Optimism, Lifestyle, and Longevity in a Racially Diverse Cohort of Women

Hayami K. Koga MD; Claudia Trudel-Fitzgerald PhD; Lewina O. Lee PhD; Peter James PhD; Candyce Kroenke ScD; Lorena Garcia DrPH; Aladdin H. Shadyab PhD; Elena Salmoirago-Blotcher MD, PhD; JoAnn E. Manson MD, DrPH; Francine Grodstein ScD; Laura D. Kubzansky PhD

Disclosures

J Am Geriatr Soc. 2022;70(10):2793-2804. 

In This Article

Abstract and Introduction

Abstract

Background: Research has suggested optimism is associated with healthy aging and exceptional longevity, but most studies were conducted among non-Hispanic White populations. We examined associations of optimism to longevity across racial and ethnic groups and assessed healthy lifestyle as a possible mediating pathway.

Methods: Participants from the Women's Health Initiative (N = 159,255) completed a validated measure of optimism and provided other demographic and health data at baseline. We evaluated associations of optimism with increments in lifespan using accelerated failure time models, and with likelihood of exceptional longevity (survival to age ≥90) using Poisson regression models. Causal mediation analysis explored whether lifestyle-related factors mediated optimism-lifespan associations.

Results: After covariate adjustment, the highest versus lowest optimism quartile was associated with 5.4% (95% confidence interval [CI] = 4.5, 6.4%) longer lifespan. Within racial and ethnic subgroups, these estimates were 5.1% (95%CI = 4.0, 6.1%) in non-Hispanic White, 7.6% (95%CI = 3.6, 11.7%) in Black, 5.4% (95%CI = −0.1, 11.2%) in Hispanic/Latina, and 1.5% (95% CI = −5.0, 8.5) in Asian women. A high proportion (53%) of the women achieved exceptional longevity. Participants in the highest versus lowest optimism quartile had greater likelihood of achieving exceptional longevity (e.g., full sample risk ratio = 1.1, 95%CI = 1.1, 1.1). Lifestyle mediated 24% of the optimism-lifespan association in the full sample, 25% in non-Hispanic White, 10% in Black, 24% in Hispanic/Latina, and 43% in Asian women.

Conclusions: Higher optimism was associated with longer lifespan and a greater likelihood of achieving exceptional longevity overall and across racial and ethnic groups. The contribution of lifestyle to these associations was modest. Optimism may promote health and longevity in diverse racial and ethnic groups. Future research should investigate these associations in less long-lived populations.

Introduction

Growing evidence suggests positive psychological factors are associated with lower risk of morbidity and mortality, above and beyond simply signaling the absence of depression or other markers of poor psychological functioning.[1] In particular, optimism—the generalized expectation of positive future outcomes[2]—has been consistently associated with improved health outcomes, including exceptional longevity[3]—surviving well past the average age of death (in 2018, this was 81.2 years for women and 76.2 years for men in the US).[4] Although optimism is partly heritable (23%–32%),[5] experimental research has demonstrated that optimism is modifiable with accessible methods that actively target optimism such as writing exercises and cognitive-behavioral strategies.[6] This work, in conjunction with findings linking optimism to a range of outcomes including physical health[1] suggest optimism may be a novel target for intervention to improve health. Moreover, studies looking into the racial and ethnic differences in the association between optimism and health suggest that optimism may provide benefits to health across racial and ethnic groups,[7] however evidence that these effects generalize remains limited.

Prior work has suggested more versus less optimistic individuals take more proactive approaches to promoting their health and they are more likely to engage in healthy behaviors such as increased physical activity, healthier diet, and not smoking.[8] This evidence suggests such behaviors may mediate the relationship between optimism and longevity. However, the association between optimism and health behaviors appears to be bidirectional and although plausible, conclusive evidence to support that optimism precedes and leads to healthy behaviors is not yet available. Moreover, whether and how much these behaviors mediate the association between optimism and health is understudied. Further, if optimism provides benefits to health similarly across racial and ethnic groups, the mediating pathways involved might also work similarly across diverse groups.

Thus, we used data from the WHI, a longitudinal study of racial and ethnically diverse women to evaluate the association of optimism with lifespan and exceptional longevity. In prior WHI research (N = 97,253), higher optimism was associated with reduced mortality risk in both non-Hispanic White and Black women;[7] however, the authors did not further consider Hispanic/Latina or Asian women, nor did the study examine the potential mediating effect of health behaviors.

We tested two hypotheses: (1) higher optimism would be associated with longer lifespan and exceptional longevity across racial and ethnic categories, (2) lifestyle factors would mediate this association across racial and ethnic groups. We considered a range of relevant covariates based on prior work, including baseline health status and depression, which has been linked with both optimism and mortality.[3]

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