The Distribution And Correlates Of Self-rated Health Status In Chinese Adults And Its Relationship With Cancer Morbidity And Mortality

Objectives:Understanding the correlates of self-rated health(SRH)can help public health professionals prioritize health-promotion and disease-prevention interventions.This study aimed to investigate the distribution and correlates of global SRH(GSRH)and age-comparative SRH(ASRH)in middle-aged and elderly Chinese.Meanwhile,this study aim to investigate the relations of GSRH and ASRH with all cancer and site-specific cancers morbidity and mortality in Chinese adults.Methods:A total of 512891 participants aged 30-79 years old were recruited into the China Kadoorie Biobank study between 2004 and 2008.When analyzing the correlates of GSRH and ASRH,we excluded 2 paticipants with missing data on body mass index(BMI),and 512889 participants were included.When analyzing the relations of GSRH and ASRH with all cancer and site-specific cancers mortality,511499 participants without missing information on parent history of cancer(N=1346),BMI(N=2)and menopause status(N=44)at baseline were followed from baseline until 31 December 2013 were included.When analyzing the relations of GSRH and ASRH with all cancer and site-specific cancers morbidity,we further excluded 2571 participants with a prior history of cancer,and 508928 participants were included.Incident cancer cases were identified through the chronic diseases surveillance system and national health insurance system.Information on cause-specific mortality was obtained periodically through China’s Center for Disease Control(CDC)Disease Surveillance Points system.Logistic regression models were used to calculate the relations of different factors with GSRH and ASRH.Population attributable risks(PARs)were used to estimate the contribution of multiple comorbidities to poor GSRH and worse ASRH.Cox proportional hazard regression was used to evaluate relations of GSRH and ASRH with all cancer and site-specific cancers morbidity and mortality.Results:1.Among participants,45.76%reported their GSRH as good or excellent,and 18.18%reported better ASRH.In the multivariate model,men tended to report a good GSRH and better ASRH compared with women,old people were more likely to report poor GSRH but better ASRH.Socioeconomic and lifestyle factor that were associated with good GSRH and better ASRH included:high educational level,high household income,high level of physical activity,quitting smoking by own choices,current alcohol drinking,overweight and obesity.On the other hand,quitting smoking because of illness,former alcohol drinking status,underweight and lost more than 2.5 kg weight in the past year were associated with poor GSRH and worse ASRH.Suffering from various diseases increased the chance of reporting a poor GSRH[OR(95%CI)ranged from 1.10(1.07,1.13)for fracture to 3.18(2.66,3.81)for rheumatic heart disease]and a worse ASRH[OR(95%CI)ranged from 1.17(1.12,1.22)for fracture to 7.32(6.70,7.98)for stroke].From the population perspective,7.55%of poor GSRH and 12.50%of worse ASRH could attributed to the hypertension.2.After an average follow-up of 7.10 years,a total of 17463 incident cancer cases occurred,including 3527 cases of lung cancer,2209 cases of stomach cancer,1940 cases of liver cancer,1911 cases of colorectal cancer,1659 cases of esophageal cancer,and 1472 cases of breast cancer.In the multivariate model,compared with those who reported excellent GSRH,the hazard ratios(HR)and 95%confidence intervals(CI)of all cancer,stomach cancer,liver cancer and lung cancer in subjects with poor GSRH were 1.26(1.19-1.34),1.44(1.22-1.69),1.42(1.19-1.69),and 1.25(1.10-1.43),respectively.Compared with those who reported better ASRH,the HRs and 95%CIs of all cancer,stomach cancer,liver cancer and breast cancer in subjects with worse ASRH were1.20(1.14-1.26),1.29(1.12-1.48),1.54(1.32-1.81)and 1.21(1.01-1.45),respectively.3.During 3661017 person-years of follow-up,a total of 8735 subjects died of cancer,including 2139 from lung cancer,2038 from liver cancer,1227 from stomach cancer,1019 from esophageal cancer,609 from colorectal cancer and 220 from breast cancer.In the multivariate model,compared with excellent GSRH,the HRs and 95%CIs for all cancer,esophageal cancer,stomach cancer,colorectal cancer,liver cancer,lung cancer and breast cancer mortality associated with poor GSRH were 1.40(1.29-1.52),1.38(1.09-1.75),1.40(1.13-1.72),1.42(1.15-1.75),1.23(1.04-1.45)and 1.75(1.06-2.89),respectively.Compared with better ASRH,the HRs and 95%CIs for all cancer,esophageal cancer,stomach cancer,liver cancer and breast cancer mortality associated with worse ASRH were 1.27(1.18-1.36),1.36(1.12-1.65),1.21(1.01-1.45)and 1.43(1.19-1.72),respectively.Conclusions:1.We found numbers of demographic and socioeconomic characteristics health behaviors,and multiple diseases were significantly associated with GSRH and ASRH.Our results highlights the importance of establishing social policy to achieve greater social and economic equality in society in order to reduce the health inequity.Meanwhile,our study highlights the importance of improving personal and community health by modifiable factors particularly healthy lifestyles.In addition,prevention measures concentrated on cardiometabolic diseases are beneficial to improve the overall SRH level of the population.2.Poor GSRH and worse ASRH were significantly associated with the risk of all cancer,gastric cancer and liver cancer.In addition,poor GSRH were significantly associated with the risk of lung cancer,and worse ASRH were significantly associated with the risk of breast cancer.More studies are needed to further confirm the association between self-rated health status and cancer risk.3.In this large prospective cohort study,we found that poor GSRH and worse ASRH were significantly associated with the all cancer,esophageal cancer,stomach cancer and liver cancer.In addition,poor GSRH were significantly associated with the risk of lung cancer and breast cancer mortality.