Association Between Self-rated Health Status And Risk Of Cardiovascular Morbidity And Mortality In The Chinese Population

Part 1 Association of self-rated health status with future risk of ischemic heart diseaseObjective: To examine the associations of two SRH measures with ischemic heart disease(IHD)in the Chinese population.Methods: Over 0.5 million adults from 10 cities of China were followed from baseline(2004-2008)until 31 December 2013.GSRH and ASRH were inquired in baseline questionnaires.Incident IHD cases were identified through linkage to well-established disease registry systems and national health insurance system.Cox proportional hazard regression was used to estimate the associations between SRH measures and incident risk of IHD.Results: During 3423542 person-years of follow-up,we identified 24705 incident cases of IHD.In multivariable-adjusted models,both general SRH and age-comparative SRH were significantly associated with incident IHD.Compared with excellent SRH,the HRs(95% CIs)of good,fair,and poor SRH were 1.03(0.99-1.08),1.32(1.27-1.38),and 1.78(1.70-1.86),respectively.Compared with better age-comparative SRH,the HRs(95% CIs)of same and worse age-comparative SRH were 1.22(1.18-1.27)and 1.78(1.70-1.86),respectively.The associations persisted in all subgroup analyses,though slightly modified by study location,education and income levels.Conclusions: A simple question of self-assessment of health status was significantly associated with incident IHD in Chinese adults.Individuals and healthcare providers can use SRH measures as a convenient measure to assess future IHD risk.Part 2 Association of self-rated health status with risk of stroke incidenceObjective: To prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in the Chinese population.Methods: A total of 494113 participants from the CKB study without prior heart diseases or cancer(486541 without stroke and 7572 with stroke)were followed from baseline(2004-2008)until 31 December 2013.GSRH and ASRH were obtained from baseline questionnaires.First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data.Cox proportional hazard regression was used to estimate all associations.Results: We identified 27662 first-ever stroke and 2909 recurrent events during an average of 7.0 years of follow-up.Compared with excellent GSRH,the HRs and 95% CIs for first-ever stroke associated with good,fair and poor GSRH were 1.04(1.00-1.08),1.19(1.15-1.23),and 1.50(1.43-1.57)in the multivariate model,respectively.Compared with better ASRH,the HRs(95% CIs)of same and worse ASRH were 1.13(1.10-1.17)and 1.51(1.45-1.58),respectively.The relations of SRH measures with ischemic stroke and hemorrhagic stroke were similar to that with total first-ever stroke.In participants with prior stroke history,the HR and 95% CI for people with poor GSRH was 1.45(1.24-1.70)compared with excellent GSRH,and those with worse ASRH was 1.42(1.23-1.65)compared with people with better ASRH.Additionally,the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke.Conclusions: This large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke,regardless of stroke subtype.Part 3 Self-rated health measures and their relations to all-cause and cardiovascular mortalityObjective: Though SRH has been used to predict all-cause and cause-specific mortality in various western populations,results were inconsistent and little has been done in Chinese.In this study,we aim to examine the associations of GSRH/ASRH with CVD and all-cause mortality.Methods: A total of 512891 adults aged 30-79 y from 10 areas of China were followed from baseline(2004-2008)until 31 December 2013 in the CKB study.GSRH and ASRH were asked in baseline questionnaires.Causes for mortality were monitored through linkage with established Disease Surveillance Point system and health insurance records.Multivariable-adjusted Cox proportional regression models were used to estimate the HRs and 95% CIs for the association between SRH measures and all-cause or cardiovascular mortality.Results: During an average of 7.2 years' follow-up,25933 deaths were recorded,among which 12025 were from cardiovascular disease.Compared with excellent GSRH,the HRs(95% CIs)for all-cause and cardiovascular mortality associated with poor GSRH was 1.98(1.89-2.08)and 2.33(2.17-2.51),respectively.Relative to better ASRH,the HR(95% CI)for all-cause and cardiovascular mortality associated with worse ASRH was 1.86(1.78-1.94)and 2.26(2.12-2.41),respectively.Conclusions: In this large prospective cohort study in Chinese,participants reporting poor GSRH or worse ASRH had significantly higher risk of total and cardiovascular mortality.Part 4 Office-based non-laboratory prediction model for cardiovascular diseasesObjective: To establish an office-based non-laboratory prediction model and score sheet for cardiovascular diseases in the Chinese population,and explore the utility of GSRH/ASRH in the risk prediction models.Method: 50% males(N=99557)and 50% females(N=143714)without baseline cardiovascular diseases,cancer or missing body mass index(BMI)values in the CKB study were used to establish CVD risk prediction models,the remaining 50% males and 50% females were used for model validation and comparison.First event of CVD,including first event of IHD,stroke,morbidity or mortality,were monitor through linkage with National Death Surveillance System,National Disease Surveillance system and National Insurance System,verbal autopsy was conducted by trained investigators when necessary.Cox proportional hazard regression was used to establish prediction models and risk score sheet,we then assessed the discrimination,calibration,sensitivity and specificity of the logistic algorithms for predicting CVD events.Results: The predictors included in the CVD prediction models includes traditional risk factors such as age,BMI,hypertension,diabetes,smoking,family history of CVD and several other office-based non-laboratory factors including marriage(males),menopause status(females),education level,geographical region(south/north),and GSRH.The area under ROC curves(AUC)for male and female prediction models are 0.758 and 0.760 respectively,and the calibration for two models were less satisfied(P<0.05).Compared with the GSRH model established in our study,overestimation of CVD risk in Chinese population was much higher for the non-laboratory model proposed by FHS.The risk score ranges from-10 to 30,the risk based on score models ranges from 0.6-98.5%(for males)and 0.7%-97.4%(for females).Conclusions: The office-based non-laboratory CVD prediction models including GSRH had good discrimination,yet the calibrations of these models were not good enough.Though the predictive power of GSRH model was more suitable for Chinese population compared with the FHS model,we still need to identify more non-laboratory CVD risk factors to improve the calibration of the GSRH model.