Participants in large health surveys are often asked the question: How good is your health?
Norwegian researchers have analysed such data from over 100,000 women in the Norwegian Women and Cancer study. The women were between 41 and 70 years old when the study began.
"Our findings show that older women who assessed their health as poor had a higher risk of dying early than those who rated their health as good," says Ida Løken Killie.
She is working on a PhD about self-reported health at UiT the Arctic University of Norway.
Even after researchers adjusted for lifestyle factors and social differences, they still found these correlations.
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Underlying disease?
When the participants in the study filled out the questionnaire, they were cancer-free. The researchers excluded those who had previously had cancer.
It has been speculated that we may perceive changes in our own health before they can be detected by blood tests or other examinations, says Ida Løken Killie.(Photo: UiT the Arctic University of Norway)
Through links to the Cancer Registry of Norway, the researchers obtained information about cancer diagnoses during the follow-up period.
Those who reported having poor health at the start of the study had a slightly higher risk of developing cancer.
"This could either mean that they had underlying symptoms due to an undiagnosed cancer or that they had a lifestyle or other risk factors associated with cancer," says Killie.
An interesting correlation
The researchers also wanted to investigate whether there was a difference in the relationship between self-reported health and early death among those who develop cancer and those who do not.
"When we look at those who develop cancer and those who do not separately, it's interesting to find that the relationship is much stronger among those who do not get cancer," says Killie.
She believes this can be explained by the fact that cancer is a significant cause of death in itself. Having good health beforehand does not necessarily protect against death if one develops a cancer type with a poor prognosis.
The fact that the correlation between poor self-reported health and death is much stronger among those who did not get cancer suggests that the perception of poor health may be an even more important risk factor for early death than previously assumed, Killie believes.
"The majority of us will not develop cancer during our lifetime," she says.
Should be given more emphasis
Killie believes it is not surprising that people have quite a good insight into their own health condition.
She therefore believes this should be given more emphasis, both in clinical settings and in public health planning.
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This study was conducted only on women. Whether the correlation is equally strong for men remains uncertain, she says.
"The results vary. Some studies show that the correlation is stronger for women, some find it stronger for men, and others find no gender difference," she says.
Cardiovascular diseases as well
Other studies have also found a correlation between self-reported health and death, not just from cancer but from other diseases as well.
Finnish researchers, for instance, found a link between poor self-reported health and the risk of cardiovascular disease in a study.
A study from the Nord-Trøndelag Health Survey in 2015 showed that the relationship between self-reported health and mortality is roughly equally strong across occupational groups and income groups.
Important to monitor changes
It has been speculated that we may perceive changes in our own health before they can be detected by blood tests or other examinations, says Killie.
This underscores the importance of paying attention to changes in health status, both on a personal level and within healthcare systems.
"This is a simple question to ask and therefore an easy tool to use. We just need to find out more about how it can be applied in patient follow-ups or public health initiatives," she says.
Could be an early sign of disease
Geir F. Lorem, a professor of psychology at UiT The Arctic University of Norway, contributed to Ida Løken Killie's study.
He previously led a study that reached a similar conclusion in 2020.
"We followed around 24,000 people in Tromsø and found that self-reported health is a strong predictor of mortality, even after adjusting for diseases, health behaviours, and clinical data such as blood pressure and BMI," says Lorem.
The effect was particularly evident in the first five years.
"This suggests that when you report poor health, it may be an early sign of disease or an increased health risk," he says.
This challenges traditional ways of assessing health risks, according to Lorem.
"If patients say they have poor health, it should be taken seriously – even if tests do not show clear problems," he says.
Geir F. Lorem is a professor of psychology at UiT the Arctic University of Norway.(Photo: UiT)
Can be used in medical practice
He believes that the study opens up an important discussion on how subjective health perceptions can be used in medical practice.
The question 'How would you assess your own health?' can provide valuable information that might not emerge in a regular doctor's appointment, Lorem believes.
It could become part of standard screening in primary healthcare and help identify vulnerable patients early, he suggests.
"Recognising a patient's subjective health perception can also strengthen the relationship between healthcare providers and patients and increase trust in the treatment," says Lorem.
