Association of Religious Service Attendance With Mortality Among Women.
Association of Religious Service Attendance With Mortality Among Women.
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宗教服务出席率与女性死亡率的关联。
DOI：
10.1001/jamainternmed.2016.1615
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发表时间：
2016-06-01
影响因子：
39
通讯作者：
VanderWeele TJ
中科院分区：
文献类型：
--
作者：
Li S;Stampfer MJ;Williams DR;VanderWeele TJ
关于服务出勤率和死亡率之间关系的研究往往受到反向因果关系方法学的限制，无法评估随时间推移的影响，以及关于调解人和特定原因死亡率的信息有限。我们在护士健康研究(NHS)的前瞻性队列中评估了出勤率和死亡率之间的关系，该队列包括74534名在基线水平上没有心血管疾病(CVD)和癌症的女性。宗教服务出席人数是通过自我报告的问题进行评估的，并于1992年收集，随后每四年收集一次。我们使用考克斯比例风险模型和带有时变协变量的边际结构模型来检验参加宗教活动与全因死亡率和特定原因死亡率之间的关系。我们调整了广泛的人口统计协变量、生活方式因素和在随访期间重复测量的病史，并进行了敏感性分析，以检查潜在的未测量和残留混杂的影响。在1996年至2012年的随访期间，我们发现了13,537人死亡，其中2,721人死于心血管疾病，4,479人死于癌症。在对主要生活方式、危险因素和参加人数进行多因素调整后，与从未参加过宗教活动的妇女相比，每周参加宗教活动一次以上的妇女全因死亡率降低33%(危险比[HR]=0.67，95%可信区间[CI]：0.62~0.71，趋势与t；0.0001)。比较每周参加宗教活动超过一次的妇女和从不参加宗教活动的妇女，心血管死亡率的比率为0.73(P<0.0001)，癌症死亡率的比率为0.79(P<0.0001)。在敏感性分析中，结果是稳健的。我们发现有证据表明，社会支持、抑郁症状、吸烟和乐观情绪在出勤率和死亡率之间起到了中介作用。频繁参加宗教活动与全因死亡率、心血管死亡率和癌症死亡率显著降低相关。
Studies on the relation between service attendance and mortality often have been limited by inadequate methodology for reverse causation, inability to assess effects over time, and limited information on mediators and cause-specific mortality. We evaluated associations between attendance and mortality in a prospective cohort, the Nurses’ Health Study (NHS), which included 74,534 women who were free of cardiovascular disease (CVD) and cancer at baseline. Religious service attendance was assessed by a self-reported question and was collected in 1992 and every four years subsequently. We used Cox proportional hazard model and marginal structural models with time-varying covariates to examine the association of religious service attendance with all-cause and cause-specific mortality. We adjusted for a wide range of demographic covariates, lifestyle factors and medical history measured repeatedly during the follow-up, and performed sensitivity analyses to examine the influence of potential unmeasured and residual confounding. During follow-up from 1996 until 2012, we identified 13,537 deaths, including 2,721 due to cardiovascular diseases and 4,479 due to cancer. After multivariate adjustment for major lifestyle, risk factors and attendance in 1992, attending religious service more than once/week was associated with 33% lower all-cause mortality, compared with women who had never attended religious services (Hazard Ratio [HR]=0.67, 95% confidence interval [CI]: 0.62–0.71, p for trend <0.0001). Comparing women who attended religious services more than once per week with those who never attend, the HR for cardiovascular mortality was 0.73 (0.62–0.85, p for trend <0.0001); and cancer mortality was 0.79 (0.70–0.89, p for trend <0.0001). Results were robust in sensitivity analysis. We found evidence that social support, depressive symptoms, smoking and optimism mediated the relationship between attendance and mortality. Frequent religious service attendance was associated with significantly lower risk of all-cause, cardiovascular and cancer mortality.
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