Self-rated health and mortality risk in relation to gender and education: a time-dependent covariate analysis

This study examines the relations between self-rated health (SRH) at baseline, SRH as a time-dependent covariate (TDC), and
mortality by gender and education in a community-dwelling older population in Spain. The data used are from the longitudinal
study “Aging in Leganes”, launched in 1993, carried out in a community-dwelling representative sample (n = 1,560) of the older population of Leganes (Spain). Mortality was assessed in 2008. Proportional regression models were
fitted to examine the association between mortality and baseline SRH, and SRH as a TDC among subjects aged 65–85 at baseline.
The multivariate analyses were stratified by gender and education and adjusted for sociodemographic factors, smoking and physical
activity, physical and mental morbidity, and ADL disability. SRH and SRH as a TDC were significant predictors of mortality
in men and in people with some education, but not in women or in illiterate persons. SRH and declines in SRH were associated
with increased mortality risk in older men and in those who can read and write in this Mediterranean population. Given current
improvements in education and decreasing gender inequality, health professionals in Spain should pay attention to both current
SRH and declines in SRH in their patients regardless of gender and literacy.