Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study

Abstract

Background and purposeSelf-rated health (SRH) is a consistent and strong predictor of all-cause and cardiovascular mortality in various populations. However, the associations between SRH measures and risk of first-ever or recurrent stroke were rarely explored. We thus aim to prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in Chinese population. MethodsA total of 494,113 participants from the China Kadoorie Biobank without prior heart diseases or cancer (486,541 without stroke and 7,572 with stroke) were followed from baseline (2004 to 2008) until December 31, 2013. General and age-comparative SRH were obtained from baseline questionnaires. First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data. ResultsWe identified 27,662 first-ever stroke and 2,909 recurrent events during an average of 7.0 years of follow-up. Compared with excellent general SRH, the hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever stroke associated with good, fair, and poor general SRH were 1.04 (1.00 to 1.08), 1.19 (1.15 to 1.23), and 1.49 (1.42 to 1.56) in the multivariate model, respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.13 (1.10 to 1.17) and 1.51 (1.45 to 1.58), respectively. The relations of SRH measures with ischemic stroke, hemorrhagic stroke, and recurrent stroke were similar to that with total first-ever stroke. However, the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke. ConclusionsThis large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke, regardless of stroke subtype.

Self-rated health after stroke: a systematic review of the literature

“…Of these, 49% ( n = 25) included subjects from European countries [5, 21, 22, 30–49] and 27.5% ( n = 14) included subjects from North America [50–63]. The majority had a longitudinal design ( n = 30, 58.8%) [5, 22, 30–32, 34, 36–42, 46–48, 52, 56–58, 60, 61, 63–69]. Only three longitudinal studies (10%) [34, 62, 65] were randomized clinical trials, and one (3.3%) [66] was a quasi-experimental study.…”

“…Regarding the SRH assessment, 72.5% of the studies ( n = 37) [5, 21, 22, 30, 33, 37, 39, 43–46, 49–52, 59–64, 66, 68–71, 73–77] used general direct questions ( n = 21, 67.7%) [5, 30, 33, 37, 39, 43, 46, 49, 51, 59–61, 64, 68–71, 73, 74, 76, 77] or comparative direct questions ( n = 15, 48.4%) [5, 21, 22, 30, 44, 45, 50–52, 62, 63, 66, 69, 73, 75]. Comparative SRH referred to patients’ current health status in comparison to an earlier period [5, 37, 43, 51, 54–56, 66] or to people of the same age [21, 22, 38, 43, 50, 56, 66, 69, 73, 75]. SRH was also assessed by the full (SF-36) [35, 47, 49, 62, 65] and short (SF-12) versions of the Short-Form Health Survey questionnaire [40, 44]; the visual analogue scale [33, 45, 59, 61, 67]; and the EuroQol 5D (EQ5D) [33, 45, 59, 61].…”

“…The predictive power of SRH for stroke mortality could not be confirmed since significant results were observed in two studies [43, 66] but not in two others [22, 64]. SRH was associated with morbidity, especially after a stroke [31, 53, 69], and with return to work and post-stroke stability [44]. A combination of diabetes and stroke was strongly associated with poor SRH [58].…”

“…Many studies have demonstrated the predictive power of SRH for mortality and morbidities among various populations [8, 36, 69]. However, two studies employing a logistic regression model adjusted for sociodemographic factors and morbidities found that SRH did not predict mortality after stroke.…”

Relative deprivation of assets defined at multiple geographic scales, perceived stress and self-rated health in China

“…Information on self-rated health, which has been previously shown to be associated with medically certified health conditions (Wu et al, 2013) or subsequent health outcomes (Shen et al, 2014;Dong et al, 2018) in China, was obtained by asking "how do you rate your health compared to people at your age". Response options include very poor, poor, fair, good and excellent.…”