Homocysteine, hypertension, and risks of cardiovascular events and all-cause death in the Chinese elderly population: a prospective study.

BACKGROUND: Increased homocysteine levels are associated with the risk of cardiovascular disease (CVD) and death. However, their prevention has not been effective in decreasing CVD risk. This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD. METHODS: This prospective study was conducted among 1,257 elderly participants (mean age: 69 years). A questionnaire survey, physical examinations, and laboratory tests were conducted to collect baseline data. Hyperhomocysteinemia was defined as homocysteine level ≥ 15 µmol/L. H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia. Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death. RESULTS: Over a median of 4.84-year follow-up, hyperhomocysteinemia was independently associated with incident CVD events and all-cause death. The hazard ratios (HRs) were 1.45 (95% CI: 1.01-2.08) for incident CVD events and 1.55 (95% CI: 1.04-2.30) for all-cause death. After adjustment for confounding factors, H-type hypertension had the highest HRs for incident CVD events and all-cause death. The fully adjusted HRs were 2.44 for incident CVD events (95% CI: 1.28-4.65), 2.07 for stroke events (95% CI: 1.01-4.29), 8.33 for coronary events (95% CI: 1.10-63.11), and 2.31 for all-cause death (95% CI: 1.15-4.62). CONCLUSIONS: Hyperhomocysteinemia was an independent risk factor, and when accompanied by hypertension, it contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

Residual beneficial effects after a 3-year integrated intervention on stroke in China: a 10-year prospective follow-up.

OBJECTIVES: To evaluate whether an intervention program designed to reduce stroke incidence would have long-term residual effects on reducing all-cause and cause-specific mortalities, including cancer 10 years after the intervention was completed. METHODS: This is a posttrial analysis. We prospectively observed the mortality of a community-based trial of primary prevention of stroke in China performed between July 1987 and June 1990 by extending the follow-up to 30 June 2000. At the baseline, 26,607 adults aged 35 years or above and free from stroke were recruited from five cites of mainland China; 13,212 and 13,395 were assigned into intervention and control group, respectively. Participants in intervention group received a regularly integrated intervention including lifestyle intervention and hypertensive drug treatment. The controls did not receive intervention provided by the investigators. RESULTS: During the 10-year posttrial follow-up period, we observed a significant reduction on overall deaths [hazard ratio 0.91; 95% confidence interval (CI) 0.83, 0.99] and stroke mortality (hazard ratio 0.79; 95% CI 0.63, 1.00). An insignificant late trial beneficial effect was observed for hypertensive disease (hazard ratio 0.69; 95% CI 0.30, 1.58), ischemic heart disease (hazard ratio 0.87; 95% CI 0.64, 1.17), other nonmalignant diseases, and most cancer sites. CONCLUSION: This study demonstrates that a 3-year integrated intervention program successful for stroke prevention had long-term residual beneficial effects on reducing overall disease burdens among urban Chinese population, especially for the deaths from stroke. However, whether the integrated intervention also leads to reduced mortality of cardiovascular diseases and cancer would have to be confirmed by future larger studies.

[Metabolic syndrome is an independent risk factor for cardiovascular disease events in patients with ischemic stroke].

OBJECTIVE: To explore the association between metabolic syndrome (MS) and risk of cardiovascular disease events (CVD) in patients with ischemic stroke. METHOD: A total of 1087 patients with ischemic stroke were enrolled from 5 community-based medical centres and underwent baseline evaluation on risk factors of stroke during the period of Jan. 2003 to Dec. 2006. After baseline survey, all patients were followed up until Dec 31, 2008 and new CVD events were recorded. MS was defined using CDS criteria. Proportional hazard models were used to assess the HRs and 95% CI of CVD events associated with MS and other components. RESULTS: The prevalence of MS was 40.4% at baseline. During an average follow-up of 3.5 years, 178 patients developed new CVD events. After adjusted for age, gender, smoking, drinking, marriage status, education level, hospitalization, recurrence of stroke, stroke duration, depression, cognition impairment and ADL, MS remains the independent predictor for the risk of CVD events. Compared with patients with non-MS, the risk of CVD events increased by 44% (HR: 1.44, 95%CI: 1.06 - 1.95). The risk of CVD also increased with the number of MS components. Compared with patients with 1 or less than 1 components of MS, the risk of CVD events increased by 30% (HR: 1.30, 95% CI: 0.83 - 2.04) in those with 2 components and by 69% (HR: 1.69, 95%CI: 1.11 - 2.56) in those with 3 or more components of MS. Hypertension and hyperglycemia and impaired fasting glucose also served as independent risk factors for CVD event (all P < 0.001). CONCLUSIONS: MS was independently associated with increased risk of CVD events in patients with ischemic stroke. There was a dose-response relationship between the numbers of MS components and the risk of CVD event.

[A cohort study on mortality and risk of death among population diagnosis as dementia, at base-line survey, in Beijing].

OBJECTIVE: To study the mortality and risk of death on dementia among ageing population. METHODS: A random sample including 2788 elderly residents was studied. Dementia was diagnosed under the two-phase procedure in 1997. In phase 1, questionnaire was administered, including the Mini-Mental State Examination (MMSE) tested. In phase 2, all the elderly who showed low MMSE score and some with normal MMSE score, were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM-III-R and NINCDS-ADRDA. The same sample was followed up in 2000 and 2004 the same way and data on deaths and causes was gathered. The overall time for follow-up was 7.25 years. RESULTS: 171 cases with dementia were diagnosed from 2788 subjects in 1997, with a crude death rate (CDR) of dementia was 7.8 per 1000 person-years and age-standardized CDR as 5.5 per 1000 person-years. The death rate was increased exponentially with age. In the dementia group, the total number of deaths was 133, with the CDR as 236 per 1000 person-years and the age-standardized CDR as 206 per 1000 person-years, in the end of the survey. In the non-dementia group, the total number of deaths was 680, with CDR as 40 per 1000 person-years and the age-standardized CDR as 31 per 1000 person-years. The difference in the two groups was statistically significant. The hazard ratio (HR) of dementia death appeared to be the biggest in the 60 - 74 - year group than the other groups. Data was analyzed with the Cox proportional hazards model after making necessary adjustment on potential covariates with the HR of dementia as 2.181 (95%CI: 1.751 - 2.717). The HRs were 2.524 (95%CI: 1.964 - 3.243) in Alzheimer's disease and 1.859 (95%CI: 1.213 - 2.850) in vascular dementia. CONCLUSION: The CDR and HR of dementia were higher than the non-dementia group in the aging population, showing that dementia was one of the most important risk factors on death in the aging population.

[Study on the incidence and risk factors of dementia in elderly residents from communities in Beijing].

OBJECTIVE: To study the incidence of dementia and its risk factors among the elderly living in the community of Beijing. METHODS: A sample of 2788 elderly residents from Beijing were investigated regarding the incidence of dementia which was diagnosed using two-stage method in 1997. In the first stage, questionnaire was filled, including MMSE checked up. In the second stage, all the elderly who had lower MMSE score and some with normal MMSE score were examined by neurologists. The clinical diagnosis of dementia was set up by two neurologists according to the criteria of DSM-III-R and NINCDS-ADRDA. The same sample was followed up on 2000 and 2004 by the same way, with the overall time for following-up as 7.25 years. RESULTS: 171 dementias cases were diagnosed among the 2788 elderly in 1997. At the end of the survey, another 180 new cases developed. The average weighted incidence was 0.84/100 person year, adjusted by age (it's same followed), with 0.64/100 person year in males and 1.01/100 person years in females. The incidence of vascular dementia was 0.35/100 person years, with male as 0.39/100 person year and female as 0.32/100 person years. The incidence of dementia was increasing with age, but decreasing with time of education by Multinomial Logistic Regression Analysis. Old age and illiterate appeared to be the risk factors for dementia. People with stroke history and elevated systolic blood pressure were risk factors for vascular dementia. CONCLUSION: The incidence of dementia in the elderly in Beijing was higher than in other areas of China. Old age and illiterate were risk factors for dementia. Being male, illiterate, with stroke history and elevated systolic blood pressure were risk factors for vascular dementia.

[Prospective study on associations between levels of total cholesterol, triglyceride and risk of ischemic and hemorrhagic strokes].

OBJECTIVE: To explore associations between levels of total cholesterol (TC), triglyceride (TG) and incidence of ischemic and hemorrhagic strokes in populations. METHODS: Baseline investigations on stroke-related risk factors and physical examinations were performed in 10 093 (> 35 years) stroke-free urban community residents from 5 cities in China during May to July in 1987, follow-up investigations on stroke events were made during 1998 to 2000. The hazard ratios and 95% confidence intervals (CI) of ischemic and hemorrhagic strokes in middle, high tertiles of baseline TC or TG levels were compared with low baseline tertile residents using the Cox regression model. RESULTS: There were 491 first strokes during the 8-years cohort follow-up. Compared with the low tertile, risk of ischemic stroke in the middle and high tertiles of TC level was increased by 61% (HR: 1.61, 95%CI: 1.14-2.27) and 58% (HR: 1.58, 95%CI: 1.12-2.22) after adjustments for DBP, age, sex and other variables in the Cox proportional hazards model. Compared with the low tertile, risk of ischemic stroke in the high tertile of TG level was increased by 43% (HR: 1.43, 95%CI: 1.02-2.00). However, risk of hemorrhagic stroke in the middle and high tertiles of TC level decreased by 12% (HR: 0.88, 95%CI: 0.64-1.22) and 33% (HR: 0.67, 95%CI: 0.48-0.95) compared with the low tertile. CONCLUSIONS: Elevated serum TC and TG are independent risk factors for risk of ischemic stroke. However, low TC was related with increased risk of hemorrhagic stroke.

[Effects and trends of stroke and life expectancy among older adults--from 1990s to 2000s].

OBJECTIVE: To explore the experience of stroke influencing the life expectancy (LE), active life expectancy (ALE), inactive life expectancy (IALE), and the trend of life expectancy among older adults, from 1990s to 2000s in Beijing, China. METHODS: A representative sample of 3257 elderly people living in urban or rural communities in Beijing were followed up from 1990 until 2004. Their health and survival status had been surveyed every 3-5 years. Activity Daily Living (ADL) scale, recommended by WHO was used to evaluate the physical function capability of the elderly. SAS was used to estimate LE, ALE and IALE for both periods of 1992-1997 and 2000-2004 by age and by areas of residency (rural or urban). RESULTS: LE and ALE were shorter, and IALE was longer, among the elderly with stroke than those without stroke at all age groups. Functional status at baseline was also a very important factor in determining ALE and IALE. For those active at baseline, ALE in the elderly with stroke was shorter than those without. There were no differences found in IALE between those with or without stroke, but ALE was longer than IALE. For the elderly with stroke and inactive at baseline, their IALE were longer than ALE and their ALE were at low levels in all age groups. Among those with stroke and living in urban, their LE and ALE were longer than those living in the rural area. When comparing with the period of 1992-1997, both LE and ALE increased during the period of 2000-2004 in all the elderly groups, both in urban and rural areas. The largest increment occurred among those with stroke who originated in an inactive state. CONCLUSION: Stroke reduced both quality and quantity of life of the elderly. The reductions of LE and ALE were greater among the elderly with stroke in rural than in urban areas. Both LE and ALE increased from 1992-1997 to 2000-2004 among the elderly with stroke in both urban and rural areas.

Stroke and active life expectancy among older adults in Beijing, China.

PURPOSE: Increasing stroke prevalence, population ageing and economic change in China necessitate a better understanding of the impact of stroke. This study examines the impact of stroke on disability and trends over time. METHOD: Data are from longitudinal surveys conducted in the Beijing municipality from 1992 to 1997 and 2000 to 2004. Multi-state life tables constructed from hazard models are used to estimate life expectancy (LE) and active life expectancy (ALE). The active state is defined using six functional tasks and mortality is determined using interviewer follow-ups. RESULTS: LE and ALE are higher among those without stroke. Population-based estimates for the cohort observed beginning in 1992 indicate LE at age 55 of about 17 for those who have had a stroke and about 21 for others, whereas years of active life are about 14 and 19, respectively. Disability status at baseline is important for determining ALE. For those active, LE and ALE patterns are similar regardless of stroke status. For those inactive, the stroke group lives almost their entire lives inactive. Stroke reduces years of life by 20-40%, but active life by up to 90%. CONCLUSION: Trends in ALE among those with stroke suggest possible influences of rapid development, concomitant improvement in health care and an increased focus on disease management.

Influence of different health-care systems on health of older adults: a comparison of Hong Kong, Beijing urban and rural cohorts aged 70 years and older.

OBJECTIVE: To explore the hypothesis that better health status of elderly populations is primarily determined by the provision of freely accessible health service at low or no cost to the user and a social welfare system. METHOD: Information was collected by questionnaire from surveys of three cohorts of elderly (70 years and older) Chinese. Data from two health-care systems were compared: the low-cost or free government-subsidized system in Hong Kong, and the market-orientated user-pays system in urban (Beijing), and rural China. RESULTS: The Beijing rural cohort had the best health profile, whereas the Hong Kong cohort had the worst, despite the better lifestyle practices in the Hong Kong and Beijing urban cohorts compared with the Beijing rural cohort, and higher socioeconomic status in the Beijing urban and Hong Kong cohorts. However, the Beijing rural cohort had the highest prevalence of functional limitations. CONCLUSION: While health-care systems may affect life expectancy at birth, psychosocial, lifestyle and socioeconomic factors influence subsequent health status of elderly people in a complex manner.

[Study on the isolated systolic hypertension and its prognosis among 2866 elderly residents at the community level in Beijing].

OBJECTIVE: We followed a group of community residents above 60 years old to investigate how isolated systolic hypertension (ISH) could influence the prognosis in the long run among the elderly. METHODS: A selected sample of 60 year olds and over from the Beijing residential communities was randomized ascertained to a longitudinal study. Baseline data was collected in 1993 and 11 years later in 2004, the all-cause death, mortality of cardiovascular and cerebrovascular diseases were observed and analyzed. RESULTS: (1) The morbidity of hypertension(HT) was 61.7% and ISH was 27.8% seen in baseline survey while the SBP was increasing with age. (2) The longitudinal study showed that the total mortality and the mortality of cardiovascular and cerebrovascular diseases in HT group were higher than in the normal blood pressure(BP) group. The total mortality in the group ISH was higher than in normal BP group (55.2%: 46.2%; P < 0.01). The mortality OR for group ISH/group normal BP was 1.4 and group DSH/group normal BP was 1.6. The level of SBP was related to prognosis too which showed that the mortality appeared the lowest in 120-139 mm Hg group, and increased when the level of SBP was above 140 mm Hg. CONCLUSION: SBP was an independent risk factor on the all-cause mortality and the mortality of cerebrovascular diseases in eldevly. ISH also appeared a risk factor on the prognosis among the elderly, suggesting that more attention should be paid to it and treatment be carefully addressed.

[Evaluation on a community-based intervention program among people with different risk factors of stroke].

OBJECTIVE: To evaluate the effect of a long-term community-based intervention program on risk factors of stroke among people with different risk factors. METHODS: In 1987,2 geographically separated communities with 10 000 registered residents of each, were selected as either intervention or control communities in Beijing and Changsha. A cohort containing 2700 subjects at the age of 35 years or older,and free of stroke were sampled from each community. The baseline survey was conducted to screen the subjects at high risk for intervention and there were 5319 and 5506 subjects enrolled in intervention and control cohorts,respectively. Then,a program for controlling the risk factors of stroke was initiated in the intervention cohort and health education was provided to the whole intervention community. A follow-up survey was conducted in 1999. The information on incidence and mortality of stroke was collected. RESULTS: Comparing with the control cohort, the risk of incidence and mortality of stroke decreased by 22 % ( HR = 0.78,95 % CI:0. 66-0.92) and 73 % (HR = 0.27,95 % CI:0. 17-0.42) in intervention cohort. The risks of stroke were lower in intervention cohort than in control cohort among almost all of the sub-groups with or without risk factors of stroke except for being male,current smokers and current alcohol drinkers. The risk of death caused by stroke decreased significantly in those with or without the risk factors of stroke. CONCLUSION: The long-term community intervention on the risk factors of stroke could effectively reduce the risk of incidence and mortality of stroke among people with or without the risk factors of stroke. More attention should be paid to the males and those who smoke or drink alcohol.

Subtype hypertension and risk of stroke in middle-aged and older Chinese: a 10-year follow-up study.

BACKGROUND AND PURPOSE: Hypertension is the most important indicator of stroke. We aim to compare the long-term effects of the subtypes of hypertension on the risk of stroke in a Chinese cohort. METHODS: A total of 26,587 subjects > or =35 years of age and free of stroke were recruited in 5 cities in 1987. The subtypes of hypertension were defined as isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH), as well as managed hypertension (MHT), according to the criteria of systolic blood pressure > or =140 or diastolic blood pressure >90 mm Hg or under antihypertensive treatment. The relative risks of stroke with the subtypes of hypertension, compared with normotensives, were estimated using the Cox model after adjustments for age, sex, and other confounders. RESULTS: The prevalence of hypertension was: ISH 7.1%, SDH 18.4%, IDH 6.7%, and MHT 3.9%. During a total of 233 437 person years of follow-up, 1107 subjects developed stroke (614 ischemic and 451 hemorrhagic events and 42 unclassified). SDH patients were at the highest risk of stroke among all the hypertensives. The hazard ratio and 95% CI was 2.96 (2.49 to 3.52) for all stroke, 4.05 (3.10 to 5.30) for hemorrhagic, and 2.33 (1.84 to 2.95) for ischemic stroke. Although the incidence of stroke was higher in the older population, the effect of hypertension, especially SDH, on hemorrhagic stroke is stronger in the middle-aged population. CONCLUSIONS: ISH and IDH are similarly prevalent in the population; both are independent predictors of stroke. Patients with SDH are at the highest risk of stroke and should be treated more aggressively.

[Study on the active life expectancy of the elderly and its longitudinal transition in Beijing].

OBJECTIVE: Focus on the Active Life Expectancy (ALE) of elderly in Beijing and the transition in recent years. METHODS: A representative sample of 3257 elderly people who lived in the urban, suburban and rural communities in Beijing that had been followed up for 12 years. Their health and survival status had been surveyed every 2-3 years. Activity Daily Living scale (ADL), recommended by WHO was used to evaluate the physical function capability of the elderly. IMaCH 0.8 was used to estimate life expectancy (LE) and active life expectancy (ALE) for both periods while age, sex and rural/urban residence areas were adjusted. RESULTS: Longitudinally, data showed that the main characters remained unchange throughout the two periods including 1) LE, ALE, ALE/LE of elderly living in urban area were higher than those living in rural area; 2) LE seemed longer in women than men, but ALE/LE was less in women. The transition between two period showed that 1) LE increased modestly in all groups but less prominent in urban residents and in females; 2) ALE was not significantly changed in the rural elderly but declined markedly in women living in the urban area; 3) ALE/LE of the elderly declined in all groups, especially in urban and oldest old groups. CONCLUSION: In Beijing, elderly AL-E did not increase in parallel with the increase of LE while ALE/LE of the elderly declined significantly in recent years. In order to improve quality of life of the elderly and to increase their ALE, emphasis should be given to prevention of cardiovascular, cerebrovascular and other chronic diseases while reducing the occurrence of physical disability and strengthening on rehabilitation would be the basic health care measures.

[A comprehansive evaluation on stroke prevalence among elderly in urban and rural areas of Beijing, 2002].

OBJECTIVE: To describe the prevalence and disability of stroke as well as the stroke-related diseases among elderly in urban and rural regions of Beijing. METHODS: In 2002, three communities were selected from urban, suburb and rural regions from Beijing areas, respectively. Twenty percent of the elderly were randomly selected from three communities. The information about history of stroke, hypertension, heart diseases and diabetes, self-rated health (SRH), activity of daily living (ADL) and instrumental ADL (IADL), smoking and drinking habits, knowledge about cardiovascular diseases prevention were collected. RESULTS: A total of 2487 elderly were interviewed and the prevalence of stroke was 12.9% (321/2481). Eighty-seven of the stroke patients were diagnosed by CT/MRI. 19.9% of stroke patients had experienced 2 or more attacks. The highest prevalence of stroke was in the urban region and the lowest in the rural region (16.9% vs. 8.5%, P for trend < 0.01) while it was higher in males than in females (P < 0.05). The prevalence of stroke tended to increase with age in urban and 34.6% of the stroke patients had recovered completely. The proportions of poor SRH, ADL and IADL dependence, as well as the prevalences of hypertension, heart diseases and diabetes were higher among the elderly with stroke than those without. Although rates of awareness and treatment of hypertension were at the high levels among the elderly with stroke , the control rate was low, especially in the rural region (as low as 4.3%). The level of knowledge on the prevention of cardiovascular diseases, and the rates of smoking and drinking were similar between the elderly with or without stroke. CONCLUSION: The prevalence of stroke had increased dramatically during the past decade in Beijing. The proportion of poor SHR, ADL and IADL dependence, prevalence rates of stroke related diseases were higher among the elderly with stroke than those without. Secondary prevention of stroke among Beijing elderly called for urgent action.

[Evaluation of predictive effect of some health-related indices on deaths among ageing residents through a 8-years' follow-up study in Beijing].

OBJECTIVE: To study the predictive effects of some health status indicators to deaths in the elderly population. METHODS: In 1992, a cohort of 3257 people older than 55 years old was formed from Beijing urban and suburb area. Demographic and information of activity of daily living (ADL), self-rated health (SRH), chronic diseases history and other related variables were collected at baseline survey in 1992. MMSE and CES-D were studied in 2101 on 3257 elderly people. Follow-up surveys were conducted in 1994, 1997 and 2000, to find that a total number of or= 75), resident place (suburb) and education level (illiteracy). The functional disability, poor self-rated health status, history of chronic diseases and abnormal cognition function were the major predictors of deaths. Multinomial logistic regression analysis showed that after adjustment for sex, age, residential place, education level and history of chronic diseases, functional disability, poor self-rated health status and abnormal cognition function remained as significant independent predictors to death. CONCLUSIONS: Functional disability, poor self-rated health status and abnormal cognition function were the most valuable indicators of death. Not only they had joined predictive effects to death, but also remained relatively independent. They had important value in the evaluation on healthy prognosis and the life quality of the elderly.

[Community intervention on hypertension and stroke].

OBJECTIVE: To evaluate the community-based intervention on reduction of hypertension and stroke in different age groups and subtypes hypertension. METHODS: In 6 cities, 2 geographically separated communities with a registered population about 10 000 of each were selected as either intervention or control communities. A cohort containing 2 700 subjects, 35 years or older, and free of stroke were sampled from each community. The baseline survey was conducted to screen the subjects for intervention. In each city, a program for control of hypertension, heart diseases and diabetes was initiated in the intervention cohort and health education was provided to the whole intervention community. A follow-up survey was conducted 3 years later. RESULTS: Within 3 years, the prevalence of hypertension increased in both intervention and control cohorts, as well as in the middle and elderly cohorts, especially in the middle aged in control group. Among hypertensives in the intervention cohort, the rates of awareness, treatment and control of hypertension got improved. The incidence of stroke was 29% lower (HR = 0.71, 95% CI: 0.58 - 0.87) and mortality of stroke was 40% lower (HR = 0.60, 95% CI: 0.42 - 0.86) in the intervention cohort than the control cohort. The intervention was most effective in reduction of stroke for those with isolated systolic hypertension and combined systolic and diastolic hypertension (All P < 0.05). Meanwhile, all-cause mortality was 11% lower (HR = 0.89, 95% CI: 0.78 - 0.99) in the intervention cohort than in the control cohort. CONCLUSION: The community-based intervention was effective in controlling the development of hypertension and stroke, while the elderly people benefit more than the middle aged people from the intervention.

[Study on the relationship between self-rated health situation and health status in the elderly-an 8-year follow-up study from Multidimentional Longitudinal Study of Aging in Beijing].

OBJECTIVE: To study the relationship between self-rated health (SRH) and prevalence of chronic diseases, and all-cause mortality in the elderly population. METHODS: In 1992, a cohort of 3257 people > or = 55 years old was selected from Beijing, the information of SRH and other related variables were collected from 3 157 subjects at the baseline survey. Three follow-up surveys were conducted in 1994, 1997 and 2000, respectively. RESULTS: The SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Comparing the subjects with excellent SRH, the prevalence rates of chronic diseases, stroke, heart diseases and respiratory system diseases were almost doubled among those with average and poor SRH. By 2000, 993 death occurred. All-cause mortality was negatively associated with SRH, i.e. the risk of death was 12% which was 53% higher for the subjects with average SRH (HR = 1.12, 95% CI: 0.93 - 1.35) and poor SRH (HR = 1.53, 95% CI: 1.25 - 1.88) than those with excellent SRH, respectively. The risks of death from stroke and heart disease were 2.25 (HR = 2.25, 95% CI: 1.67 - 3.04) and 2.22 (HR = 2.22, 95% CI: 1.61 - 3.07) times higher among the subjects with poor SRH than those with excellent SRH respectively. After adjustment for age, gender, resident place, marriage status, education, satisfaction on their own economic condition, seeing doctors or hospitalized within the last 1 year, history of chronic disease, cognition function, body mass index, activities of daily living and depression, as well as deleted the subjects died within first or third year of the baseline survey respectively, poor SRH remained a significantly independent predictor to all-cause death as well as to the death of stroke and heart diseases. CONCLUSIONS: The frequency of poor SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Poor SRH was associated with the prevalence of chronic conditions and mortality among the elderly. The findings suggested that SRH might have served as an important indicator in the evaluation on health status among the elderly.