Abstract
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.
Highlights
The social determinants of health framework is the current dominant paradigm in public health and epidemiology
As have the small number of previous investigations with US nationally-representative samples, this study shows a protective effect of religious attendance against all-cause mortality [21, 22, 23]
The protective effect of frequent attendance is partially mediated by health behaviors and to a lesser extent, social ties, a finding again similar to that of other studies [21, 22, 23, 24, 25]
Summary
The social determinants of health framework is the current dominant paradigm in public health and epidemiology. It originated in the 1960s with the Whitehall Studies of British civil servants, which established that there was a social gradient of health inequality stretching across all social strata within this single work sector [1]. Further studies of data from England and Wales and the United States confirmed health inequality gradients tied to socioeconomic indicators of income and education in large, representative populations [2]. In 2008 the World Health Organization’s Commission on Social Determinants of Health published a report arguing that worldwide health inequalities arise from “. . .the conditions in which people live and die are, in turn, shaped by political, social, and economic forces.”. In 2008 the World Health Organization’s Commission on Social Determinants of Health published a report arguing that worldwide health inequalities arise from “. . .the circumstances in which people grow, live, work, and age. . ..” The Commission further argued that “. . .the conditions in which people live and die are, in turn, shaped by political, social, and economic forces.” there has been a pronounced recent public health emphasis on the upstream social conditions that are "fundamental causes" [4] of health throughout the life course
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