BMJ Open 2:e000760 doi:10.1136/bmjopen-2011-000760
  • Diabetes and endocrinology
    • Research

Self-rated health and mortality in individuals with diabetes mellitus: prospective cohort study

  1. Ute Nöthlings8
  1. 1Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
  2. 2Centre for Clinical Research Dalarna, Falun, Sweden
  3. 3Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
  4. 4Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
  5. 5National Institute for Public Health and the Environment Centre for Prevention and Health Services Research, Bilthoven, The Netherlands
  6. 6Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aalborg, Denmark
  7. 7Department of Clinical Sciences, Lund University, University Hospital, Malmö, Sweden
  8. 8Institute for Experimental Medicine, Section for Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
  1. Correspondence to Dr Patrik Wennberg; patrik.wennberg{at}
  • Received 13 December 2011
  • Accepted 20 January 2012
  • Published 15 February 2012


Objectives To investigate whether low self-rated health (SRH) is associated with increased mortality in individuals with diabetes.

Design Population-based prospective cohort study.

Setting Enrolment took place between 1992 and 2000 in four centres (Bilthoven, Heidelberg, Potsdam, Umeå) in a subcohort nested in the European Prospective Investigation into Cancer and Nutrition.

Participants 3257 individuals (mean ± SD age was 55.8±7.6 years and 42% women) with confirmed diagnosis of diabetes mellitus.

Primary outcome measure The authors used Cox proportional hazards modelling to estimate HRs for total mortality controlling for age, centre, sex, educational level, body mass index, physical inactivity, smoking, insulin treatment, hypertension, hyperlipidaemia and history of myocardial infarction, stroke or cancer.

Results During follow-up (mean follow-up ± SD was 8.6±2.3 years), 344 deaths (241 men/103 women) occurred. In a multivariate model, individuals with low SRH were at higher risk of mortality (HR 1.38, 95% CI 1.10 to 1.73) than those with high SRH. The association was mainly driven by increased 5-year mortality and was stronger among individuals with body mass index of <25 kg/m2 than among obese individuals. In sex-specific analyses, the association was statistically significant in men only. There was no indication of heterogeneity across centres.

Conclusions Low SRH was associated with increased mortality in individuals with diabetes after controlling for established risk factors. In patients with diabetes with low SRH, the physician should consider a more detailed consultation and intensified support.


  • To cite: Wennberg P, Rolandsson O, Jerdén L, et al. Self-rated health and mortality in individuals with diabetes mellitus: prospective cohort study. BMJ Open 2012;2:e000760. doi:10.1136/bmjopen-2011-000760

  • Contributors PW, OR and UN were involved in the study concept and planned the analyses. PW, OR, HB, DS, RK, BT, AS, BBdM and UN contributed in the acquisition of the data. PW was responsible for statistical analyses and drafted the paper. PW, OR, LJ and UN interpreted the results. All authors participated in critical revision of the manuscript and approved the final version. PW is the guarantor.

  • Funding This study was supported by a European Foundation for the Study of Diabetes/Sanofi-Aventis grant. The European Foundation for the Study of Diabetes or Sanofi-Aventis had no role in the design or conduct of the study, collection or analysis of the data or preparation or approval of the manuscript and did not have any influence on the contents.

  • Competing interests All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval Ethics approval was provided by the IARC Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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