reconsidering survival and church attendance in modern denmark - an invitation to creative thinking...
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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
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Yoichi Chida, Andrew Steptoe, Lynda H. Powell: Religiosity/Spirituality and Mortality. A Systematic Quantitative
Review (2009). (Included studies = 69)
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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
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WHY? Theoretical diagram over possible causal paths
(Koenig 1999)
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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)
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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.
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Control-variables
• Gender, education• Physical and mental health (some
constructed and computed)• Social connections (some constructed and
computed)• Health behaviors
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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
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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
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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
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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)
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Both gender
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Men
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Women
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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
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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)
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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?
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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”
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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!
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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?
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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
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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
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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
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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
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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)
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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?
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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!