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Carolien L. van den Brink, MSc, Marja Tijhuis, PhD, Geertrudis A.M. van den Bos, PhD, Simona Giampaoli, MD, Aulikki Nissinen, MD and Daan Kromhout, PhD

Carolien L. van den Brink, Marja Tijhuis, and Daan Kromhout are with the National Institute for Public Health and the Environment, The Netherlands. Carolien L. van den Brink and Geertrudis A.M. van den Bos are with the Department of Social Medicine, Academic Medical Center, University of Amsterdam, The Netherlands. Simona Giampaoli is with the National Institute of Health, Rome, Italy. Aulikki Nissinen is with the National Public Health Institute, Helsinki, Finland. Daan Kromhout is with the Division of Human Nutrition, Wageningen University and Research Center, Wageningen, The Netherlands.

Correspondence: Requests for reprints should be sent to Carolien van den Brink, National Institute for Public Health and the Environment, Center for Prevention and Health Services Research, PO Box 1, 3720 BA Bilthoven, The Netherlands (e-mail: carolien.van.den.brink{at}rivm.nl).

Objectives. To investigate the effect of disability severity and the contribution of self-rated health and depressive symptoms to 10-year mortality.

Methods. Longitudinal data were collected from 1141 men aged 70 to 89 years from the Finland, Italy, and the Netherlands Elderly Study from 1990 to 2000. Disability severity was classified into 4 categories: no disability, instrumental activities, mobility, and basic activities of daily living. Self-rated health and depressive symptoms were classified into 2 and 3 categories, respectively. Multivariate Cox proportional hazard models were used to calculate mortality risks.

Results. Men with severe disability had a risk of mortality that was more than 2-fold higher (hazard ratio [HR]=2.41; 95% confidence interval [CI]=1.84, 3.16) than that of men without disability. Men who had severe disability and did not feel healthy had the highest mortality risk (HR = 3.30; 95% CI = 2.52, 4.33). This risk was lower at lower levels of disability and higher levels of self-rated health. The same trend was observed for depressive symptoms.

Conclusions. For adequate prognoses on mortality or for developing intervention strategies, not only physical aspects of health but also other health outcomes should be taken into account.

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