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Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An
Wei Duan-Porter1, Susan Nicole Hastings, Brian Neelon
1Health Services Research and Development, Durham VA Medical Center, Durham, NC, USA, wei.duan-porter@duke.edu.
Insights
Control beliefs impact survival for individuals with chronic conditions. High perceived constraints increase risk, while health-specific control offers protection, independent of diabetes or hypertension.
Area of Science:
- Psychology
- Public Health
- Epidemiology
Background:
- Chronic illnesses represent a significant burden in the USA, contributing to mortality, morbidity, and healthcare expenditure.
- Control beliefs, encompassing perceived constraints and mastery, may influence health outcomes in individuals managing chronic conditions.
Purpose of the Study:
- To investigate the association between control beliefs and the risk of mortality, stroke, and myocardial infarction (MI).
- To specifically examine these associations in individuals with diabetes mellitus (DM) and/or hypertension.
Main Methods:
- Retrospective cohort study utilizing data from 5,662 Health and Retirement Study participants.
- Assessed perceived global control (constraints, mastery) and health-specific control via self-report.
- Event-free survival (death, stroke, MI) was tracked over time.
Main Results:
- Elevated risks for adverse events were associated with diabetes (HR 1.33) and hypertension (HR 1.31).
- Higher perceived constraints significantly increased event risk (HRs 1.55-1.61).
- Health-specific control demonstrated a protective effect, significantly reducing risk in the highest quartile (HR 0.70).
Conclusions:
- Control beliefs did not modify the risk associated with diabetes or hypertension.
- However, control beliefs independently predicted significant differences in event-free survival for the overall cohort.
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.
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