Self-rated health as a predictor of mortality and healthcare use in older adults at high risk of hospitalisation: a prospective cohort study in Sweden
Abstract
Objective This study aimed to evaluate the predictive value of self-rated health (SRH) on mortality and healthcare use in older adults (aged ≥75 years) at high risk of hospitalisation in comparison to an objective measure of comorbidities, the Charlson Comorbidity Index (CCI). Design Prospective cohort study conducted within the research project ‘Proactive Primary Care for Frail Elderly Persons’. Setting 19 primary care practices in south-east Sweden, between January 2018 and December 2019. Participants In total, 355 adults aged ≥75 years were included in the study. They were among the 11% older adults with the highest predicted risk of hospitalisation, as identified by a statistical prediction model for unplanned hospital admission. Outcome measures Outcomes were all-cause mortality and healthcare use measured as hospital care days and the number of physician visits in primary and secondary care. These were analysed for different groups of SRH and comorbidities measured using the CCI. Results SRH was grouped into Excellent/Very good, Good, Fair and Poor. The overall mortality rate was 26.5%. Compared with the Poor group, the adjusted HRs were significantly lower for Excellent/Very good (HR=0.2; 95% CI: 0.1 to 0.8, p=0.02) and Fair (HR=0.5; 95% CI: 0.3 to 1.0, p=0.04). Compared with the comorbidity group CCI 0–1, CCI 2–3 had an adjusted HR of 2.2 (95% CI: 1.1 to 4.6, p=0.03), CCI 4–5 had an adjusted HR of 2.6 (95% CI: 1.2 to 5.4, p=0.01) and CCI>5 had an HR of 4.9 (95% CI:…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 355 participants or records.
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