Self-rated health status and risk of ischemic heart disease in the China Kadoorie Biobank study: a population based cohort study

Background: Self-rated health (SRH) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease (IHD) have not been extensively explored, especially in Chinese population. Methods and Results: Over 0.5 million adults from 10 cities of China were followed from baseline (2004-2008) until 31 December 2013. Global SRH and age-comparative SRH were inquired in baseline questionnaires. Incident IHD cases were identified through linkage to well-established disease registry systems and national health insurance system. During 3,423,542 person-years of follow-up, we identified 24,705 incident cases of IHD. In multivariable-adjusted models, both SRH and age-comparative SRH were significantly associated with incident IHD. Compared with excellent SRH, the HRs (95% CIs) of good, fair, and poor SRH were 1.02 (0.98-1.07), 1.32 (1.27-1.37), and 1.76 (1.68-1.85), respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.23 (1.19-1.27) and 1.78 (1.70-1.86), respectively. The associations persisted in all subgroup analyses, though slightly modified by study location, education and income levels. Conclusions: A simple question of self-assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient measure to assess future IHD risk