Religious attendance linked to lower mortality in elderly

July 23, 1999

DURHAM, N.C. -- A study of nearly 4,000 elderly North Carolinians has found that those who attended religious services every week were 46 percent less likely to die over a six-year period than people who attended less often or not at all, according to researchers at Duke University Medical Center.

After controlling for factors that could influence death rates -- such as medical illnesses, depression, social connections, health practices and demographics -- the frequent religious attenders were still 28 percent less likely to die than others in the study. The size of the effect was so strong that it was equal to that of not smoking cigarettes, Duke psychiatrist Dr. Harold Koenig said

Results of the study, funded by the National Institutes of Mental Health, are published in the July/August issue of Journal of Gerontology, medical sciences edition. Koenig, lead author of the research report, said it is the fourth major study published in the past two years documenting a relationship between religious attendance and longer survival.

"Participating in religious services is associated with significant health benefits in elderly people, even when you take into account the fact that religious people tend to start out with better health practices and more social support," Koenig said.

The current findings build on a series of earlier studies at Duke and elsewhere showing that religious people have lower blood pressure, less depression and anxiety, stronger immune systems and cost the health care system less than people who are less religiously involved.

In the Duke study, researchers arrived at their conclusions by analyzing data from a massive, 10-year research effort funded by the National Institutes of Health. Called the Established Populations for the Epidemiologic Studies of the Elderly (EPESE), the study cataloged information on how older North Carolinians age -- everything from social practices to religious behavior to eating and exercise habits.

Of the 1,177 subjects who died during the 6-year study period, 22.9 percent were frequent church attenders compared to 37.4 percent who were infrequent attenders.

While researchers can't explain the association between religious behavior and health, they say there is evidence that religious participation benefits people through a number of psychosocial, biological and behavioral pathways.

First, frequent religious service attenders reported having larger social networks and hence experienced greater social support than infrequent attenders, Koenig said. High levels of social support have been linked to better mental health, and they may also increase the likelihood that illnesses will be detected by friends and family and thus treated more rapidly, he said. Moreover, better mental health may confer protection against a wide range of physical illnesses, from heart disease to stroke, that have been linked to people with depression.

"In dozens of studies, depression has been shown to increase the death rate from all causes," Koenig said. "So it stands to reason that if religious participation fosters better mental health, then death rates would be lower among this population."

Second, the worship and adoration associated with religious rituals may directly contribute to mental well-being by serving as coping mechanisms for stressful events or physical illnesses later in life, Koenig said. "Such positive feelings may counteract stress and convey health effects, like enhanced immune function, that go far beyond the prevention of depression or other negative emotions," he said.

Third, said Koenig, people who cope better with life's ups and downs appear to be less inclined to drink, smoke and engage in other destructive health habits. Even at baseline measurement in the current study, religious elderly people were physically healthier and reported leading healthier lifestyles than less frequent attenders.

But these factors were not sufficient to explain the relationship between religious attendance and longer survival found in the current study or others recently conducted around the nation, Koenig said.

In one of the largest studies to date on the subject, researchers at the University of California at Berkeley, produced similar results in a 28-year study of 5,000 people aged 21 to 65 years old. They found that people who attended religious services at least once a week had a 23 percent lower risk of dying over the study period than less frequent attenders, even after controlling for health, social and demographic factors.

Future EPESE studies will attempt to identify the specific psychosocial, behavioral and biological mechanisms by which religious involvement could affect health and mortality.

Duke University Medical Center

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