Mon Nov 28 2022

Self‑rated health and chronic infammation are related and independently associated with hospitalization and long‑term mortality in the general population

Results

Relationship between SRH and suPAR levels. The participants had a median suPAR level of 3.4 ng/ mL (IQR: 2.7–4.3), and suPAR levels increased with worse SRH (Fig. 2). When reducing SRH into 3 categories, suPAR levels for participants reporting excellent/very good SRH were 3.2 ng/mL (IQR: 2.6–4.0), 3.4 ng/mL (IQR: 2.8–4.3) for those reporting good SRH, and 3.8 ng/mL (IQR: 3.1–4.9) for those reporting fair/bad SRH (Supplementary Table 2).

Individual and mutually adjusted associations of SRH and suPAR with the risk of acute hospitalization.
‘Within two years after the initial exam, 437 participants (8.0%) needed acute hospital care, 8 (0.2%) died, and 10 (0.2%) were unreachable for follow-up. When examining suPAR levels continuously, we found a doubled suPAR level linked to a higher risk of urgent hospital visits. This association was clear without adjustments (Sub-distribution HR: 1.50, 95% CI: 1.27 to 1.78, P<0.0001) and even after adjustments (SDHR: 1.30, 95% CI: 1.06 to 1.59, P=0.011). The data showed no significant interaction between suPAR levels and sex (P=0.46). Looking at SRH and suPAR in three categories, we noted those reporting good or fair/bad SRH and those with medium or high suPAR faced a higher risk of hospitalization than those with excellent/very good SRH or low suPAR. Adjusting for both SRH and suPAR did not weaken these links. We also tested if SRH and suPAR independently influenced hospitalization risk by introducing an interaction term between them. This interaction showed no significant effect, indicating suPAR and SRH’s impact on hospitalization risk operates independently (P=0.62).

Methods

Study and Participants

The Danish Inter99 cohort study focused on preventing ischemic heart disease. It involved 13,016 participants, aged 30–60, randomized into two groups for either high or low lifestyle counselling. Out of these, 6,784 agreed to participate and underwent baseline examinations from March 1999 to January 2001. These examinations consisted of clinical checks, detailed questionnaires on lifestyle, socioeconomic status, mental health, and SRH, and blood tests. The study linked participants to Danish health and social registers for hospitalization, ICD-10 codes, and death information. Conducted under the Declaration of Helsinki’s guidelines, the Capital Region of Denmark’s Scientific Ethics Committee (KA 98 155) and the Danish Data Protection Agency approved it. It also received a clinical trial registration (ClinicalTrials.gov; NCT00289237). All participants gave written consent before joining. The original study found no impact from the lifestyle intervention. For the current study, we included participants with available data on both SRH and suPAR levels (n=5490, Fig. 1).

Self Rated Health was assessed at baseline via a self-administered questionnaire. The question was formulated as: “How do you think your health is, all in all?”, with the following possible answers: “excellent”, “very good”, “good”, “fair”, or “bad”.

Serum levels of suPAR (ng/mL) at baseline were measured using the suPARnostic ELISA assay (Virogates, Birkeroed, Denmark) as previously reported 36. Samples were measured in singlets, but according to the manufacturer of the suPARnostic ELISA, the intra‐assay variation is 2.8%, and the inter-assay variation as 9.2%. Samples with values below the detectable range of the assay (0.6 ng/mL) were excluded (n=13), and samples with values above the detectable range were assigned a value corresponding to the upper limit of quantification (22 ng/mL, n=2).

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