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Article Excerpt
Objectives: The scientific community has recently taken a serious interest in the relation between religious involvement and adult mortality risk in the United States. We review this literature, highlighting key findings, limitations, and future challenges.
Methods: Literature from medicine, epidemiology, and the social sciences is included.
Results: Taken together, the existing research indicates that religious involvement is related to US adult mortality risks. The evidence is strongest for public religious attendance and across specific religious denominations. The evidence is weakest for private religious activity. The mechanisms by which religious involvement appear to influence mortality include aspects of social integration, social regulation, and psychological resources.
Conclusions: The religion-mortality literature has developed in both size and quality over the past decade. Fruitful avenues for continued research include the analysis of (1) more dimensions of religious involvement, including religious life histories; (2) population subgroups, including specific race/ethnic and socioeconomic populations; and (3) a richer set of social, psychologic, and behavioral mechanisms by which religion may be related to mortality.
Key Words: adult mortality, religious activity and involvement, religious denominations
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There is a long tradition of research that addresses the association between religion and mortality, especially suicide. Only recently, however, has the scientific community taken a serious interest in how religious factors may impact the mortality risk of individuals in the US population more generally. In addition to examining the magnitude of the religion-mortality relation, this line of research has begun examining the mechanisms by which religion influences mortality outcomes. Much of this work suggests that religious involvement offers a protective advantage in regard to mortality. (1) This body of research has also generated both considerable publicity and debate. Despite some criticism, recent empiric results appear to be quite strong and are based on higher quality data sets and more sophisticated methodologies than ever before.
This report reviews the medical, public health, and social science literature that has empirically addressed the religionmortality linkage in the United States. Our objectives are to (1) examine key findings in the area of religion and mortality, describing the limitations as well as consistencies and inconsistencies of the work to date; (2) describe which indicators of religious involvement have been used, which study populations have been used, and for which subgroups of the population religious factors seem to be most strongly associated with mortality outcomes; (3) review the mechanisms by which religious involvement might be associated with adult mortality; and (4) highlight the key critiques of, and forthcoming challenges for, this literature.
Research on Religion and Mortality Outcomes
Religious denominational differences in mortality
Denominational differences in mortality were given substantial attention throughout the 1970s and 1980s and continue to surface in this literature. The greatest focus has been on Mormons, Seventh Day Adventists, and members of other religious groups with distinctive lifestyle guidelines. Members of these denominations--especially those who are active--enjoy reduced mortality risk compared with the general population. (2-8) In fact, Manton et al (9) reported that two of the select US population subgroups with extremely high life expectancies are Mormons and Seventh Day Adventists. Jewish individuals, particularly males, have also been shown to have lower mortality rates than the non-Jewish white population. (10) Because of the lack of specific denominational affiliation information in most large data sets, almost no attention has been given to whether or not there are mortality differences between Catholics and Protestants and between different Protestant groupings, such as liberal and conservative denominations.
In addition to individual-level studies, there is a rich parallel tradition of aggregate-level studies linking the religious denominational composition of geographic units with mortality rates. (11) Recent studies indicate that counties with high concentrations of Mormons and evangelical Protestants tend to have lower suicide and/or cancer mortality rates, and those with Catholic concentrations also have lower suicide rates. In contrast, counties with concentrations of Jews, liberal Protestants (eg, Episcopalians, Presbyterians), and nonreligious persons tend to have elevated suicide and cancer mortality rates, statistically controlling for numerous covariates. (12,13)
Among metropolitan areas, those with high congregational membership rates and those with high levels of religious homogeneity tend to exhibit lower suicide and homicide rates than others. (14-16) At the same time, metropolitan areas with higher percentages of conservative Protestants have been found to have higher homicide rates in the South but not elsewhere in the country, suggesting regional variations in the meaning of religious denominational concentrations for mortality outcomes. (17)
Public religious attendance and mortality
The largest and most consistent body of research has focused on public religious attendance, where a number of studies have found a relation between more frequent attendance and lower adult mortality. A recent meta-analysis (18) found that less frequent attendance at religious services was associated with 1.29 times the odds of mortality in follow-up studies compared with individuals who attend more frequently.
Two recent nationally representative studies have demonstrated this linkage. Hummer et al (19) used data from the 1987 National Health Interview Survey linked to the National Death Index (NHIS-NDI) and showed that religious attendance at baseline was associated with adult mortality risk in a graded fashion over the ensuing 8 years. Although demographic factors, health selectivity, social ties, and health behavior were responsible for a portion of the differences, religious attendance maintained a moderately strong and graded relation with mortality risk, even in the most complete regression model. The association was of greater magnitude for some causes (eg, respiratory diseases, external causes) in comparison to others (eg, circulatory diseases) but worked in the same direction across causes and was statistically significant for most causes despite relatively small cell sizes...
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