Self-rated health and adverse health outcomes: an exploration and refinement of the trajectory hypothesis.

OBJECTIVES To examine the hypothesis that the relationship between poor self-rated health and adverse health outcomes simply reflects self-assessments of declining health trajectories rather than current health status. METHODS A 12-month follow-up of 786 disadvantaged adults aged 50-99 years old was conducted. Baseline markers of poor self-rated health and declining health trajectory were used to predict 12-month follow-up reports of the expectations of being hospitalized within one year, being placed in a nursing home within five years, and dying within ten years. Hierarchical multivariable logistic regression was used with poor self-rated health entered first, standard epidemiologic covariates entered next, and declining health trajectory entered last. RESULTS Poor self-rated health was not independently associated with expectations for being hospitalized, but declining health trajectory independently increased the risk of such expectations by 65-88%. Neither poor self-rated health nor declining health trajectory were independently associated with expectations for being placed in a nursing home, but both were independently associated with expectations for dying, increasing such expectations by 70-105%. DISCUSSION The relationship between poor self-rated health and adverse outcomes is not a simple reflection of unmeasured self-assessments of impending decline or doom. Rather, the effects of poor self-rated health and declining health trajectory appear to be independent and complementary.