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

W. Duan-Porter, S.N. Hastings, B. Neelon, C.H. Van Houtven

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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. © 2015, Society of General Internal Medicine.
Original languageEnglish
Pages (from-to)1156-1163
Number of pages8
JournalJournal of General Internal Medicine
Issue number8
StatePublished - 2015

Bibliographical note

Cited By :5

Export Date: 26 December 2018


Correspondence Address: Duan-Porter, W.; Health Services Research and Development, Durham VA Medical CenterUnited States


  • cardiovascular risk
  • control beliefs
  • mortality
  • insulin
  • adult
  • aged
  • Article
  • cerebrovascular accident
  • cohort analysis
  • death
  • demography
  • diabetes mellitus
  • event free survival
  • female
  • health belief
  • heart infarction
  • human
  • hypertension
  • major clinical study
  • male
  • observational study
  • psychological aspect
  • self report
  • attitude to health
  • longitudinal study
  • middle aged
  • patient
  • psychology
  • retrospective study
  • risk factor
  • treatment outcome
  • Aged
  • Diabetes Mellitus
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Hypertension
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Myocardial Infarction
  • Patients
  • Retrospective Studies
  • Risk Factors
  • Stroke
  • Treatment Outcome


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