OBJECTIVES: To determine if self-rated health is associated with mortality and explore predictors of poor self-rated health in a large-scale real-world dataset.

METHODS: Participants of the UK Biobank were recruited between 2006 and 2010. At baseline, participants attended an assessment center and completed a questionnaire where they provided demographic and health-related information and were asked to rate their overall health as ‘excellent’, ‘good’, ‘fair’ or ‘poor’. Mortality was determined through linkage with national death registries. Hazard ratios (HRs) for each health category and 5-year mortality were estimated using Cox proportional hazards models. Demographic and health-related predictors of self-rated health were identified using multinomial logistic regression models and presented as relative risks. All models included the age, sex, Townsend deprivation index, diabetes status, depression status, and hypertension status as covariates.

RESULTS: This study included 496,488 participants (mean [SD] age = 56.5 [8.1] years, 54% female, 95% White ethnicity). Overall, 16% of participants reported excellent health, 58% reported good health, 21% reported fair health, and 5% reported poor health. Risk of mortality increased with increasingly poor health in a dose-dependent but non-linear manner. Compared to people with self-reported excellent health, increased risks of mortality were observed in people with self-reported good (HR = 1.3 [1.2, 1.4]), fair (HR = 2.4 [2.2, 2.6]), and poor (HR = 6.3 [5.8, 7.9] health. When considering demographic and health-related predictors, South Asian ethnicity, higher social deprivation and the presence of depression, diabetes, and hypertension were all independently associated with a higher relative risk of reporting poor health compared to excellent health.

CONCLUSIONS: These findings highlight the value of patient-reported outcomes in observational research and the need to target public health strategies towards people at risk for poorer health outcomes, particularly ethnic minorities, and those with mood and/or cardiometabolic conditions.