Self-rated health status and illiteracy as death predictors in a Brazilian cohort

Abstract

Cohort studies assessing predictive values of self-rated health (SRH) and illiteracy on mortality in low-to-middle income countries are missing in the literature. Aiming to determine if these two variables were death predictors, an observational prospective population-based cohort study was conducted in a Brazilian small city. The cohort was established in 2002 with a representative sample of adults living in the city, and re-assessed in 2015. Sociodemographic (including illiteracy), anthropometric, lifestyle, previous CVD, and SRH data were collected. Cox proportional hazard models were designed to assess SRH and illiteracy in 2002 as death (all causes, CVD and non-CVD) predictors in 2015. From a total of 1066 individuals included in this study, 95(9%) died of non-CVD causes and 53(5%) from CVD causes. Mortality rates were higher among those with worse SRH in comparison to better health status categories for all causes of death, CVD and non-CVD deaths (p<0.001 for all outcomes). Similarly, illiterate individuals had higher mortality rates in comparison to non-illiterate for all causes of death (p<0.001), CVD (p = 0.004) and non-CVD death (p<0.001). Higher SRH negatively predicted CVD death (HR 0.44; 95%CI 0.44–0.95; p = 0.027) and all causes of death (OR 0.40; 95%CI 0.20–0.78; p = 0.008) while illiteracy positively predicted Non-CVD death (OR 1.59; 95%CI 1.03–2.54; p = 0.046). In conclusion, we found in this large Brazilian cohort followed for 13 years that better health perception was a negative predictor of death from all causes and CVD deaths, while illiteracy was a positive predictor of non-CVD deaths.

Fatores associados à autopercepção de saúde entre idosos de grupos comunitários

“…Finalmente, é importante descatar que, apesar da pergunta utilizada para medir a autopercepção de saúde não ser validada para a população brasileira, tampouco para a população idosa, ela tem atraído a atenção de pesquisadores no Brasil e no mundo, uma vez que apresenta uma evidência acumulada de sua associação com mortalidade, é simples de ser apliacada e de baixo custo, além de ser facilmente compreendida pelos participantes (8)(9)(10) . Essas características do instrumento são especialmente importantes no contexto brasileiro, onde 42,3% da população tem menos de oito anos de estudo (3) , havendo um percentual ainda maior entre as pessoas idosas.…”

“…Nesse sentido, a autopercepção é definida como conjunto de atributos ou características pelos quais o indivíduo descreve a si mesmo, sendo a mesma construída a partir de experiências e interpretações próprias (7) . Quando empregada na descrição do estado geral de saúde, a autopercepção ou autoavaliação é um indicador válido de qualidade de vida, morbidade e funcionalidade, e um bom preditor de mortalidade (8) , de forma que seu uso tem se ampliado, nas últimas décadas, como importante marcador de saúde nessa faixa etária (4,9,10) , por ser simples, de baixo custo e com elevado potencial de aplicabilidade na triagem de risco para controle e redução da vulnerabilidade da pessoa idosa (11) .…”

Personal Perception of Health in Urban Women of Low Socioeconomic Status: A Qualitative Study

“…[2][3][4][5][6][7] Self-perception of health is an important factor associated with patient outcomes, including quality of life, mental health, and physical health. [8][9][10][11] Chronic conditions including cancer, diabetes, and heart disease contribute to a lower self-perception of health compared to those without chronic conditions. 8,9,12 Economic status is associated with perception of health, with a greater income linked to a higher self-perception of health.…”

“…13 Many studies have explored self-perception of health, associated health outcomes, and health promoting behaviors in different populations. [8][9][10][11][12][13] However, there is a gap in the literature regarding this experience specifically in women of low SES. It is important to explore this experience in order to improve health outcomes and reduce disparities in this population.…”

Cohort Studies with Mortality Data from the Brazilian Population: a Rising National Requirement

“…Nevertheless, traditionally epidemiological studies assessing the impact of different risk factors on mortality have historically been conducted in high-income countries. 1 …”