Healthy lifestyle partly mediates the association between self-rated health and risk of overall and cause-specific mortality

作者：Ya Miao, Bin Zhao, Yi Yang, Kai Yu, Linda M. Liao, Stephanie J. Weinstein, Fang Fang, Ben Lü, Demetrius Albanes, Jiaqi Huang · 发表于：BMC Medicine · 年份：2025 · 被引用次数：4 · 研究领域：Nutritional Studies and Diet、Health disparities and outcomes、Cardiovascular Health and Risk Factors

BACKGROUND: Self-rated health status is a subjective but important indicator of an individual's perception of overall health. However, it remains unclear whether lifestyle may mediate or modify the association of self-rated health status with overall and cause-specific mortality. METHODS: This prospective cohort analysis included 401,410 US adults from the National Institutes of Health-AARP Diet and Health Study. Self-rated health was categorized as "very good to excellent," "good," or "poor to fair." A healthy lifestyle was defined by a normal body mass index, never smoking, moderate alcohol consumption, adequate physical activity, and a higher diet quality score. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and cause-specific mortality were estimated using multivariable-adjusted Cox models. RESULTS: During a median follow-up of 23.6 years, we ascertained 181,776 deaths. Compared with individuals reporting "very good to excellent" health, those reporting "poor to fair" health had an elevated risk of overall mortality (HR = 1.90, 95% CI: 1.87-1.93) as well as mortality from cardiovascular disease (CVD), heart disease, stroke, cancer, respiratory disease, diabetes, infection, and injuries and accidents (risk increment ranged from 24% to 361%). Mediation analysis showed that 5.1% to 33.6% of the observed associations were mediated by lifestyle. Self-rated health was more strongly associated with overall mortality than traditional risk factors except smokin...