Table 2.
Religious-service attendance (at least once/week vs never) and subsequent health and well-being across adulthood [the Growing Up Today Study (GUTS) from 2007 to 2010 or 2013 questionnaire wave, N = 9862; the Nurses’ Health Study II (NHSII) from 2001 to 2008, 2009 or 2013 questionnaire wave, N = 68 376; the Health and Retirement Study (HRS) from 2008 to 2014 or from 2010 to 2016 questionnaire wave, N = 13 770].a
| Never(Ref.)b | GUTS At least once/week | NHSII At least once/week | HRS At least once/week | Sample-size weighted Meta-Analytic Combined Estimate |
||||
|---|---|---|---|---|---|---|---|---|
| RR/β (95% CI) | RR/β (95% CI)c,d | RR/β (95% CI)c,d | RRc | βd | 95% CI | p-valuee | ||
| Physical health | ||||||||
| All-cause mortality | 1.00 | — | 0.74 (0.63, 0.86) | 0.72 (0.63, 0.83) | 0.74 | 0.65, 0.84 | <0.002*** | |
| No. of physical-health problems | 0.00 | –0.02 (–0.10, 0.06) | –0.04 (–0.05, –0.02) | –0.02 (–0.09, 0.05) | –0.03 | –0.05, –0.01 | <0.002*** | |
| Diabetes | 1.00 | 0.67 (0.25, 1.75) | 0.92 (0.85, 1.01) | 1.09 (0.97, 1.24) | 0.91 | 0.81, 1.03 | 0.141 | |
| Hypertension | 1.00 | 0.85 (0.55, 1.32) | — | 1.04 (0.96, 1.12) | 0.95 | 0.79, 1.15 | 0.354 | |
| Stroke | 1.00 | — | 1.01 (0.86, 1.18) | 0.95 (0.80, 1.12) | 1.00 | 0.87, 1.14 | 0.398 | |
| Heart Disease | 1.00 | — | 0.93 (0.78, 1.10) | 0.93 (0.81, 1.07) | 0.93 | 0.80, 1.07 | 0.235 | |
| Cancer | 1.00 | 0.37 (0.15, 0.94) | 0.96 (0.91, 1.01) | 0.97 (0.84, 1.12) | 0.87 | 0.78, 0.97 | 0.015* | |
| Overweight/obesity | 1.00 | 1.02 (0.90, 1.16) | 0.97 (0.95, 1.00) | 1.05 (0.94, 1.18) | 0.99 | 0.96, 1.02 | 0.343 | |
| Health behaviours | ||||||||
| Heavy drinking | 1.00 | 0.66 (0.54, 0.81) | 0.57 (0.50, 0.64) | 1.31 (0.92, 1.86) | 0.66 | 0.59, 0.73 | <0.002*** | |
| Current cigarette smoking | 1.00 | 0.83 (0.70, 0.98) | 0.70 (0.62, 0.79) | 0.67 (0.40, 1.14) | 0.71 | 0.63, 0.80 | <0.002*** | |
| Short sleep duration | 1.00 | 0.96 (0.80, 1.15) | 0.98 (0.93, 1.02) | — | 0.97 | 0.93, 1.02 | 0.207 | |
| Frequent physical activity | 1.00 | — | 1.01 (0.98, 1.03) | 1.10 (0.86, 1.42) | 1.02 | 0.98, 1.07 | 0.245 | |
| Preventive-healthcare use | 1.00 | 0.98 (0.90, 1.06) | 1.02 (1.00, 1.05) | — | 1.02 | 1.00, 1.04 | 0.103 | |
| Psychological distress | ||||||||
| Depression diagnosis | 1.00 | 0.69 (0.57, 0.84) | 0.86 (0.82, 0.91) | 0.85 (0.69, 1.04) | 0.84 | 0.80, 0.89 | <0.002*** | |
| Depressive symptoms | 0.00 | –0.18 (–0.29, –0.07) | –0.10 (–0.11, –0.08) | –0.13 (–0.20, –0.06) | –0.11 | –0.13, –0.09 | <0.002*** | |
| Anxiety symptoms | 0.00 | –0.04 (–0.12, 0.05) | –0.06 (–0.08, –0.03) | — | –0.05 | –0.07, –0.03 | <0.002*** | |
| Hopelessness | 0.00 | –0.09 (–0.22, 0.04) | –0.08 (–0.10, –0.05) | –0.05 (–0.11, 0.02) | –0.07 | –0.10, –0.05 | <0.002*** | |
| Loneliness | 0.00 | –0.19 (–0.29, –0.10) | –0.03 (–0.05, –0.01) | –0.11 (–0.20, –0.02) | –0.06 | –0.08, –0.04 | <0.002*** | |
| Psychosocial well-being | ||||||||
| Positive affect | 0.00 | 0.14 (0.06, 0.22) | 0.09 (0.07, 0.11) | 0.10 (0.01, 0.20) | 0.10 | 0.08, 0.12 | <0.002*** | |
| Life satisfaction | 0.00 | 0.13 (0.04, 0.22) | — | 0.11 (0.03, 0.20) | 0.12 | 0.06, 0.18 | <0.002*** | |
| Social integration | 0.00 | — | 0.27 (0.25, 0.29) | 0.22 (0.13, 0.28) | 0.26 | 0.24, 0.28 | <0.002*** | |
| Purpose in life | 0.00 | — | 0.29 (0.27, 0.30) | 0.05 (–0.02, 0.11) | 0.25 | 0.23, 0.26 | <0.002*** | |
RR, risk ratio; CI, confidence interval.
The notation ‘—’ indicates the particular outcome was not measured in that cohort (note: in NHSII, only self-reported information on hypertension was available, whereas data on other physical-health outcomes were verified against medical records. Therefore, this study did not examine hypertension in NHSII). The analytic sample in each cohort was restricted to those who responded to the baseline questionnaire wave in which religious-service attendance was measured. Multiple imputation was performed to impute missing data on all variables.
A set of generalized estimating equations or regression models were used to regress each outcome on religious-service attendance separately, to estimate the OR for rare binary outcomes (with binomial distribution, the OR would approximate the RR for rare outcomes, rare outcome defined as the prevalence <10%,), the RR for non-rare binary outcomes (Poisson distribution, non-rare outcome defined as prevalence ≥10%) or β (where the outcome follows a normal distribution). If the reference value is ‘1’, the effect estimate is OR or RR; if the reference value is ‘0’, the effect estimate is β.
GUTS: All models controlled for participants’ age, sex, race/ethnicity, marital status, geographic region, maternal attachment, childhood-abuse victimization, their mother’s report of socio-economic status (SES) (i.e. subjective SES, household income, census tract college education rate and census tract median income), participants’ prior religious-service attendance, prior health status or prior health behaviours (i.e. prior depressive symptoms, hopelessness, loneliness, binge eating, overweight/obesity, smoking, heavy drinking, marijuana use, use of other illicit drugs, prescription-drug misuse, history of sexually transmitted infections, preventive-healthcare use, frequency of volunteering and voting-registration status).
NHSII: All models controlled for participants’ age, race/ethnicity, marital status, geographic region, employment status, night-shift schedule, perceived stress, subjective SES, pre-tax household income, census tract college education rate, census tract median income, childhood-abuse victimization and prior health status or prior health behaviours (i.e. prior positive affect, hopelessness, community engagement, number of close friends, depressive symptoms, preventive-healthcare use, dietary quality, heavy drinking, current smoking, frequent physical activity, number of physical-health problems: overweight/obesity, type 2 diabetes, stroke, heart disease, cancer).
HRS: All models controlled for participants’ age, sex, race/ethnicity, marital status, geographic region, income, level of education, wealth, employment status, health insurance, childhood abuse, prior religious-service attendance and prior health status or prior health behaviours (i.e. prior positive affect, purpose in life, life satisfaction, optimism, perceived mastery, depressive symptoms, loneliness, hopelessness, negative affect, social integration, heavy drinking, current smoking, exercise and number of physical-health problems: overweight/obesity, type 2 diabetes, stroke, heart disease, hypertension, cancer).
The effect estimates for the outcomes of current smoking (NHSII, HRS), heavy drinking (NHSII, HRS), all-cause mortality (NHSII), diabetes (GUTS, NHSII), hypertension (GUTS), stroke (NHSII), heart disease (NHSII), short sleep duration (NHSII) and cancer (GUTS) were OR. These outcomes were rare (prevalence <10%), so the OR would approximate the RR. Effect estimates for other dichotomized outcomes were RR.
All continuous outcomes were standardized (mean = 0, standard deviation = 1) and β was the standardized effect size.
p < 0.05 before Bonferroni correction;
p < 0.01 before Bonferroni correction;
p < 0.05 after Bonferroni correction (the p-value cut-off for Bonferroni correction is 0.05/22 outcomes = 0.002).