Diagnostic labelling influences self-rated health. A prospective cohort study: the HUNT Study, Norway

Abstract

Background.Studies have shown an independent association between poor self-rated health (SRH) and increased mortality. Few studies, however, have investigated any possible impact on SRH of diagnostic labelling.Objective.To test whether SRH differed in persons with known and unknown hypothyroidism, diabetes mellitus (DM) or hypertension, opposed to persons without these conditions, after 11-year follow-up.Methods.Prospective population-based cohort study in North-Trøndelag County, Norway, HUNT2 (1995–97) to HUNT3 (2006–08). All inhabitants aged 20 years and older were invited. The response rate was 69.5% in HUNT2 and 54.1% in HUNT3. In total, 34144 persons aged 20–70 years were included in the study population. The outcome was poor SRH.Results.Persons with known disease had an increased odds ratio (OR) to report poor SRH at follow-up; figures ranging from 1.11 (0.68–1.79) to 2.52 (1.46–4.34) (men with hypothyroidism kept out owing to too few numbers). However, in persons not reporting, but having laboratory results indicating these diseases (unknown disease), no corresponding associations with SRH were found. Contrary, the OR for poor SRH in women with unknown hypothyroidism and unknown hypertension was 0.64 (0.38–1.06) and 0.89 (0.79–1.01), respectively.Conclusions.Awareness opposed to ignorance of hypothyroidism, DM and hypertension seemed to be associated with poor perceived health, suggesting that diagnostic labelling could have a negative effect on SRH. This relationship needs to be tested more thoroughly in future research but should be kept in mind regarding the benefits of early diagnosing of diseases.

Diabetes prevalence among older people receiving care at home: associations with symptoms, health status and psychological well‐being

“…In contrast to the findings of Jørgensen et al [29], those with undiagnosed diabetes reported significantly poorer health status than those with known diabetes. The former group also reported poorer overall health and psychological well-being compared with the other diabetes categories; however, this difference was not statistically significant.…”

Precision medicine in the clouds

“…To underscore, these people considered themselves well at baseline, but upon entering the study, they were all regarded as in suboptimal health. This entails a change in identity, and may result in pathologization and worry 20,21 .…”

Personalized medicine: evidence of normativity in its quantitative definition of health

“…It may also stifle important debates about what physicians and scientists are actually doing when, for example, they label someone as ‘at risk’ or as afflicted by ‘bipolar’, ‘PTSD’ or ‘chronic Lyme’. Moreover, by selecting a reference of health and making any deviation of functioning from that reference the responsibility of the individual or a public health system, one effectively labels an unknown segment of the population as deviants with respect to optimal health, thereby potentially also inflicting iatrogenic harm such as anxiety or altered self-image [ 47 ]. It is far from obvious that this important definitional work can be left to scientists at the ISB or other abstract agents ‘skilled in the art’.…”