post-menopausal women. Lower SRH was also associated with incident CVD and cancer