Effect of cancer screening and desirable health behaviors on functional status, self-rated health, health service use and mortality

OBJECTIVES: To determine whether some health behaviors of older people (e.g., obtaining cancer screens) have a limited and others (e.g., exercise) have a broad association with population-level health status 4 to 6 years later. DESIGN: Longitudinal cohort. SETTING: North Carolina five-county urban and rural area. PARTICIPANTS: Representative community residents aged 71 and older (Duke Established Populations for Epidemiologic Studies of the Elderly; African American, n=1,256; white, n=974) who provided information on cancer screening and health behaviors. MEASUREMENTS: Demographics, health conditions, functional status, health service use, health insurance. Dependent measures were functional status and self-rated health 4 years later, hospitalization within 4 years, and death within 6 years. Data were analyzed using descriptive statistics, multivariable logistic regression, and Cox proportional hazards. RESULTS: In fully adjusted analyses, cancer screening had no significant protective association with functional status, self-rated health, hospitalization, or death. Smoking was a risk factor for hospitalization (odds ratio (OR)=1.48, 95% confidence interval (CI)=1.07-2.05), and death (hazard rate (HR)=1.81, 95% CI=1.47-2.23). Sufficient food reduced hospitalization (OR=0.38, 95% CI=0.15-0.94) and mortality (HR=0.70, 95% CI=0.49-1.02). Regular exercise protected against poor mobility (OR=0.56, 95% CI=0.41-0.77), and poor self-rated health (OR=0.61, 95% CI=0.45-0.82). Lower activity level increased the hazard of death (HR=1.18, 95% CI=1.03-1.36). CONCLUSION: Disease-specific screens are important at an individual level but, because of low incidence of condition and comorbidity, may not be associated with population-level health 4 to 6 years later. Practice of health behaviors with a broader focus is associated, at a population level, with better functional status and self-rated health and lower rates of hospitalization and death 4 to 6 years later.