Reconsidering survival and church attendance in modern Denmark

- an invitation to creative thinking

RESEARCH IN FAITH AND HEALTH IN SECULAR

SOCIETY

May 18th 2010

University of Southern Denmark

Peter la Cour, ph.d.Multidisciplinary Pain Center, National Hospital, Copenhagen

Yoichi Chida, Andrew Steptoe, Lynda H. Powell: Religiosity/Spirituality and Mortality. A Systematic Quantitative

Review (2009). (Included studies = 69)

General findings:

Church attendance associates with lower mortality

Private religiosity (prayer, TV-sermons etc) usually do not associate with low mortality – due to ”fox-hole-religiousity”

Long time meditation associates with lower blood pressure and changes in brain structure

WHY? Theoretical diagram over possible causal paths

(Koenig 1999)

Religion and survivalA 20-year follow-up on 734 Danes

born in 1914Peter la Cour, Kirsten Avlund, Kirsten Schultz-Larsen (2006)

Glostrup 1914-cohorte:• 734 persons• Real medical examination and personal

interviews as 70-year old in 1984

• 20 year follow-up on death i 2004 (and 2005)

Measures of religion

“Are you a member of a religious community?”a) Folkekirke b) Katolic c) Mosaic d) Other e) Not a member

“Does it mean anything to you?” = Importance of affiliation (a) yes, (b) no, (c) Don’t know

“Are you attending church?” = Church attendance(a) never, (b) rarely (i.e. just religious ceremonies), (c) often (i.e. more than religious ceremonies.)

“Do you listen to religious radio orTV?” = Religious mediaAnswers handled as above.

Control-variables

• Gender, education• Physical and mental health (some

constructed and computed)• Social connections (some constructed and

computed)• Health behaviors

Value ImportantanceOdds ratioDemographicsGender Male 35.4%

Female 62.3% 3.00 (2.14 - 4.20) ***Education < 12 y 47.0%

≥ 12 y 61.8% 1.839 (1.12 - 3.02) *Medical and mental healthADL unimpaired 50.5%

impared 45.7% .82 (.58 - 1.17)Self-rated health extraordinary/ good 48.9%

not quite good / bad 49.0% .99 (.64 - 1.52)Chronic conditions not present 47.1%

present 49.9% 1.2 (.80 - 1.57)Depression not present 48.8%

present 54.2% 1.28 (.55 - 2.83)Anxiety not present 48.4%

present 56.4% 1.38 (.72 - 2.66)

Importance of membership

Value Church Odds ratioDemographicsGender Male 61.1%

Female 69.2% 1.43 (1.05 - 1.94) *Education < 12 y 66.0%

≥ 12 y 60.2% .78 (.50 - 1.30)Medical and mental healthADL unimpaired 66.5%

impared 62.6% .84 (.61 - 1.16)Self-rated health extraordinary/ good 66.3%

not quite good / bad 60.9% .79 (.54 - 1.17)Chronic conditions not present 68.8%

present 63.3% .78 (.57 - 1.08)Depression not present 65.6%

present 55.9% .66 (.33 - 1.33)Anxiety not present 64.6%

present 72.5% 1.45 (.77 - 2.73)

Church attendance 1

Social connectionsMarried (living partner) No 68.1%

Yes 63.6% .82 (.59 - 1.13)Frequency of social contactless than once a week 55.6%

more than once a week71.3% .1.98 (1.45 - 2.71) ***Given help to others no 58.9%

yes 69.3% 1.58 (1.16 - 2.15) **

Help received no 56.1%yes 72.2% 2.03 (1.45 - 2.76) ***

Public help received no 66.4%yes 54.8% .61 (.36 -1.04)

Health behaviourSmoke no 66.7%

daily 63.2% .86 (.63 - 1.16)Alcohol less than 14/week 65.3%

more than 14/week 64.6% .97 (.62 - 1.51)BMI under 25 61.5%

over 25 69.5% 1.43 (1.05 - 1.94) *

Church attendance 2

Church attendance

Model Total sample Females MalesN = 732 N = 367 N = 365Hazard Ratios (95 % CI)Hazard Ratios (95 % CI)Hazard Ratios (95 % CI)

1. Church attendance only .73 (.62 - .87) ** .73 (.57 - .95) * .78 (.62 - .99) *2. Model 1. + Gender and education .76 (.64 - .91) ** .71 (.54 - . 92) ** .80 (.63 - 1.01)3 Model 2. + Health, physical and mental.78 (.66 - .93) ** .71 (.54 - .93) ** .85 (.67 - 1.09)4. Model 3. + Social support. .82 (.68 - .98) * .73 (.55 - .96) * .91 (.71 - 1.17)5 Model 4. + Health behaviour .82 (.68 - .97) * .73 (.55 - .97) * .92 (.71 - 1.18)

Both gender

Men

Women

Raw, computed means 2004Importance Suvival, Yes = 83.40 year (SD .37) No = 81.80 year (SD .35)(p <. 001) (computed survival limited to 90.22). Big gender differences:Women, difference 1.26 år, (p = .03)Men, difference 0.30 år, (p = NS)

Church attendance in 1984 Survival for church attenders = 83.30 years (SD .28) Non-attenders = 81.33 (SD .39), (p for difference <.001, computed survival limited to

90.22). Women, difference 2.19 year (p = .02)Men, difference 1.34 years, (p = .04)

Religious media i 1984 User = 82.79 (SD .33)Non-user = 82.43 (SD .33) Women, difference 0.57 years, NSMen, difference - 1.25 years, NS

Raw, computed means 2005

Church attendance? in 1984 • Survival for attenders = 83.54 years

(SD .30) • Non-attenders = 81.48 (SD .41), (p for

difference <.001, computed survival limited to 91.07).

• women, difference 2.22 years, (p = .02)• men, difference 1.43 years, (p = .04)

Explanations?

1. How to explain/understand the effects of church attendance?

2. How to explain/understand the gender differences?

Are the explaining variables gender specific? One or two questions?

What it is not explaning things:

The explanation is not the church attendance in itself!

The dichotomized church attendance showed significance when done ”often + rare” versus ”never” - not ”often” versus ”rare + never”

What it is not explaning things:

The explanation is not usual lifestyle factors:

Tobacco – 4% difference, non-sign

Alcohol – 1 % difference, non-sign

BMI – 8 % difference, significant, but the wrong way!

Other suggestions

Forgiveness – mediating all /nearly all religious/(mental) health meassures in three American samples (Lawler-Row 2010)

Any reason this should be the case i Denmark?

Any reason that it should be gender specific?

ANOVA

    Sum of Squares df

Mean Square F Sig.

Education binary, >12 y =1 Between Groups ,133 1 ,133 1,189 ,276MOBILITET-T ASDL 0=bad 6=good Between Groups 9,038 1 9,038 2,837 ,093

ADL binary 1= impaired Between Groups ,242 1 ,242 1,089 ,297

SELFRATED HEALTH LAST YEAR Between Groups ,432 1 ,432 1,003 ,317Selfrated health binary, godt=0 Between Groups ,207 1 ,207 1,384 ,240OTHER HEART CONDITION Between Groups ,161 1 ,161 1,712 ,191

STROKE IN BRAIN Between Groups ,206 1 ,206 4,951 ,026BRAIN HEAMORHAGE Between Groups ,008 1 ,008 ,554 ,457BLOOD PRESSURE TO HIGH Between Groups ,026 1 ,026 ,133 ,716

DIABETES MELLITUS Between Groups ,027 1 ,027 ,558 ,455BRONKITIS Between Groups ,000 1 ,000 ,001 ,971METABOLISM DISEASE Between Groups ,034 1 ,034 ,623 ,430EPILEPSI Between Groups ,013 1 ,013 ,746 ,388Count cronical conditions Between Groups 1,405 1 1,405 1,864 ,173

Croniscal conditions, binary, present=1 Between Groups ,005 1 ,005 ,021 ,886HYPERTENSION-SYSTOLISK OG DIASTOLOSK Between Groups ,023 1 ,023 ,017 ,895

     HypertensionKSLbinary Between Groups ,023 1 ,023 ,109 ,742BRONCHITIS KSL Between Groups ,024 1 ,024 ,232 ,631Myocardieinfakt KSL Between Groups ,244 1 ,244 4,529 ,034Diabetes Between Groups ,341 1 ,341 ,746 ,388Diabetes, binary KSL Between Groups ,073 1 ,073 ,764 ,382WALKING DISABILITY PGA LAMMELSER/STYRINGSBESVÆR

Between Groups ,019 1 ,019 ,159 ,691

           Walking disability KSL binary Between Groups ,019 1 ,019 ,159 ,691ARTROSIS Between Groups 3,805 1 3,805 2,399 ,122ArtroserKSL binær Between Groups ,283 1 ,283 1,197 ,274Count chronical conditions KSL Between Groups 5,791 1 5,791 5,500 ,019Chronical conditions binary KSL Between Groups ,502 1 ,502 2,221 ,137

SATISFIED AND IN GOOD SPIRITS Between Groups

,142 1 ,142 2,415 ,121

MORNINGFATIQUE Between Groups

,003 1 ,003 ,021 ,886

FATIQUE DURING DAY Between Groups

,167 1 ,167 8,576 ,004

TILSATISFIED WITH CURRENT LIFE

Between Groups

,050 1 ,050 ,967 ,326

depressed, yes=1(score2 and more) Between Groups

,060 1 ,060 1,352 ,245

AFRAID OF BEING ALONE AT HOME IN DAYTIME

Between Groups

,054 1 ,054 1,944 ,164

          

ANXIETY ATTACKS Between Groups

,014 1 ,014 ,289 ,591

Anxiety, binary, present =1 Between Groups

,085 1 ,085 1,316 ,252

CIVILSTATUS Between Groups

,283 1 ,283 ,392 ,532

Married =1 Between Groups

,337 1 ,337 1,486 ,223

SOCIAL CONTACT WITH CHILDREN Between Groups 13,994 1 13,994 5,308 ,022

SOCIAL CONTACT WITH GRANDCHILDREN /Great GRANDCHILDREN

Between Groups 24,314 1 24,314 8,388 ,004

           SOCIAL CONTACT WITH FRIENDS Between Groups 19,605 1 19,605 14,700 ,000

Contact with children, grandchildren or friends >1XWeek=1

Between Groups 4,409 1 4,409 19,166 ,000

           LOOKED FOR OTHERS Between Groups ,982 1 ,982 4,585 ,033SEWED FOR OTHERS Between Groups ,840 1 ,840 5,369 ,021

REPAIRED FOR OTHERS Between Groups ,383 1 ,383 1,940 ,164

HOUSE HELP FOR OTHERS Between Groups ,462 1 ,462 3,444 ,064Given help to others (count on activities) Between Groups 10,277 1 10,277 11,437 ,001

Givetn help to others, binary Between Groups 2,011 1 2,011 8,460 ,004

Within Groups 173,508 730 ,238    HELP FROM CHILDREN DRESSING/BATHING Between Groups ,003 1 ,003 1,942 ,164

HELP FROM CHILDREN WASH Between Groups ,002 1 ,002 ,055 ,814

HELP FROM CHILDREN COOKING Between Groups ,014 1 ,014 ,889 ,346HELP FROM CHILDREN CLEANING Between Groups ,011 1 ,011 ,496 ,482

HELP FROM CHIILDREN SHOPPING Between Groups ,010 1 ,010 ,327 ,567

NO CONTINOUS HELP FROM CHILDREN Between Groups 3,440 1 3,440 14,057 ,000

OTHER KID OF HELP FROM CHILDREN Between Groups 1,974 1 1,974 7,994 ,005

FRIENDS HELPING DRESSSING Between Groups ,001 1 ,001 ,534 ,465

           FRIENDS HELPING WASH Between Groups ,004 1 ,004 ,250 ,617

FRIEND HELPING COOKING Between Groups ,004 1 ,004 ,250 ,617FRIENDS HELPING CLEANING Between Groups ,013 1 ,013 ,982 ,322

FRIENDS HELPING SHOPPING Between Groups ,000 1 ,000 ,012 ,912

INO CONTINOUS HELP FROM FRIENDS/SIBLINGS Between Groups ,325 1 ,325 3,021 ,083

OTHER FORM OF HELP FROM FRIENDS Between Groups ,170 1 ,170 1,618 ,204

Received help from private Between Groups 18,338 1 18,338 10,984 ,001

Recieved help from private, binary Between Groups 5,017 1 5,017 20,932 ,000

Home help from society Between Groups 4,788 1 4,788 2,229 ,136

Home help from society, Binary Between Groups ,262 1 ,262 3,368 ,067

PRESENT SMOKER Between Groups

1,000 1 1,000 1,055 ,305

Smoke daily =1 Between Groups

,246 1 ,246 ,991 ,320

BEER / WEEK Between Groups

,425 1 ,425 ,008 ,927

VINE / WEEK Between Groups

,280 1 ,280 ,018 ,894

LIQUER/WEEK Between Groups

1,966 1 1,966 ,137 ,711

Alcohol /week Between Groups

8,810 1 8,810 ,087 ,768

Amount /week over 14 =1 Between Groups

,002 1 ,002 ,018 ,893

BMI Between Groups

36,737 1 36,737 1,920 ,166

BMI over 25 =1 Between Groups

1,274 1 1,274 5,134 ,024

Remarks

• When analysis are done gender specific, some gender differences are found, but not many.

• There is some litterature on social relations, altruism and physical and mental health

• The issues are about both giving and receiving help (not altruism)

If social connections are the binding tie - are they confounders (conditions) or a mediators (results

of) church attendance?We really do not know…..

Survival

Giving and receiving help

Con-founder?

Church attendance

Medi-ator?

Survival is still an enigma!• Lack of social connections: a confounder (condition) or a mediator (result of) never going to church i secular society?

•How can gender differences be understood?

•The main significant effect is completely un-explained!