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Background: Self-rated health (SRH) predicts all-cause mortality in many studies; whereas, SRH has been inconsistently related to disease specific death, at least in part because often carefully documented cause of death is lacking. Methods: Physician-adjudicated cardiovascular disease (CVD), cancer, and other outcomes were evaluated in the Women’s Health Initiative (WHI) multi-ethnic Observational Study (OS) cohort of 93,6756 postmenopausal women, aged 50 to79 years. SRH was assessed by the RAND36 at baseline and three years later. Results: After adjusting for confounders, compared with women reporting excellent health, the risk of all-cause death among women reporting fair/poor health was significantly higher (HR=1.91, CI 1.68, 2.16) during a 7.6 year (1.6) follow-up, as were risks of death from CVD (HR=2.12, CI 1.65, 2.71) and from cancer (HR=1.40, CI, 1.15, 1.69) but not accidental death (HR=1.39, CI 0.69, 2.76). Compared with women whose scores did not change over the initial three years of follow-up, SRH that worsened significantly was associated with higher risk of all-cause (HR=2.06), CVD (HR=1.71) and cancer (HR=2.22) mortality; whereas, women with improved SRH had significantly lower all-cause, CVD and cancer mortality risks (HR: 0.78, 0.80, and 0.79, respectively). Conclusions: Low SRH and a decrease in SRH over three years were strongly associated with increased risks of all-cause, CVD, cancer and other cause mortality after more than 7 years of follow-up in post-menopausal women. Lower SRH was also associated with incident CVD and cancer

Self-rated Health and Medical Outcomes in the Women’s Health Initiative: The Aging Continuum, Health, Morbidity, Mortality