Li Ying, Chen Yilin, Ding Xiwen, Chen Yin, Jiang Wei
Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China.
School of medicine, Zhejiang University, Hangzhou, China.
AIMS Public Health. 2025 Mar 20;12(2):360-377. doi: 10.3934/publichealth.2025021. eCollection 2025.
The salutary effects of a sense of control on health are well acknowledged; however, rigorous studies evaluating its effect on mortality remain scarce. This study aimed to study the association between a sense of control and mortality and to identify the effect of changes in this sense of control on mortality risk. This prospective cohort study included 22,793 participants over age 50 and their spouses, drawn from a nationally representative U.S. sample from 2006 to 2018. Cox proportional hazard regression analyses estimated the association between sense of control and all-cause mortality. Kaplan-Meier survival curves were compared using the log-rank test, and changes in sense of control levels associated with mortality risk were evaluated using the Cox proportional hazards model. Over the 12-year follow-up period, 5027 deaths were recorded. An increased sense of control was significantly associated with decreased mortality risk, as revealed by stratified analysis according to sex and age. Hazard ratios (HRs) for the second, third, and fourth quartiles of sense of control levels were 0.91 (95% CI, 0.84-0.98), 0.83 (95% CI, 0.77-0.92), and 0.79 (95% CI, 0.72-0.87), respectively, relative to the first quartile. Compared to individuals with stable sense of control scores from baseline to study conclusion, the HR was 0.58 (95% CI, 0.48-0.70) for those with increased scores and 1.81 (95% CI, 1.53-2.13) for those with decreased scores. High levels of sense of control were significantly associated with reduced mortality risk. These findings underscore the importance of a sense of control as a focus for public health interventions.
掌控感对健康的有益影响已得到广泛认可；然而，评估其对死亡率影响的严谨研究仍然稀缺。本研究旨在探讨掌控感与死亡率之间的关联，并确定这种掌控感的变化对死亡风险的影响。这项前瞻性队列研究纳入了2006年至2018年从美国全国代表性样本中选取的22793名50岁以上的参与者及其配偶。Cox比例风险回归分析估计了掌控感与全因死亡率之间的关联。使用对数秩检验比较Kaplan-Meier生存曲线，并使用Cox比例风险模型评估与死亡风险相关的掌控感水平变化。在12年的随访期内，记录了5027例死亡病例。按性别和年龄分层分析显示，掌控感增强与死亡风险降低显著相关。相对于第一四分位数，掌控感水平第二、第三和第四四分位数的风险比（HR）分别为0.91（95%CI，0.84-0.98）、0.83（95%CI，0.77-0.92）和0.79（95%CI，0.72-0.87）。与从基线到研究结束时掌控感得分稳定的个体相比，得分增加者的HR为0.58（95%CI，0.48-0.70），得分降低者的HR为1.81（95%CI，1.53-2.13）。高掌控感与降低的死亡风险显著相关。这些发现强调了掌控感作为公共卫生干预重点的重要性。
