Discordance Between Physician and Patient Self-Rated Health and All-Cause Mortality

Background: Self-assessments of health are a strong predictor of mortality. Whether self-assessment of health provides additional information beyond a physician’s assessment is unclear. Methods: We analyzed data on 14,530 US adults from the Third National Health and Nutrition Examination Survey. General selfrated health (GSRH)—‘‘In general, would you say your health is Excellent, Very Good, Good, Fair, or Poor?’’—and a single question to physician examiners following a medical examination rating participants’ health, both on a 5-point scale of Excellent, Very Good, Good, Fair, or Poor were assessed for the period 1988-1994. All-cause mortality was assessed through December 31, 2006 (n 5 3,460 deaths). Results: Agreement between participant GSRH and physicianassessed health was 53.8% (42.1% Excellent/Very Good, 8.7% Good, and 3.0% Fair/Poor; weighted Kappa statistic 5 0.20). After adjustment, participants who reported better GSRH compared to the physician assessment of their health experienced lower mortality (hazard ratio 5 0.76, 95% CI: 0.66-0.87). Also, participants reporting worse health than the physician assessment experienced higher mortality (hazard ratio 5 1.45, 95% CI 1.24-1.70). Conclusions: Individuals who reported worse health than was assessed by a physician had increased mortality. These results warrant evaluation of whether GSRH collection in the clinical setting improves outcomes.