Clinical Epidemiology (Feb 2024)
Associations Between Self-Rated Health and Mortality in the Norwegian Women and Cancer (NOWAC) Study
Abstract
Ida Løken Killie,1 Tonje Braaten,1 Geir Fagerjord Lorem,2 Kristin Benjaminsen Borch1 1Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway; 2Department of Psychology, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, NorwayCorrespondence: Ida Løken Killie, Department of Community Medicine, Faculty of Health Sciences, UiT Arctic University of Norway, Breivika, Tromsø, 9037, Norway, Tel +47 776 25199, Email [email protected]: We investigated the association between self-rated health (SRH) and cancer incidence and SRH and all-cause mortality among Norwegian women.Population and Methods: We used data from 110,104 women in the Norwegian Women and Cancer (NOWAC) cohort aged 41– 70 years at baseline. We used flexible parametric survival analysis with restricted cubic splines to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between SRH and mortality in the entire cohort. We employed the same method in a multistate design to assess associations between baseline SRH and 1) cancer incidence, and 2) all-cause mortality in subgroups of women who did and did not receive a cancer diagnosis during follow-up.Results: With very good SRH as reference category for all associations and median age at end of follow-up, lower SRH was associated with increased mortality (HRgood SRH 1.19, 95% CI 1.12– 1.26) and HRpoor SRH 1.81, 95% CI 1.66– 1.97). Lower SRH at baseline was associated with cancer incidence (HRgood SRH 1.14, 95% CI 1.08– 1.20 and HRpoor SRH 1.44, 95% CI: 1.32– 1.58). Poor baseline SRH was associated with increased mortality for women who received a cancer diagnosis (HRpoor SRH 1.20, 95% CI 1.04– 1.39), and SRH showed a strong association with increased mortality for women who stayed cancer free (HRgood SRH 1.59, 95% CI 1.44– 1.77 and HRpoor SRH 3.34, 95% CI 2.91– 3.84).Conclusion: Lower SRH at baseline predicted increased cancer risk and all-cause mortality in middle-aged to older women. Poor SRH at baseline predicted all-cause mortality in women who later received a cancer diagnosis. Both good and poor SRH at baseline predicted all-cause mortality in women who stayed cancer-free, and the association was stronger for these women compared to both the entire cohort and to women who were subsequently diagnosed with cancer.Keywords: self-rated health, cohort study, multistate, cancer, mortality, women
