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Patients? Self-Rated Health Worth Doctors? Attention

From left: Christopher Fagundes and Kyle Murdock. Image by Jeff Fitlow/Rice University.

Patients’ self-rated health is a better long-term predictor of illness and death than standard blood tests, blood pressure measurements, cholesterol ratings, or other symptomatic evidence a doctor might gather, according to a new study from Rice University.

The study in Psychoneuroendocrinology lays out mounting statistical evidence to support this conclusion.

The team led by Christopher Fagundes, PhD, a Rice assistant professor of psychology, and postdoctoral researcher Kyle Murdock, PhD, found evidence to bolster their theory that self-rated health-what you’d say when a doctor asks how you feel your health is in general-is as good as and perhaps even better than any test to describe one’s physiological condition.

“As psychologists, we think, ‘They’re sensing something. There’s something going on here,'” Fagundes said.

The researchers found existing data that established solid links between self-rated health and rising levels of herpesvirus activity, an important marker of poor cellular immunity that promotes high levels of inflammation.

“We found that self-rated health was associated with reactivation of herpesviruses,” Murdock said. “We’re not talking about the sexually transmitted disease, but viruses that are associated with things like cold sores that are ubiquitous among adults.”

“Herpesvirus activity is a very good functional marker of cellular immunity, because almost everybody has been exposed to one type of the virus or another,” Fagundes said. “It doesn’t mean you’re sick; it’s probably been dormant in your cells for most of your life. But because it reactivates at a cellular level and prompts the immune system to fight it, it becomes a great marker of how the system is working.

“You can imagine that when the immune system’s fighting something, you get more inflammation throughout the body, and inflammation contributes to disease. That’s it in a nutshell,” he said.

Previous studies by Fagundes and others demonstrated the link between herpesvirus activation and inflammation.

“We found that poor self-rated health was associated with more reactivation of these latent herpesviruses, which was associated with higher inflammation, and we know those two things are associated with morbidity and mortality, as well as some cancers, type 2 diabetes, and cardiovascular disease,” Murdock said.

Further analysis showed that those who reported feeling in good health had low virus and inflammation levels, while those who said they felt poorly were high on the virus and inflammation scales.

The researchers noted that primary care physicians are highly unlikely to check for herpesvirus activity or inflammation. “It’s too hard an assay to do clinically and takes too much time,” Fagundes said. “They look at things like white blood cell counts in cancer patients but would never do a herpesvirus latency test, and tests for inflammation would be rare. These are good markers for long-term health, but not for things that are going to impact you tomorrow.”

He said scientists haven’t yet identified the channel that gives people a sense of impending illness. One theory is that fatigue is a marker. Another possibility is a sense of imbalance in the gut microbiome, another avenue of future study.

But doctors should still pay close attention to what patients report. “When a patient says, ‘I don’t feel like my health is very good right now,’ it’s [a] meaningful thing with a biological basis, even if they don’t show symptoms,” Fagundes said.

This article was adapted from information provided by Rice University.