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Clinical Decisionmaking

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Patient self-assessments of health provide information not captured by clinical assessments or medical histories

How men and women assess their own health provides unique information not captured by standard clinical assessments or medical histories. This applies even more to men than to women, according to a study supported in part by the Agency for Healthcare Research and Quality (HS07002). The researchers found that how individuals assessed their own health predicted survival for men and, to some extent, predicted functional limitations for both men and women. This information was not rendered superfluous by the inclusion of data from a standardized physical exam and a set of laboratory tests, according to Ellen L. Idler, Ph.D., of Rutgers University.

Dr. Idler and her colleagues examined relative hazards for death and functional limitations according to self-ratings of health using prospective data from the NHANES I Epidemiologic Follow-up Study, a representative sample of U.S. adults aged 25-74 years. Individuals in the study sample have been followed since the First National Health and Nutrition Examination Survey (NHANES I) was conducted in 1971-1975.

There was an indirect relationship between men's self-rated health and their risk of death. Men who reported excellent health had a 48 percent lower risk of death than men who reported poor health, men who reported very good health had a 44 percent lower risk of death, and those who reported good health had a 32 percent lower risk of death. Self-reports of excellent, very good, and good health did not significantly reduce the risks of death compared with self-reports of poor health among women.

In 1992, men's excellent self-rated health subtracted 9.5 points from functional limitation scores, and self-ratings of fair health reduced scores by 7.3 points, with scores for very good and good health falling in between in dose-related fashion. There was no significant relationship for women's self-rated health and functional limitation scores in 1992, after adjusting for prior limitations.

More details are in "Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992," by Dr. Idler, Louise B. Russell, Ph.D., and Diane Davis, B.A., in the American Journal of Epidemiology 152(9), pp. 874-883, 2000.

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