Is Religiosity or Spirituality Protective For Heart Disease?

Désirée Lie, MD, MSEd

Disclosures

April 21, 2010

Commentary

Religiosity and spirituality have been variously defined in studies of health and illness,[1] ranging from single questions asking about the frequency of attending religious services to multi-item questionnaires. such as:

  • The SpREUK[2];

  • The Ironson-Woods Spirituality/Religiousness Index[3];

  • The Daily Spiritual Experience Scale[4]; and

  • The Spiritual Wellbeing Scale.[5]

Religious behavior may be assessed through membership in a religious organization, rate of attendance at its functions, frequency of prayer, and involvement in social activities of the organization. Different components of religiosity and spirituality may mediate different health effects. For example, behavioral indicators, such as church attendance, can affect well-being through social integration and support.[6] Spiritual experiences that provide a sense of purpose and meaning may promote hope and affect psychological well-being by influencing depression, marital satisfaction, alcohol use and drug abuse. [7,8,9] Religious participation may also be a safe haven to avoid stigmatization by society for certain conditions.

Background

The concept that religious behavior or religiosity and spirituality was associated with longevity was observed in the 1990s, when mortality was found to be lower among frequent churchgoers than among nonattenders.[10,11,12] In particular, a 2002 study in Alameda County, California, observed that among 6545 residents, infrequent attenders of church compared with frequent attenders had significantly higher rates of death from:[13]

  • Circulatory diseases (hazard ratio [HR], 1.21);

  • Gastrointestinal diseases (HR, 1.99); and

  • Respiratory conditions (HR, 1.66).

The researchers proposed that religious participation, like socioeconomic status, was a protective factor that promoted health through a variety of pathways.

In older adults, religious well-being was found to correlate well with existential well-being and higher scores on psychological well-being measures, as well as healthier behaviors.[14] Church attendance among older adults may also correlate with use of more preventive behaviors, perhaps through a socialization mechanism.[15] Among patients with advanced cancer, survival was observed to be higher among those with higher religiosity or spirituality.[16]

Mechanism of Action: How Might Religiosity Improve Health?

One proposed mechanism for improving mortality among healthy, religious persons is reduced cardiovascular risk, possibly related to lifestyle or other cardioprotective effects of religious behavior.[17] For example, religion has a prohibitive influence on lifestyle risk factors, such as smoking; in fact, studies have documented lower rates of smoking among those with high religiosity or spirituality.[18]

Paradoxically, the rate of obesity may be higher among those who attend religious services more frequently. In a study with 8 years of follow-up, 4 dimensions of religiosity (attendance, salience, media practice, and consolation) were associated with higher BMI among women.[19] In terms of weight, however, other researchers have found differential effects depending on religious denomination and sex. For example, high levels of religious media practice and affiliation with the Baptist denomination was associated with increased incidence of obesity in women [20,21] ("Religious media practice" is home practice employing religious television or radio programming, books, magazine, or a combination. Although these practices are not necessarily solitary, they do allow access to food and beverages, which could account for the higher rate of obesity.)[19] Another study found that the effect of religiosity on BMI disappeared when smoking behavior was controlled for, suggesting that the possible association between religious participation and obesity may be a consequence of lower smoking rates among religious persons.[17]

A recent study of a multiethnic population that included 5474 white, black, Hispanic, and Chinese participants aged 45 to 84 years measured 3 dimensions of religiosity (frequency of participation, prayer and meditation, and spirituality) and used the 5-item Daily Spirituality Experiences Scale to assess feelings of closeness to God.[22] Overall, this study found no consistent association between religiosity and the presence of subclinical indicators, such as left ventricular function, intima-media thickness, and coronary calcium. Over 4 years of follow-up, no significant difference in cardiovascular events was observed between the religious and nonreligious groups. However, the study confirmed the higher likelihood of obesity and lower likelihood of smoking among those with higher religious and spirituality scores.

Problems in Design of Studies of Religiosity

Among adolescents and young adults, a systematic review found that in 43 studies published from 1998 to 2003, 37 distinct religious variables were defined, with unclear frameworks in most studies.[23] The variables ranged from assessing religious importance to religious behaviors of attendance and prayer. However, 8 of the 10 highest-quality studies found evidence of a positive effect of religious participation on health attitudes and behaviors, and protection against:

  • Substance abuse;

  • Alcohol abuse;

  • Early initiation of sexual behavior; and

  • Smoking.

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