Discordance between physician and patient self-rated health and all-cause mortality

Background: Self-assessments of health are a strong predictor of mortality. Whether self-assessment of health provides additional information beyond a physician's assessment is unclear.

Methods: We analyzed data on 14,530 US adults from the Third National Health and Nutrition Examination Survey. General self-rated health (GSRH)-"In general, would you say your health is Excellent, Very Good, Good, Fair, or Poor?"-and a single question to physician examiners following a medical examination rating participants' health, both on a 5-point scale of Excellent, Very Good, Good, Fair, or Poor were assessed for the period 1988-1994. All-cause mortality was assessed through December 31, 2006 (n = 3,460 deaths).

Results: Agreement between participant GSRH and physician-assessed health was 53.8% (42.1% Excellent/Very Good, 8.7% Good, and 3.0% Fair/Poor; weighted Kappa statistic = 0.20). After adjustment, participants who reported better GSRH compared to the physician assessment of their health experienced lower mortality (hazard ratio = 0.76, 95% CI: 0.66-0.87). Also, participants reporting worse health than the physician assessment experienced higher mortality (hazard ratio = 1.45, 95% CI 1.24-1.70).

Conclusions: Individuals who reported worse health than was assessed by a physician had increased mortality. These results warrant evaluation of whether GSRH collection in the clinical setting improves outcomes.