How do discrepancies between self-rated and physical health predict self-reported overnight hospitalizations in later life?

objectivesDiscrepancies between self-rated health (SH) and physical health (PH) are linked to physical and psychological health outcomes in older adults. We investigate whether such discrepancies are also associated with self-reported overnight hospitalizations.

designA prospective, observational cohort design.

methodsWe followed 4373 older adults aged ≥60 years over a 6-year period in the Health and Retirement Study (2016-2022). Health asymmetry scores were computed by regressing baseline SH onto PH and extracting the residuals, reflecting the degree to which SH deviates from PH. Zero-inflated negative binomial mixed models, including a random intercept term, tested whether health asymmetry scores predicted (1) any overnight hospitalization and (2) the cumulative number of nights spent in hospital, adjusting for SH, PH and covariates.

resultsOver a 6-year follow-up, 55.34% of participants self-reported at least one overnight hospital stay. Higher health asymmetry scores (i.e., greater health optimism, where SH exceeded PH) were significantly associated with a lower expected number of nights spent in hospital (incidence ratio rate: 0.80; 95% confidence interval: 0.72, 0.89; p < .001), independent of SH and PH. However, health asymmetry was not significantly associated with the probability of belonging to the 'never hospitalized' group, in the zero-inflation component.

conclusionsDiscrepancies between SH and PH predict the intensity of self-reported hospital use above and beyond SH and PH alone. Although health asymmetry did not distinguish those, who were never hospitalized, older adults' interpretations of their health still carry prognostic value and may represent an important psychosocial determinant of health care utilization.