Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study

TitleControl Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study
Publication TypeJournal Article
Year of Publication2015
AuthorsDuan-Porter, W, Hastings, SN, Brian Neelon, van Houtven, CH
JournalJournal of General Internal Medicine
KeywordsHealth Conditions and Status

Background: Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness. Objective: To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension. Design: Retrospective cohort study. Participants: A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI. Main Measures: Perceived global control, measured as two dimensions constraints and mastery and health-specific control were self-reported. Event-free survival was measured in years, where event was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents family. Key Results: Mean baseline age was 66.2 years; 994 (16.7 ) had DM and 3,023 (53.4 ) hypertension. Overall, 173 (3.1 ) suffered incident strokes, 129 (2.3 ) had incident MI, and 465 (8.2 ) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 CI 1.07 1.67), hypertension (1.31, 95 CI 1.07 1.61) and perceived constraints in the third (1.55, 95 CI 1.12 2.15) and fourth quartiles (1.61, 95 CI 1.14 2.26). Health-specific control scores in the third (HR 0.78, 95 CI 0.59 1.03) and fourth quartiles (HR 0.70, 95 CI 0.53 0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95 CI 1.41 2.64). Conclusions: Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort. 2015 Society of General Internal Medicine


Export Date: 29 May 2015 Article in Press

Endnote Keywords

health condition/Mortality/MORBIDITY/incident stroke/myocardial infarction/diabetes mellitus/hypertension

Endnote ID


Citation Key8144
PubMed ID25792069
PubMed Central IDPMC4510216