A new analysis of thousands of health care visits over a two-year period found that a person with low self-confidence is one of the most at-risk groups for heart disease.
A number of studies have linked poor self-esteem to higher rates of diabetes and high blood pressure, but it has never been demonstrated in a large-scale study.
Researchers from Columbia University, Johns Hopkins University, the University of Washington, and others examined health care records from nearly 5,000 people aged 25 to 79 and found that people who were more insecure about their health were about twice as likely to develop cardiovascular disease as people who reported a high level of self-doubt.
The study, published in the New England Journal of Medicine, looked at health care-seeking patients in the US and Australia, as well as people in the United Kingdom.
It found that those who reported low self esteem were more likely to have their health care utilization increase by 20 percent or more over the next year.
The authors write that the risk of a person developing cardiovascular disease increases with a person’s body mass index (BMI) – the weight in kilograms divided by the square of the height in meters.
“While there is a clear relationship between BMI and health, it is not clear that BMI is a good predictor of cardiovascular risk,” lead author Jens Loesch told reporters at a press briefing.
“There are other factors that might also be at play.
For example, it might be that people with high levels of self esteem are more likely than those with low levels of confidence to use health care.”
It’s the first study to look at BMI in this way, but previous studies have shown a relationship between self-deprecating comments and heart disease risk.
“Self-depreciating comments have been shown to be associated with increased cardiovascular risk, but there is no clear association between self esteem and cardiovascular risk for people with low BMIs,” the researchers wrote.
“We focused on the relationship between BMIs and health-related quality of life in this study, and found a stronger relationship between low BMI and health care use among people with lower BMIs than among those with high BMIs.”
People with a BMI of less than 18.5 had the lowest rates of use of health services.
They were also more likely at risk of developing cardiovascular problems.
The researchers also found that patients with low confidence were also much more likely not to use a primary care doctor, suggesting that a high reliance on health care was a greater risk factor for heart failure than being obese.
The risk of death and disability due to heart failure increased with higher BMIs, and it was particularly high among patients with high BMI and a history of heart attack.
Low self-worth is linked with cardiovascular disease.
The report authors noted that self-perception and self-reported health-risk factors were both related to the rate of use and quality of care, but that it was not clear whether these factors were correlated with health-status, which is often not included in health care costs.
“Our findings suggest that the higher BMI is, the greater the likelihood that patients will not have access to primary care, which would have consequences for the health status of the patient population,” Loesck said.
He added that while it’s not yet clear whether the association is causal, it’s possible that the relationship is driven by factors like lack of access to care.
He cautioned that it’s also not clear what would happen if people who are perceived to be low self worth have health issues in the future, but noted that these factors are often hard to measure.
“These findings provide additional information that can help us understand how people with health issues develop their health and the health of their patients,” Loech said.
“It may be that our experience in the current study may provide us with additional insights about the importance of health-oriented behaviors to improving health status and reducing the incidence of cardiovascular disease.”
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