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Religious Commitment and Health Status
Do people of different religious denominations have different average life expectancies?
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Numerous investigators have demonstrated that persons who participate regularly in religious activities live longer compared with others with less religious involvement.1-2 The effect of specific religious denominations on survival is less clearly defined. Studies of conservative religious groups with a strict lifestyle, particularly Latter-day Saints (Mormons), Seventh-Day Adventists, Amish, and Hutterites,3-4 generally show longer survival rates3-4 along with lower age-specific rates of cardiovascular disease and cancer. These findings have been attributed to a variety of factors, including healthy dietary, sexual, and other practices as well as supportive social networks.5-6
However, findings for many other religious groups are mixed. For example, studies of Jews indicate lower than average rates of certain forms of cancer (eg, penile, cervical, and uterine cancer6), but when county-wide mortality data were examined, Jews had higher than average rates of cancer mortality, while Mormons were associated with lower than average rates.7 Also, a simple classification of affiliation ("Jewish" vs "non-Jewish") may miss important behavioral and ethnic differences. For example, Orthodox Jews have lower mortality rates from cardiovascular problems, cancer, and all other causes8-9 than nonpracticing, secular Jews, and Mizrahi Sephardic Jews have lower mortality rates from myocardial infarction than other Jews.10
The assessment of religious affiliation is fraught with methodological challenges. In certain instances, religious affiliation may be inadequately or inaccurately assessed (eg, by using location of burial in particular cemeteries as a measure of religious affiliation5) or affiliation may be viewed or used incorrectly as a proxy for socioeconomic status or ethnicity. Many comparative studies have used only simple taxonomies (Seventh-Day Adventist vs non–Seventh-Day Adventist or Protestant, Catholic, Jewish, other/none), which ignore the heterogeneity of many faiths' traditions. Furthermore, combining the category of "other" religious beliefs with that of "none" is inappropriate.11
Further studies, using expanded taxonomies of religious affiliation5 and behaviorally based measures of religious involvement (eg, indexes of religious attendance and markers of private and public religious activity) are needed to better assess the effect of specific religious affiliations in the future.12
Dale A. Matthews, MD
Georgetown University Medical Center
General Internal Medicine
3800 Reservoir Rd NW
Washington, DC 20007
M. E. McCollough;
J. P. Swyers;
M. G. Milano;
David B. Larson, MD, MSPH;
H. G. Koenig
Washington
1. Matthews DA. The Faith Factor. New York, NY: Viking Press; 1998.
2. Matthews DA, Koenig HG, Thoresen C, Friedman R. Physical health. In: Larson DB, Swyers JP, McCullough ME, ed. Scientific Research on Spirituality and Health: A Consensus Report. Rockville, Md: National Institute for Healthcare Research, US Dept of Health and Human Services; 1998.
3. Jarvis GK, Northcott HC. Religion and differences in morbidity and mortality. Soc Sci Med. 1987;25:813-824.
4. Troyer H. Review of cancer among 4 religious sects: evidence that lifestyles are distinctive sets of risk factors. Soc Sci Med. 1988;26:1007-1017.
5. McCullough ME, Larson DB, Koenig HG, Lerner R. The mismeasurement of religion: a systemic review of mortality research. Mortality. 1999;4:183-194.
6. Levin JS, Schiller PL. Is there a religious factor in health? J Relig Health. 1987;26:9-36.
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7. Dwyer JW, Clarke LL, Miller MK. The effect of religious concentration and affiliation on county cancer mortality rates. J Health Soc Behav. 1990;31:185-202.
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8. Kark JD, Shemi G, Friedlander Y, et al. Does religious observance promote health? mortality in secular vs religious kibbutzim in Israel. Am J Pub Health. 1996;86:341-346.
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9. Goldbourt U, Yaari S, Medalie JH. Factors predictive of long-term coronary heart disease mortality among 10,059 male Israelis civil servants and municipal employees. Cardiology. 1993;82:100-121.
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10. Medalie JH, Kahn HA, Neufeld HN, Riss E, Golbourt U, Perlstein T. Myocardial infarction over a five-year period. J Chronic Dis. 1973;26:63-84.
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11. Larson DB, Larson SS. The Forgotten Factor in Physical and Mental Health: What Does the Research Show? Rockville, Md: National Institute for Healthcare Research; 1994.
12. Larson DB, Donahue MJ, Lyons JS, et al. Religious affiliations in mental health research samples as compared with national samples. J Nerv Ment Dis. 1989;177:109-111.
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Arch Fam Med. 1999;8:476.
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