Idler Ellen, Blevins John, Kiser Mimi, Hogue Carol
Department of Sociology, Emory University, Atlanta, Georgia, United States of America.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
PLoS One. 2017 Dec 20;12(12):e0189134. doi: 10.1371/journal.pone.0189134. eCollection 2017.
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.
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，利用这一框架来理解社会、经济和政治状况对健康和死亡率影响的研究，很少将宗教机构和宗教联系纳入其中。我们调查了一系列经过充分衡量的社会和经济决定因素，以及几项宗教参与度指标，将其作为成人死亡率的预测因素。2004年，对年龄在50岁及以上的健康与退休研究受访者（N = 18370）进行了访谈，并对全因死亡率进行跟踪至2014年。暴露变量包括宗教礼拜出席情况、重要性和宗教归属。其他健康的社会决定因素包括基线时测量的性别、种族/族裔、教育程度、家庭收入和净资产。混杂因素包括身心健康。健康行为和社会关系作为潜在的解释变量纳入。对Cox比例风险回归进行了复杂样本设计调整。在对混杂因素进行调整后，参加宗教仪式与死亡率呈剂量反应关系，即经常参加宗教仪式的受访者死亡率风险比从不参加的受访者低40%（风险比=0.60，95%置信区间0.53 - 0.68）。认为宗教“非常重要”的受访者死亡率风险高4%（风险比=1.04，95%置信区间1.01 - 1.07）；宗教归属与死亡率风险无关。较高的收入和净资产与较低的死亡率风险相关，女性、拉丁裔族裔和本土出生者也是如此。在美国成年人样本中，在一系列其他健康的社会和经济决定因素背景下，宗教参与是多方面的，且显示出较低和较高的死亡率风险。
