Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study
Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study
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DOI：
10.1371/journal.pone.0189134
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发表时间：
2017-12-20
期刊：
影响因子：
3.7
通讯作者：
Hogue, Carol
中科院分区：
文献类型：
--
作者：
Idler, Ellen;Blevins, John;Hogue, Carol
健康的社会决定因素框架使人们认识到社会力量在决定人口健康方面的首要重要性。然而，使用这一框架来了解社会、经济和政治条件对健康和死亡率的影响的研究很少包括宗教机构和联系。我们调查了一组衡量良好的社会和经济决定因素，以及几个宗教参与的衡量标准，作为成人死亡率的预测因素。健康和退休研究中年龄在50岁及以上的受访者(N=18,370)在2004年接受了采访，并跟踪调查了2014年的全因死亡率。暴露变量为宗教出席、重要性和从属关系。健康的其他社会决定因素包括性别、种族/族裔、教育、家庭收入和以基线计算的净资产。混杂因素包括身体和精神健康。健康行为和社会关系被包括为潜在的解释变量。针对复杂样本设计对COX比例风险回归进行了校正。在调整混杂因素后，参加宗教活动与死亡率存在剂量-反应关系，经常参加宗教活动的受访者的死亡率比从未参加过宗教活动的人低40%(HR=0.60，95%CI 0.53+/-0.68)。对那些宗教“非常重要”的人来说，风险增加了4%(HR=1.04，95%可信区间1.01+/-1.07)；宗教信仰与死亡风险无关。收入和净资产越高，死亡风险越低，女性、拉丁裔种族和土生土长的人也是如此。宗教参与是多方面的，在一组其他社会和经济健康决定因素的综合背景下，在美国成人样本中显示死亡风险较低和较高。
The social determinants of health framework has brought a recognition of the primary importance of social forces in determining population health. Research using this framework to understand the health and mortality impact of social, economic, and political conditions, however, has rarely included religious institutions and ties. We investigate a well-measured set of social and economic determinants along with several measures of religious participation as predictors of adult mortality. Respondents (N = 18,370) aged 50 and older to the Health and Retirement Study were interviewed in 2004 and followed for all-cause mortality to 2014. Exposure variables were religious attendance, importance, and affiliation. Other social determinants of health included gender, race/ethnicity, education, household income, and net worth measured at baseline. Confounders included physical and mental health. Health behaviors and social ties were included as potential explanatory variables. Cox proportional hazards regressions were adjusted for complex sample design. After adjustment for confounders, attendance at religious services had a dose-response relationship with mortality, such that respondents who attended frequently had a 40% lower hazard of mortality (HR = 0.60, 95% CI 0.53 +/- 0.68) compared with those who never attended. Those for whom religion was "very important" had a 4% higher hazard (HR = 1.04, 95% CI 1.01 +/- 1.07); religious affiliation was not associated with risk of mortality. Higher income and net worth were associated with a reduced hazard of mortality as were female gender, Latino ethnicity, and native birth. Religious participation is multi-faceted and shows both lower and higher hazards of mortality in an adult US sample in the context of a comprehensive set of other social and economic determinants of health.