To analyse poor physical function, pain, limited exercise and smoking, assessed in a patient-friendly self-report questionnaire format that has been completed by every patient at every visit over 20–30 years in the authors’ and other usual care settings, to predict 5-year mortality in a general older population.
An extended version of a Multidimensional Health Assessment Questionnaire was mailed to 2000 subjects in Finland, identified as a randomly selected control cohort for a rheumatoid arthritis cohort. The questionnaire included queries concerning baseline physical function, pain, exercise and smoking status, identical to the clinic version, as well as age and 25 medical conditions. Five-year survival was analysed according to descriptive statistics, Kaplan–Meier curves and Cox regressions.
The questionnaire was returned by 1523 subjects (76%). Five-year survival was 94% in all subjects, 98% in subjects with no disease or no acutely life-threatening disease, and 17% in subjects with an acutely life-threatening disease. Hazard ratios (HRs) for 5-year mortality were 3.5 for poor physical function, 2.2 for pain, 5.2 for limited exercise and 4.6 for smoking (p<0.01); 5-year survivals were 93%, 97%, 93% and 95%, respectively, compared with 91% for hypertension. Each of the four patient history variables predicted mortality at higher levels in subjects who reported no versus one or more acutely life-threatening conditions.
Poor physical function, pain, limited exercise and smoking can be assessed systematically on a simple standard Multidimensional Health Assessment Questionnaire, to identify potentially modifiable risk factors for premature mortality in the infrastructure of usual medical care and health maintenance.
A simple, one-page patient self-report questionnaire to assess systematically physical function, pain, limited exercise and smoking has been completed by all patients at all visits in 5–10 min in routine care in several rheumatology clinical settings for 20–30 years, including those of the authors.
Responses on this questionnaire indicating poor physical function, pain and limited exercise have been documented as significant prognostic markers for premature mortality in patients with rheumatoid arthritis, with greater significance than radiographs or laboratory tests.
Questionnaire responses in an older cohort from the general population, identified from a population register as a control cohort for a rheumatoid arthritis cohort, indicated that poor physical function, pain and limited exercise also predicted 5-year mortality significantly, in the range of smoking and hypertension.
Poor physical function, pain and limited exercise are potentially modifiable risk factors for premature mortality in the general population, in a similar range to that of smoking and hypertension.
A systematic assessment of these patient history variables is not included at most medical visits, in contrast to blood pressure or serum cholesterol, in part as most available questionnaire formats appear to add to the burden of care for patients and doctors.
Scores in a simple format on a questionnaire completed by patient self-report in 5–10 min provide quantitative data concerning physical function, pain, exercise status and smoking as significant risk factors for mortality, with virtually no additional work on the part of a health professional, to ensure that data are available for clinical review.
Poor physical function, pain and limited exercise are more significant in prognosis of death over 5 years in individuals who do not versus do report one or more potentially acutely life-threatening diseases.
Strengths and limitations of this study
Population-based subjects? Survey returned by 1523 of 2000 subjects (76%).
Questionnaire easily completed by patient self-report in 5–10 min in any clinical or research setting, or even at home.
No laboratory tests were available—it would be of interest to compare medical history variables with laboratory tests, such as serum cholesterol, in the prognosis of mortality, and whether a component of the risk according to the laboratory test may be ‘explained’ in part by a patient history measure.
All subjects were from Finland, although most data suggest that mortality experience in Finland is similar to that found in most Western countries, and reports from other countries have indicated that poor physical function, pain and limited exercise are prognostic of premature mortality. Furthermore, a response rate of >75% from the general population might be unlikely in most countries, and may be unique to Finland.
Diagnoses were available only from self-report, which can be inaccurate for certain diagnoses. However, the excess risk according to poor physical function, pain and limited exercise was greater in subjects who reported no versus any acutely life-threatening diseases.
Actual survey includes more queries and is not identical to that used in clinical settings, although actual queries about four risk factors are identical in clinical and study format.