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The effect of point of reference on the association between self-rated health and mortality


  • Manderbacka, Kristiina
  • Kåreholt, Ingemar
  • Martikainen, Pekka
  • Lundberg, Olle


This study examines the effect of point of reference on the predictive validity of self-rated health for mortality in a 5-year follow-up period. Two self-rated health measures are examined: an age group comparative question and a global question with no explicit point of reference. The baseline data (SweOld) is a nationally representative interview survey among Swedish people aged 77+ in 1992. Mortality for the 1992-1996 period was analysed using Cox proportional hazards regression models. Age-referential self-rated health was found to be a better predictor of elderly men's mortality both in non-adjusted models and in models adjusting for age and both self-rated health measures. In separate analyses, both measures were found to be equally strong predictors of women's mortality. When adding both measures into the model simultaneously, the age-referential question lost much of its predictive power. The findings suggest that self-rated health measures are not insensitive to differences in question wording.

Suggested Citation

  • Manderbacka, Kristiina & Kåreholt, Ingemar & Martikainen, Pekka & Lundberg, Olle, 2003. "The effect of point of reference on the association between self-rated health and mortality," Social Science & Medicine, Elsevier, vol. 56(7), pages 1447-1452, April.
  • Handle: RePEc:eee:socmed:v:56:y:2003:i:7:p:1447-1452

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    Cited by:

    1. Neil J. Buckley & Frank T. Denton & A. Leslie Robb & Byron G. Spencer, 2006. "Socio-economic Influences on the Health of Older Canadians: Estimates Based on Two Longitudinal Surveys," Canadian Public Policy, University of Toronto Press, vol. 32(1), pages 59-84, March.
    2. Rainer Reile & Mall Leinsalu, 2013. "Differentiating positive and negative self-rated health: results from a cross-sectional study in Estonia," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(4), pages 555-564, August.
    3. Jylhä, Marja, 2009. "What is self-rated health and why does it predict mortality? Towards a unified conceptual model," Social Science & Medicine, Elsevier, vol. 69(3), pages 307-316, August.
    4. Bakshi, Sanjeev & Pathak, Prasanta, 2010. "What makes them feel healthier? the correlates of self-perceived health among older adults in India," MPRA Paper 40541, University Library of Munich, Germany.


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