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

Abstract

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.