Ethnic variation in self-rated health–mortality association: Results from a 17-year follow-up study in Estonia

BACKGROUND AND AIM: Previous research has highlighted the role of self-rated health (SRH) as an important predictor of mortality. With substantial ethnic differences in SRH and mortality reported in Estonia, this study aims to examine the ethnic variation in SRH-mortality association in this setting. MATERIALS AND METHODS: The baseline data come from the nationally representative 1996 Estonian Health Interview Survey. Individual records of 3983 respondents in the 25-79 age group were linked with mortality data with 17 years follow-up time. The association between SRH and all-cause mortality was analyzed using the Cox regression for two ethnic groups and separately for men and women. RESULTS: Among ethnic Estonians, both men and women with bad or very bad SRH had about 60% higher mortality compared to those with good or very good SRH even after adjustment for age, socioeconomic and health-related variables. In contrast, SRH did not predict mortality among non-Estonian men and women. A strong and universal inverse association with mortality was found for personal income. Education (among men) and occupation (among women) predicted mortality only among non-Estonians, whereas ever smoking was associated with mortality in Estonian men and women. Overweight women had lower mortality risk compared to women in normal weight category. CONCLUSIONS: We found considerable ethnic variation in SRH-mortality association and in socioeconomic predictors of mortality. Further research, preferably focusing on cause-specific mortality and reporting heterogeneity of SRH could potentially shed further light on ethnic differences in SRH-mortality association in Estonia and more generally on socioeconomic inequalities in mortality in Eastern Europe.