Cross-classification between self-rated health and health status: longitudinal analyses of all-cause mortality and leading causes of death in the UK

Background: Risk stratification is an important public health priority that is central to clinical decision making and resource allocation. The aim of the present study was to examine how different combinations of self-rated and objective health status predict (i) all-cause mortality and (ii) cause-specific mortality from leading causes of death in the UK. Methods: The UK Biobank study recruited >500,000 participants, aged 37-73, between 2006-2010. The health cross-classification examined incorporated self-rated health (poor, fair, good or excellent) and health status derived from medical history and current disease status, including 81 cancer and 443 non-cancer illnesses. We examined all-cause mortality and six specific causes of death: ischaemic heart disease, cerebrovascular disease, influenza and pneumonia, dementia and Alzheimer9s disease, chronic lower respiratory disease and malignant neoplasm. Results: Analyses included >370,000 middle-aged and older adults with a median follow-up of 11.75 (IQR = 1.4) years, yielding 4,320,270 person years of follow-up. Compared to excellent self-rated health and favourable health status, all other levels of the health cross-classification were associated with a greater risk of mortality, with hazard ratios ranging from 1.22 (95% CI 1.15-1.29, pBonf. < 0.001) for good self-rated health and favourable health status to 7.14 (95% CI 6.70-7.60, pBonf. < 0.001) for poor self-rated health and unfavourable health status. Conclusions: Our findings highlight that self-rated health captures additional health-related information and should be more widely assessed across settings. The cross-classification between health status and self-rated health represents a straightforward metric for risk stratification, with applications to population health, clinical decision making and resource allocation.