Das, A., & Nairn, S. (2014). Religious attendance and physiological problems in late life. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, doi:10.1093/geronb/gbu089
Religious Attendance and Physiological Problems in Late Life Aniruddha Das1,2 and Stephanie Nairn1 1 Department of Sociology and Centre on Population Dynamics, McGill University, Montreal, Quebec, Canada.
2
Objectives. This study queried linkages of older adults’ religious attendance with their physiological health.
Results. Religious attendance was negatively associated with a system of physiological issues, consistent with mitigation of multisystemic “weathering.” Linkages were relatively uniform with inflammatory and cardiovascular but not metabolic states and were not significantly different for women than men. Effects of spousal loss on the 2 former subsystems were attenuated by regular religious attendance—in combined-gender analysis and among women, but not men. Discussion. Religious attendance may buffer older adults from physiological problems and the health effects of life events such as spousal loss. More intensive analysis is needed to explain differential linkages with specific biological subsystems. Key Words: Inflammation—Late life—Physiology—Religious attendance—Spousal loss—Weathering.
A
growing literature on the ecological context of human physiological function connects membership in lower social strata (race, socioeconomic status) to more multisystemic “weathering”—stress-induced biological wear-andtear exerted at least partly through chronically elevated or fluctuating neuroendocrine response (Geronimus, Hicken, Keene, & Bound, 2006; McEwen, 1998; Singer, Ryff, & Seeman, 2004; Sterling & Eyer, 1981). A potential outcome of this biosocial process is socially stratified accelerations in senescence (Das, 2013a; Geronimus et al., 2006; McEwen, 1998). A separate literature suggests that especially in late life, when social and personal assets generally decline, religious attendance may play a key role in buffering a person against psychosocial stress (Ellison, Burdette, & Hill, 2009; Koenig, George, & Titus, 2004; Koenig, Pargament, & Nielsen, 1998; Krause, 2008; Lawler-Row, 2010; Pargament, 1997; Schieman, Pudrovska, Pearlin, & Ellison, 2006)—with studies offering conflicting evidence on gender variations in this effect (Bednarowski, 1999; Bradshaw & Ellison, 2010; Cokely et al., 2013; Hintikka et al., 2000; Krause, Ellison, & Marcum, 2002; McFarland, 2010). If so, this protective impact may arguably extend to physiological weathering—both in general, or as triggered by major life transitions, a key process behind late-life health issues (Thoits, 2010; Wheaton, 1990). Due to both data and especially conceptual limitations, these linkages and moderations remain underexplored. Using data from the 2005–2006 U.S. National Health and Social Life Project (NSHAP)—a nationally representative
probability sample of adult Americans aged 57–85—the present study began to fill these gaps. Three topics were addressed: (a) linkages between religious attendance and a range of inflammatory, metabolic, and cardiovascular states proxying multisystemic weathering; (b) potential gender variations in these associations; and (c) mitigation by religious attendance of elevated weathering risks from spousal loss. Religious Attendance and Weathering A large literature links participation in religious services with better physical and mental health (Buck, Williams, Musick, & Sternthal, 2009; Koenig et al., 2004; Krause, 2008; Levin & Chatters, 2008), especially in late life (Daaleman, Perera, & Studenski, 2004; Koenig et al., 2004; Krause, 2008; Lawler-Row, 2010; Levin & Chatters, 2008). Starting with the work of psychologist Kenneth Pargament (1997), scholars have increasingly conceptualized these broad benefits as arising from religion’s stress-mitigating effects. Thus, studies link a strong sense of divine control with lower psychological distress among older Americans (Schieman et al., 2006) and religious attendance with more self-reported tranquility (Ellison et al., 2009). Such engagement may also foster stress-buffering network connections—with multiple studies indicating that individuals who attend religious services at least once a week receive more social and emotional support (Nooney & Woodrum, 2002; Strawbridge, Shema, Cohen, & Kaplan, 2001; Taylor & Chatters, 1988). This church-based
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected]. Received February 12, 2013; Accepted June 10, 2014 Decision Editor: Merril Silverstein, PhD
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Method. Data were from the 2005–2006 National Social Life, Health, and Aging Project, nationally representative of U.S. adults aged 57–85 years. Analyses examined associations of religious attendance with biological states, potential gender variations in these linkages, and attenuation by this factor of health effects of spousal loss.
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rate (Ellaway & Macintyre, 2006) and composite scores of biological risk (Maselko, Kubzansky, Kawachi, Seeman, & Berkman, 2007). An emerging literature in the anthropology and neuropsychology of religious rituals also suggests that emotionally charged group dynamics, common in highly devout congregations, can have positive neurophysiological and immune system effects—possibly through the production of endogenous opioid peptides (Frecska & Kulcsar, 1989; Saver & Rabin, 1997; Sosis & Alcorta, 2003). Despite these scattered findings, systematic analysis using nationally representative data to examine linkages between religious attendance and specific physiological subsystems remains missing. Accordingly, the following hypothesis was included to examine these connections. 1. Older women and men with more frequent religious attendance will have less elevated inflammatory, metabolic, and cardiovascular states. Next, while the biosocial processes delineated above arguably hold for both women and men, some scattered literature also indicates gender-specific associations. Evidence is relatively uniform on women’s greater religious attendance, especially in late life (Balbuena et al., 2013; Koenig, 1999; Krause et al., 2002; Maselko et al., 2007; McFarland, 2010). However, studies offer contradictory findings on gender patterns in the health effects of this factor. Some indicate women may be more benefited—whether in terms of mental health (Bradshaw & Ellison, 2010; Cokely et al., 2013; Hintikka et al., 2000) or survival (Koenig, 1999; Strawbridge et al., 1997). Moreover, mental health dividends of religious attendance may possibly bypass social support, at least among women—perhaps indicating a more direct effect of subjective beliefs (Hintikka et al., 2000; Koenig, 1999; Maselko et al., 2007; McFarland, 2010). Other studies, in contrast, indicate greater benefits among men (Bednarowski, 1999; Krause et al., 2002; McFarland, 2010)—possibly due to gender differences in the nature of religious participation. Ethnographic research on American women’s religious experiences suggests that they are often simultaneously insiders and outsiders in religious organizations—excluded from authority positions despite their active participation (Bednarowski, 1999). In similar vein, McFarland (2010) argues that religious roles into which women are socialized emphasize “feminine” traits, such as being obedient, nurturing, and service oriented. The corresponding “cost of caring” may, in turn, make participation in church-centered social activity detrimental to their health. In contrast, men tend to occupy more formal and high-status roles within church organizations. Additionally, in a broader social environment where men may not be encouraged to express or share emotions, religious attendance can yield a context in which receiving support becomes comfortable. Perhaps for this reason, modest involvement in organizational religiosity decreases depression in men but not for women, and these mental health benefits rise with men’s higher levels of such
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“social capital” may also enhance psychological resilience and coping-capacity in the face of life challenges (Koenig, George, et al., 1998; Pargament, Koenig, & Perez, 2000; Pargament, Smith, Koenig, & Perez, 1998). This is especially true of in late life, when individuals suffer a generalized loss of social and physical assets. Specifically, older adults experience fundamental changes in the structure of both their families and their broader social network. Children leave home, retirement uproots individuals from their social networks at work, parents and elders pass away, and health problems begin impeding social interaction (Hughes, Waite, Hawkley, & Cacioppo, 2004). Accordingly, older women and men strongly connected to church-centered social networks report improved mental health and perceived quality of life— especially in times of poor physical health (Koenig, George, et al., 1998; Koenig, Pargament, et al., 1998). Despite its stress-buffering implications, linkages between religious attendance and biological weathering remain underexplored. Biodemographic literature (McEwen, 1998; Seeman et al., 2008) suggests weathering pressures on three linked physiological subsystems—inflammatory, metabolic (e.g., obesity, diabetic problems), and cardiovascular (e.g., blood pressure [BP], heart rate)—with scattered evidence indicating a pathogenic process sequentially cascading through each of these complexes. Thus, multiple studies indicate a pathway from extended psychosocial stress to inflammation (Das, 2013a; McDade, Hawkley, & Cacioppo, 2006; Melamed, Shirom, Toker, Berliner, & Shapira, 2006; Weinstein, Vaupel, & Wachter, 2007)—possibly due to norepinephrine-driven gene expression of inflammatory mediators (Bierhaus et al., 2003; Kiecolt-Glaser, Gouin, & Hantsoo, 2010). Downstream, inflammation has a demonstrated causative role in cardiovascular problems, as well as poor blood sugar control due to insulin resistance (Grundy, Brewer, Cleeman, Smith, & Lenfant, 2004; Yudkin, 2003). More specifically, recently developed high-sensitivity C-reactive protein (CRP) assays suggest that chronic, low-grade inflammation (indicated by elevated CRP) is linked to subsequent incidence of cardiovascular disease (Danesh et al., 2000), type 2 diabetes (Pradhan, Manson, Rifai, Buring, & Ridker, 2001), and the “metabolic syndrome” (McDade & Hayward, 2009; Ridker, Buring, Cook, & Rifai, 2003). Studies also suggest a direct effect of psychosocial strain on obesity (de Wit et al., 2010) and of obesity on poor blood sugar control, diabetes, and heart disease (Grundy et al., 2004; Yudkin, 2003). Finally, chronic antecedent stress has been directly linked to blood sugar problems (Calhoun et al., 2009; Lustman et al., 2000), as well as cardiovascular issues such as higher BP (Ariyo et al., 2000; Shinn, Poston, Kimball, Saint Jeor, & Foreyt, 2001) and heart rate (Lampert et al., 2009). Arguably, if religious attendance in late life is indeed protective against stress, it may also mitigate such pathogenic processes. Consistent with this conjecture, such engagement has been linked to a lower prevalence of hypertension (Koenig, George, et al., 1998), as well as lower resting heart
Religious Attendance and Physiological Problems
engagement. Corresponding physiological patterns remain unexplored. Accordingly, to test gender variations in the weathering implications of religious attendance, the following hypothesis was included: 2. Linkages between more frequent religious attendance and physiological states will be stronger for older men than for women.
While the negative health consequences of widowhood have been the most extensively studied, evidence suggests much the same sequelae with divorce or separation (Johnson, Backlund, Sorlie, & Loveless, 2000; Lillard & Waite, 1995). Apart from the loss of dyadic assets, both the event of, and the time preceding, divorce are likely to be marked by increased stress and relational friction. In a recent study, for instance, Hughes and Waite (2009) examine the effects of marital disruption—whether through divorce or widowhood—on a small set of summary health measures and find that such events may cause long-term damage to health. In addition to such “intracouple” factors, marriages also tend to be embedded in a network of friends and family members, which may represent a key source of social and emotional support in late life (Carr & Utz, 2002; Elwert & Christakis, 2006). Whether due to grief and consequent social withdrawal or because one is socially connected through one’s spouse, widowhood or divorce may lead to a weakening of ties to this stress-buffering relational web. In turn, both the “primary stressors” of bereavement and lost dyadic assets, and “secondary stressors” represented by these broader social deficits (Pearlin, 1999; Thoits, 2010), may potentially trigger weathering. Consistent with these arguments, a recent NSHAP-based study (Das, 2013b) finds spousal loss (whether through widowhood or divorce/ separation) associated with a broad range of negative mental, metabolic, and cardiovascular states. Moreover, contrary to previous conceptions of loss as a traumatic event with transient effects (Booth & Amato, 1991; Hetherington & Kelly, 2002), physiological issues appear to be more elevated among those longer past the event— perhaps reflecting lasting coping pressures. However, it also finds physiological linkages to be more uniform among all participants and women, than men—arguably suggesting women’s deeper (and unexplained) vulnerability to this life transition. Building on this emerging evidence, it was conjectured that if religious attendance does indeed protect a person against weathering pressures, it may also mitigate the negative physiological effects of spousal loss—among women if not men. At least for mental states, some small-sample and qualitative studies do suggest such buffering, with religious engagement attenuating depression and anxiety following the loss of a partner—whether through widowhood (Fry, 2001; Woo, Chan, Chow, & Ho, 2008) or divorce (Webb et al., 2010). As among older adults in general, however, the role of this factor in mitigating loss-induced biological problems has yet to be examined. Accordingly, the following hypothesis was included to examine this potential buffering: 3. Older adults—especially women—having experienced spousal loss, whether through widowhood or divorce/ separation, will have better physiological status if they regularly attend religious services.
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Spousal Loss and Weathering: Mitigation by Religious Attendance? As noted, biodemographic studies have largely focused on weathering pressures exerted by one’s broad social position (i.e., stratification by race or class). However, a large and established stress process literature emphasizes the negative psychological effects of life transitions (Butts & Pixley, 2004; Dohrenwend, 2006; Elder, 1985; Gotlib & Wheaton, 1997; Pixley, 2008)—suggesting corresponding physiological sequelae. In other words, those experiencing such events may arguably comprise a distinct “at risk” population—with elevated weathering-induced diabetic and cardiovascular morbidity and contracted longevity. Among older adults, the loss of a spouse is perhaps the most important such turning point. While much of the literature on this life transition has focused on bereavement, the event also entails declines in a range of other assets. Marriages (especially lasting ones) tend to be characterized by longstanding household divisions of labor and investments in partnerspecific skills (Becker, 1981; Brines & Joyner, 1999). Apart from the immediate (and possibly transient) “shock” of bereavement, the loss of these assets and investments may also lead to long-term coping pressures and continued stress. Moreover, the event may also induce potentially lasting financial problems, especially among women (Gadalla, 2008, 2009; Tamborini, Iams, & Whitman, 2009; Ulker, 2009; Wilmoth & Koso, 2002). Similarly, especially among men, it may come with a loss of caregiving. Particularly among older cohorts, such aid is more likely to be provided by women to men than vice versa (Barusch & Spaid, 1989; Kaufman & Taniguchi, 2006; Stone, Cafferata, & Sangl, 1987). Multiple studies have also noted the prevalence, especially in these cohorts, of “age hypergamy,” or the tendency of women to partner with men several years older than themselves (England & McClintock, 2009; Mahay & Laumann, 2004), who may thus be less physically able at the time of loss and hence more strained by their own caregiving pressures. For instance, mean age at widowhood for NSHAP men was 66 years and for women was 59 years (p < .01). The incidence of this broad array of long-term stressors may explain greater morbidity and mortality rates among those whose partner has died (Carr, 2003; Christakis & Allison, 2006; Elwert & Christakis, 2006; Hughes & Waite, 2009; Keene & Prokos, 2008; Lee, DeMaris, Bavin, & Sullivan, 2001; Lillard & Waite, 1995; Schaefer, Quesenberry, & Wi, 1995; Williams, 2003).
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To summarize, a large literature demonstrates the psychosocial benefits of religious attendance—especially in late life. However, corresponding linkages with stressgenerated physiological problems remain underexplored. Moreover, while emerging evidence suggests associations of spousal loss with a range of biological issues—especially among women—no studies have examined mitigation of these problems by religious attendance. Method Data Data were from the nationally representative 2005– 2006 U.S. National Social Life, Health, and Aging Project (NSHAP). The sample included 1,550 women and 1,455 men aged 57–85, with an oversampling of Blacks, Hispanics, men, and those aged 75–85. In addition to self reports, data included a range of biological indicators
Measures Table 1 reports summary statistics for all variables used in the analyses. To minimize feedback to independent
Table 1. Descriptive Statistics for Variables Used in Analyses Variable Control variables Agea Educationb Gender (female)c Race/ethnicity Whitec Blackc Hispanic/otherc Diagnosed conditions Diabetesc Hypertensionc Heart failure or attackc BMI Number of marriages (lifetime)b Independent variables Religious attendance Religious attendanceb Marital status, religious attendance Married/cohabiting Spousal loss, regular religious attendancec Spousal loss, no regular religious attendancec Dependent variables Inflammatory states Log CRPa EBVa Metabolic states Waist circumferencea Log HbA1ca Cardiovascular states Systolic BPa Diastolic BPa Heart ratea
Mean
SE
Percentage
Range
N
68.02 2.60 0.52
0.19 0.04 0.01
52
57–85 years 1–4 0–1
3,005 3,005 3,005
0.81 0.10 0.09
0.02 0.01 0.02
81 10 9
0–1 0–1 0–1
2,993 2,993 2,993
0.20 0.54 0.15 29.08 1.39
0.01 0.01 0.01 6.26 0.02
20 54 15
0–1 0–1 0–1 14.06–67.30 kg/m2 1–3
3,005 3,005 2,979 2,789 2,840
3.27
0.05
0–6
2,990
0.71 0.12 0.17
0.01 0.01 0.01
0–1 0–1 0–1
2,872 2,872 2,872
1.07 155.94
0.02 2.16
0–4.62 log scale 12.72–371.35 ELISA units
1,939 1,977
38.42 1.79
0.17 0.00
22–66.5 inches 1.44–2.65 log scale
2,901 1,739
136.34 81.15 71.06
0.46 0.32 0.34
78–233 mm Hg 44–133.67 mm Hg 40–133.33 beats/min
2,935 2,935 2,932
71 12 17
Notes. Data for all analyses were from the nationally representative 2005–2006 U.S. National Social Life, Health, and Aging Project (NSHAP). Italicization denotes reference category in subsequent analyses. All estimates are weighted to account for differential probabilities of selection and differential nonresponse. Design-based SEs are given in parentheses. BMI = body mass index; BP = blood pressure; CRP = C-reactive protein; EBV = Epstein–Barr virus antibody titers; HbA1c = hemoglobin A1c. a Continuous variable. b Ordinal variable. c Dummy variable.
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(including blood and saliva samples) collected at the time of interview by nonmedically trained interviewers. The survey had a weighted response rate of 75.5% (Lindau, Schumm, Laumann, Levinson, & O’Muircheartaigh, 2007; O’Muircheartaigh & Smith, 2007). In-home interviews of household-dwelling adults were conducted between July 2005 and March 2006, in both English and Spanish. Most interviewers were experienced personnel given further training by National Opinion Research Center (NORC) at the University of Chicago and remained with the project throughout the interview period. Participant consent was obtained prior to interview. Institutional review boards at the Division of the Social Sciences and NORC at the University of Chicago approved data collection procedures.
Religious Attendance and Physiological Problems
Dependent variables.—Inflammation was indicated by CRP and Epstein–Barr virus (EBV) antibody titers—both derived from high-sensitivity assays of dried blood spots collected through capillary finger sticks (Williams & McDade, 2009). Due to heavy right skew, raw CRP values were log-transformed. Metabolic status was similarly indexed by two measures, for waist circumference, and poor blood sugar control as indicated by log-transformed hemoglobin A1c (HbA1c)—glycosylated hemoglobin as a percentage of total hemoglobin. As with the two inflammation measures, HbA1c was derived from dried blood spots. Finally, three cardiovascular states were examined—systolic and diastolic BP, in mm Hg and heart rate in beats per minute. Independent variables.—Baseline associations of religious attendance with physiological states were examined through an ordinal self-report. The exact question wording was, “Thinking about the past 12 months, about how often have you attended religious services?” Responses ranged from 0 (never) to 6 (several times a week). Next, recent findings (Das, 2013b) suggest similar linkages of types of spousal loss (divorce/separation, widowhood) with these health outcomes. Moreover—especially in gender-separate models—cell-size limitations precluded separate examination of specific partnership categories. Accordingly, mitigation of loss-induced weathering by religious attendance was explored by crosscategorizing any such marital transition (through divorce, separation, or widowhood) with regular religious attendance (once a week or more). Thus, dichotomous indicators were included for (any) spousal loss and regular religious attendance and spousal loss and no regular religious attendance, with those currently married/cohabiting as the reference. Control variables.—A respondent’s age was entered linearly as a continuous variable in all analyses. Gendercombined models also included a dichotomous indicator for being female. Next, race was indicated by a set of dummy variables for Black and Hispanic/other, with non-Hispanic White as the reference category. Seventy-seven percent of women and 70% of men in the Hispanic/other category
were non-Black Hispanics, with the remainder comprised of American Indians or Alaskan natives, Asian or Pacific Islanders, and “other.” Education—proxying greater knowledge of health issues as well as long-term socioeconomic status—was an integer score ranging from 1 (less than a high school education) to 4 (a Bachelors degree or more). While NSHAP data included a participant’s self-reported net household assets in the preceding year, this factor was not included as a control variable—partly due to missing data problems. About 12% of NSHAP respondents refused to answer this set of sensitive questions. Moreover, current financial worth was perhaps too susceptible to feedback from health—especially among older adults, with increasing health care expenses (Kington & Smith, 1997). Most importantly, as argued above, declines in these assets comprise a “primary stressor”—one among the broad array of chronic pressures induced by spousal loss—and an especially important factor among women. As such, they are best conceived as a potential mediating factor rather than a confounder—such that netting out this factor would have amounted to overcontrolling. Next, all models also adjusted for any lifetime diagnosis of diabetes or hypertension by a medical doctor, as well as any history of heart failure or attack. In addition, those for the two inflammation outcomes (log CRP, EBV) controlled waist circumference and body mass index (BMI). Finally, all analyses examining mitigation of spousal-loss effects by religious attendance (Tables 5–7) adjusted for a participant’s lifetime number of marriages—ranging from 1 to 3 or more. Missing data.—NSHAP took a randomized modularization approach to blood spot collection, to reduce respondent burden while still obtaining population-representative data (O’Muircheartaigh, Eckman, & Smith, 2009). Specifically, a random subsample of 2,494 participants was assigned to this module, with an unweighted final response rate of 82.1%, including losses due to technical difficulties (Williams & McDade, 2009). Given this sampling process, the inflammation (log CRP, EBV) and blood sugar (log HbA1c) indicators were unmeasured for some participants—that is, those not assigned to the blood spot module. However, given the modularization logic (random assignment to the module), these cases were Missing-At-Random, and hence (by design) did not compromise generalizability. Moreover, among those assigned, there were no significant differences between respondents and nonresponders with respect to either demographics (gender, race, ethnicity, age, education, income, or marital status) or basic health status (self-reported mental or physical health or the number of doctor visits in the preceding 12 months). Accordingly, no values were imputed. Analytic Strategy As noted, to reduce the likelihood of feedback from health status to independent variables, all outcomes were
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variables, outcomes were restricted to direct indicators of current physiological status rather than lifetime diagnoses of medical problems. Specifically, seven biomeasures were used to tap inflammatory, metabolic, and cardiovascular states (McEwen, 1998; Seeman et al., 2008). In preliminary analysis (available on request), pairwise correlations among these variables were inconsistent, supporting a need to examine them separately rather than as a summary index. Specifically, of the 21 possible correlations, only 12 were both positive and significant at p less than .05. With the sole exception of the two BP variables, none were higher than 0.25. Moreover, as explained below, linkages of these outcomes with the study’s key predictors also diverged—a conceptually important finding.
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All analyses were through OLS regression models. A first set tested linkages of the two inflammation (Table 2), two metabolic (Table 3), and three cardiovascular (Table 4) outcomes with frequency of religious attendance—for all participants and separately for men and women. Gender differentials were examined through postestimation Wald tests. Next, mitigation of spousal-loss effects by participation in religious services was examined by first regressing the seven outcomes on loss with and without regular (weekly or higher) religious attendance—with those currently married/cohabiting as the reference (Tables 5–7). As explained above, combination of divorce/separation and widowhood into a single “spousal loss” category was designed to avoid cell-size limitations and based on previous findings that these two statuses have similar linkages with mental and physiological health (Das, 2013b). Postestimation Wald tests were then used to examine whether the association of loss with each health outcome was significantly different (at p < .10) for those with regular religious attendance
Table 2. Associations of Religious Attendance With Inflammatory States Among U.S. Adults Aged 57–85: Coefficients (SEs) All Log CRP
a
Control variables Agea Educationb Gender (ref: menc) Womenc Ethnicity (ref: Whitec) Blackc Hispanic/otherc Diagnosed conditions (lifetime) Diabetesc Hypertensionc Heart failure or attackc Obesity Waist circumferencea BMIa Independent variable Religious attendanceb N
Men EBV
a
−0.00* (0.00) −0.07*** (0.02)
0.20 (0.27) −3.35 (2.04)
0.26*** (0.04)
3.28 (4.85)
0.23*** (0.05) 0.06 (0.06)
Log CRP
a
Women EBVa
Log CRPa
EBVa
0.00 (0.00) −0.08*** (0.02)
0.31 (0.30) −3.44 (2.54)
−0.01* (0.00) −0.07** (0.03)
0.12 (0.43) −2.91 (2.89)
12.60** (5.34) −2.48 (5.88)
0.28*** (0.08) 0.09 (0.08)
20.36** (8.23) 4.75 (8.42)
0.16* (0.08) 0.00 (0.10)
8.70 (8.70) −8.94 (9.53)
0.00 (0.06) −0.01 (0.05) 0.16*** (0.06)
−1.65 (4.44) −1.02 (3.37) 7.36 (7.20)
0.05 (0.09) −0.05 (0.07) 0.22*** (0.07)
−4.17 (5.84) −5.25 (4.99) 4.15 (7.10)
−0.07 (0.08) 0.04 (0.07) 0.08 (0.11)
2.00 (8.57) 4.14 (5.48) 10.83 (10.86)
0.02** (0.01) 0.02*** (0.01)
0.89 (0.65) 0.22 (0.53)
0.02* (0.01) 0.01 (0.01)
2.52** (1.07) −0.68 (0.95)
0.02** (0.01) 0.03*** (0.01)
−0.26 (0.89) 0.75 (0.72)
−0.04*** (0.01) 1,834
−2.23** (0.96) 1,869
−0.03** (0.01) 882
−2.64** (1.22) 902
−0.04*** (0.02) 952
−1.94 (1.47) 967
Notes. Data for all analyses were from the nationally representative 2005–2006 U.S. National Social Life, Health, and Aging Project (NSHAP). Figures in bold represent associations statistically significant at at least p
Religious Attendance and Physiological Problems in Late Life Aniruddha Das1,2 and Stephanie Nairn1 1 Department of Sociology and Centre on Population Dynamics, McGill University, Montreal, Quebec, Canada.
2
Objectives. This study queried linkages of older adults’ religious attendance with their physiological health.
Results. Religious attendance was negatively associated with a system of physiological issues, consistent with mitigation of multisystemic “weathering.” Linkages were relatively uniform with inflammatory and cardiovascular but not metabolic states and were not significantly different for women than men. Effects of spousal loss on the 2 former subsystems were attenuated by regular religious attendance—in combined-gender analysis and among women, but not men. Discussion. Religious attendance may buffer older adults from physiological problems and the health effects of life events such as spousal loss. More intensive analysis is needed to explain differential linkages with specific biological subsystems. Key Words: Inflammation—Late life—Physiology—Religious attendance—Spousal loss—Weathering.
A
growing literature on the ecological context of human physiological function connects membership in lower social strata (race, socioeconomic status) to more multisystemic “weathering”—stress-induced biological wear-andtear exerted at least partly through chronically elevated or fluctuating neuroendocrine response (Geronimus, Hicken, Keene, & Bound, 2006; McEwen, 1998; Singer, Ryff, & Seeman, 2004; Sterling & Eyer, 1981). A potential outcome of this biosocial process is socially stratified accelerations in senescence (Das, 2013a; Geronimus et al., 2006; McEwen, 1998). A separate literature suggests that especially in late life, when social and personal assets generally decline, religious attendance may play a key role in buffering a person against psychosocial stress (Ellison, Burdette, & Hill, 2009; Koenig, George, & Titus, 2004; Koenig, Pargament, & Nielsen, 1998; Krause, 2008; Lawler-Row, 2010; Pargament, 1997; Schieman, Pudrovska, Pearlin, & Ellison, 2006)—with studies offering conflicting evidence on gender variations in this effect (Bednarowski, 1999; Bradshaw & Ellison, 2010; Cokely et al., 2013; Hintikka et al., 2000; Krause, Ellison, & Marcum, 2002; McFarland, 2010). If so, this protective impact may arguably extend to physiological weathering—both in general, or as triggered by major life transitions, a key process behind late-life health issues (Thoits, 2010; Wheaton, 1990). Due to both data and especially conceptual limitations, these linkages and moderations remain underexplored. Using data from the 2005–2006 U.S. National Health and Social Life Project (NSHAP)—a nationally representative
probability sample of adult Americans aged 57–85—the present study began to fill these gaps. Three topics were addressed: (a) linkages between religious attendance and a range of inflammatory, metabolic, and cardiovascular states proxying multisystemic weathering; (b) potential gender variations in these associations; and (c) mitigation by religious attendance of elevated weathering risks from spousal loss. Religious Attendance and Weathering A large literature links participation in religious services with better physical and mental health (Buck, Williams, Musick, & Sternthal, 2009; Koenig et al., 2004; Krause, 2008; Levin & Chatters, 2008), especially in late life (Daaleman, Perera, & Studenski, 2004; Koenig et al., 2004; Krause, 2008; Lawler-Row, 2010; Levin & Chatters, 2008). Starting with the work of psychologist Kenneth Pargament (1997), scholars have increasingly conceptualized these broad benefits as arising from religion’s stress-mitigating effects. Thus, studies link a strong sense of divine control with lower psychological distress among older Americans (Schieman et al., 2006) and religious attendance with more self-reported tranquility (Ellison et al., 2009). Such engagement may also foster stress-buffering network connections—with multiple studies indicating that individuals who attend religious services at least once a week receive more social and emotional support (Nooney & Woodrum, 2002; Strawbridge, Shema, Cohen, & Kaplan, 2001; Taylor & Chatters, 1988). This church-based
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected]. Received February 12, 2013; Accepted June 10, 2014 Decision Editor: Merril Silverstein, PhD
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Method. Data were from the 2005–2006 National Social Life, Health, and Aging Project, nationally representative of U.S. adults aged 57–85 years. Analyses examined associations of religious attendance with biological states, potential gender variations in these linkages, and attenuation by this factor of health effects of spousal loss.
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rate (Ellaway & Macintyre, 2006) and composite scores of biological risk (Maselko, Kubzansky, Kawachi, Seeman, & Berkman, 2007). An emerging literature in the anthropology and neuropsychology of religious rituals also suggests that emotionally charged group dynamics, common in highly devout congregations, can have positive neurophysiological and immune system effects—possibly through the production of endogenous opioid peptides (Frecska & Kulcsar, 1989; Saver & Rabin, 1997; Sosis & Alcorta, 2003). Despite these scattered findings, systematic analysis using nationally representative data to examine linkages between religious attendance and specific physiological subsystems remains missing. Accordingly, the following hypothesis was included to examine these connections. 1. Older women and men with more frequent religious attendance will have less elevated inflammatory, metabolic, and cardiovascular states. Next, while the biosocial processes delineated above arguably hold for both women and men, some scattered literature also indicates gender-specific associations. Evidence is relatively uniform on women’s greater religious attendance, especially in late life (Balbuena et al., 2013; Koenig, 1999; Krause et al., 2002; Maselko et al., 2007; McFarland, 2010). However, studies offer contradictory findings on gender patterns in the health effects of this factor. Some indicate women may be more benefited—whether in terms of mental health (Bradshaw & Ellison, 2010; Cokely et al., 2013; Hintikka et al., 2000) or survival (Koenig, 1999; Strawbridge et al., 1997). Moreover, mental health dividends of religious attendance may possibly bypass social support, at least among women—perhaps indicating a more direct effect of subjective beliefs (Hintikka et al., 2000; Koenig, 1999; Maselko et al., 2007; McFarland, 2010). Other studies, in contrast, indicate greater benefits among men (Bednarowski, 1999; Krause et al., 2002; McFarland, 2010)—possibly due to gender differences in the nature of religious participation. Ethnographic research on American women’s religious experiences suggests that they are often simultaneously insiders and outsiders in religious organizations—excluded from authority positions despite their active participation (Bednarowski, 1999). In similar vein, McFarland (2010) argues that religious roles into which women are socialized emphasize “feminine” traits, such as being obedient, nurturing, and service oriented. The corresponding “cost of caring” may, in turn, make participation in church-centered social activity detrimental to their health. In contrast, men tend to occupy more formal and high-status roles within church organizations. Additionally, in a broader social environment where men may not be encouraged to express or share emotions, religious attendance can yield a context in which receiving support becomes comfortable. Perhaps for this reason, modest involvement in organizational religiosity decreases depression in men but not for women, and these mental health benefits rise with men’s higher levels of such
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“social capital” may also enhance psychological resilience and coping-capacity in the face of life challenges (Koenig, George, et al., 1998; Pargament, Koenig, & Perez, 2000; Pargament, Smith, Koenig, & Perez, 1998). This is especially true of in late life, when individuals suffer a generalized loss of social and physical assets. Specifically, older adults experience fundamental changes in the structure of both their families and their broader social network. Children leave home, retirement uproots individuals from their social networks at work, parents and elders pass away, and health problems begin impeding social interaction (Hughes, Waite, Hawkley, & Cacioppo, 2004). Accordingly, older women and men strongly connected to church-centered social networks report improved mental health and perceived quality of life— especially in times of poor physical health (Koenig, George, et al., 1998; Koenig, Pargament, et al., 1998). Despite its stress-buffering implications, linkages between religious attendance and biological weathering remain underexplored. Biodemographic literature (McEwen, 1998; Seeman et al., 2008) suggests weathering pressures on three linked physiological subsystems—inflammatory, metabolic (e.g., obesity, diabetic problems), and cardiovascular (e.g., blood pressure [BP], heart rate)—with scattered evidence indicating a pathogenic process sequentially cascading through each of these complexes. Thus, multiple studies indicate a pathway from extended psychosocial stress to inflammation (Das, 2013a; McDade, Hawkley, & Cacioppo, 2006; Melamed, Shirom, Toker, Berliner, & Shapira, 2006; Weinstein, Vaupel, & Wachter, 2007)—possibly due to norepinephrine-driven gene expression of inflammatory mediators (Bierhaus et al., 2003; Kiecolt-Glaser, Gouin, & Hantsoo, 2010). Downstream, inflammation has a demonstrated causative role in cardiovascular problems, as well as poor blood sugar control due to insulin resistance (Grundy, Brewer, Cleeman, Smith, & Lenfant, 2004; Yudkin, 2003). More specifically, recently developed high-sensitivity C-reactive protein (CRP) assays suggest that chronic, low-grade inflammation (indicated by elevated CRP) is linked to subsequent incidence of cardiovascular disease (Danesh et al., 2000), type 2 diabetes (Pradhan, Manson, Rifai, Buring, & Ridker, 2001), and the “metabolic syndrome” (McDade & Hayward, 2009; Ridker, Buring, Cook, & Rifai, 2003). Studies also suggest a direct effect of psychosocial strain on obesity (de Wit et al., 2010) and of obesity on poor blood sugar control, diabetes, and heart disease (Grundy et al., 2004; Yudkin, 2003). Finally, chronic antecedent stress has been directly linked to blood sugar problems (Calhoun et al., 2009; Lustman et al., 2000), as well as cardiovascular issues such as higher BP (Ariyo et al., 2000; Shinn, Poston, Kimball, Saint Jeor, & Foreyt, 2001) and heart rate (Lampert et al., 2009). Arguably, if religious attendance in late life is indeed protective against stress, it may also mitigate such pathogenic processes. Consistent with this conjecture, such engagement has been linked to a lower prevalence of hypertension (Koenig, George, et al., 1998), as well as lower resting heart
Religious Attendance and Physiological Problems
engagement. Corresponding physiological patterns remain unexplored. Accordingly, to test gender variations in the weathering implications of religious attendance, the following hypothesis was included: 2. Linkages between more frequent religious attendance and physiological states will be stronger for older men than for women.
While the negative health consequences of widowhood have been the most extensively studied, evidence suggests much the same sequelae with divorce or separation (Johnson, Backlund, Sorlie, & Loveless, 2000; Lillard & Waite, 1995). Apart from the loss of dyadic assets, both the event of, and the time preceding, divorce are likely to be marked by increased stress and relational friction. In a recent study, for instance, Hughes and Waite (2009) examine the effects of marital disruption—whether through divorce or widowhood—on a small set of summary health measures and find that such events may cause long-term damage to health. In addition to such “intracouple” factors, marriages also tend to be embedded in a network of friends and family members, which may represent a key source of social and emotional support in late life (Carr & Utz, 2002; Elwert & Christakis, 2006). Whether due to grief and consequent social withdrawal or because one is socially connected through one’s spouse, widowhood or divorce may lead to a weakening of ties to this stress-buffering relational web. In turn, both the “primary stressors” of bereavement and lost dyadic assets, and “secondary stressors” represented by these broader social deficits (Pearlin, 1999; Thoits, 2010), may potentially trigger weathering. Consistent with these arguments, a recent NSHAP-based study (Das, 2013b) finds spousal loss (whether through widowhood or divorce/ separation) associated with a broad range of negative mental, metabolic, and cardiovascular states. Moreover, contrary to previous conceptions of loss as a traumatic event with transient effects (Booth & Amato, 1991; Hetherington & Kelly, 2002), physiological issues appear to be more elevated among those longer past the event— perhaps reflecting lasting coping pressures. However, it also finds physiological linkages to be more uniform among all participants and women, than men—arguably suggesting women’s deeper (and unexplained) vulnerability to this life transition. Building on this emerging evidence, it was conjectured that if religious attendance does indeed protect a person against weathering pressures, it may also mitigate the negative physiological effects of spousal loss—among women if not men. At least for mental states, some small-sample and qualitative studies do suggest such buffering, with religious engagement attenuating depression and anxiety following the loss of a partner—whether through widowhood (Fry, 2001; Woo, Chan, Chow, & Ho, 2008) or divorce (Webb et al., 2010). As among older adults in general, however, the role of this factor in mitigating loss-induced biological problems has yet to be examined. Accordingly, the following hypothesis was included to examine this potential buffering: 3. Older adults—especially women—having experienced spousal loss, whether through widowhood or divorce/ separation, will have better physiological status if they regularly attend religious services.
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Spousal Loss and Weathering: Mitigation by Religious Attendance? As noted, biodemographic studies have largely focused on weathering pressures exerted by one’s broad social position (i.e., stratification by race or class). However, a large and established stress process literature emphasizes the negative psychological effects of life transitions (Butts & Pixley, 2004; Dohrenwend, 2006; Elder, 1985; Gotlib & Wheaton, 1997; Pixley, 2008)—suggesting corresponding physiological sequelae. In other words, those experiencing such events may arguably comprise a distinct “at risk” population—with elevated weathering-induced diabetic and cardiovascular morbidity and contracted longevity. Among older adults, the loss of a spouse is perhaps the most important such turning point. While much of the literature on this life transition has focused on bereavement, the event also entails declines in a range of other assets. Marriages (especially lasting ones) tend to be characterized by longstanding household divisions of labor and investments in partnerspecific skills (Becker, 1981; Brines & Joyner, 1999). Apart from the immediate (and possibly transient) “shock” of bereavement, the loss of these assets and investments may also lead to long-term coping pressures and continued stress. Moreover, the event may also induce potentially lasting financial problems, especially among women (Gadalla, 2008, 2009; Tamborini, Iams, & Whitman, 2009; Ulker, 2009; Wilmoth & Koso, 2002). Similarly, especially among men, it may come with a loss of caregiving. Particularly among older cohorts, such aid is more likely to be provided by women to men than vice versa (Barusch & Spaid, 1989; Kaufman & Taniguchi, 2006; Stone, Cafferata, & Sangl, 1987). Multiple studies have also noted the prevalence, especially in these cohorts, of “age hypergamy,” or the tendency of women to partner with men several years older than themselves (England & McClintock, 2009; Mahay & Laumann, 2004), who may thus be less physically able at the time of loss and hence more strained by their own caregiving pressures. For instance, mean age at widowhood for NSHAP men was 66 years and for women was 59 years (p < .01). The incidence of this broad array of long-term stressors may explain greater morbidity and mortality rates among those whose partner has died (Carr, 2003; Christakis & Allison, 2006; Elwert & Christakis, 2006; Hughes & Waite, 2009; Keene & Prokos, 2008; Lee, DeMaris, Bavin, & Sullivan, 2001; Lillard & Waite, 1995; Schaefer, Quesenberry, & Wi, 1995; Williams, 2003).
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To summarize, a large literature demonstrates the psychosocial benefits of religious attendance—especially in late life. However, corresponding linkages with stressgenerated physiological problems remain underexplored. Moreover, while emerging evidence suggests associations of spousal loss with a range of biological issues—especially among women—no studies have examined mitigation of these problems by religious attendance. Method Data Data were from the nationally representative 2005– 2006 U.S. National Social Life, Health, and Aging Project (NSHAP). The sample included 1,550 women and 1,455 men aged 57–85, with an oversampling of Blacks, Hispanics, men, and those aged 75–85. In addition to self reports, data included a range of biological indicators
Measures Table 1 reports summary statistics for all variables used in the analyses. To minimize feedback to independent
Table 1. Descriptive Statistics for Variables Used in Analyses Variable Control variables Agea Educationb Gender (female)c Race/ethnicity Whitec Blackc Hispanic/otherc Diagnosed conditions Diabetesc Hypertensionc Heart failure or attackc BMI Number of marriages (lifetime)b Independent variables Religious attendance Religious attendanceb Marital status, religious attendance Married/cohabiting Spousal loss, regular religious attendancec Spousal loss, no regular religious attendancec Dependent variables Inflammatory states Log CRPa EBVa Metabolic states Waist circumferencea Log HbA1ca Cardiovascular states Systolic BPa Diastolic BPa Heart ratea
Mean
SE
Percentage
Range
N
68.02 2.60 0.52
0.19 0.04 0.01
52
57–85 years 1–4 0–1
3,005 3,005 3,005
0.81 0.10 0.09
0.02 0.01 0.02
81 10 9
0–1 0–1 0–1
2,993 2,993 2,993
0.20 0.54 0.15 29.08 1.39
0.01 0.01 0.01 6.26 0.02
20 54 15
0–1 0–1 0–1 14.06–67.30 kg/m2 1–3
3,005 3,005 2,979 2,789 2,840
3.27
0.05
0–6
2,990
0.71 0.12 0.17
0.01 0.01 0.01
0–1 0–1 0–1
2,872 2,872 2,872
1.07 155.94
0.02 2.16
0–4.62 log scale 12.72–371.35 ELISA units
1,939 1,977
38.42 1.79
0.17 0.00
22–66.5 inches 1.44–2.65 log scale
2,901 1,739
136.34 81.15 71.06
0.46 0.32 0.34
78–233 mm Hg 44–133.67 mm Hg 40–133.33 beats/min
2,935 2,935 2,932
71 12 17
Notes. Data for all analyses were from the nationally representative 2005–2006 U.S. National Social Life, Health, and Aging Project (NSHAP). Italicization denotes reference category in subsequent analyses. All estimates are weighted to account for differential probabilities of selection and differential nonresponse. Design-based SEs are given in parentheses. BMI = body mass index; BP = blood pressure; CRP = C-reactive protein; EBV = Epstein–Barr virus antibody titers; HbA1c = hemoglobin A1c. a Continuous variable. b Ordinal variable. c Dummy variable.
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(including blood and saliva samples) collected at the time of interview by nonmedically trained interviewers. The survey had a weighted response rate of 75.5% (Lindau, Schumm, Laumann, Levinson, & O’Muircheartaigh, 2007; O’Muircheartaigh & Smith, 2007). In-home interviews of household-dwelling adults were conducted between July 2005 and March 2006, in both English and Spanish. Most interviewers were experienced personnel given further training by National Opinion Research Center (NORC) at the University of Chicago and remained with the project throughout the interview period. Participant consent was obtained prior to interview. Institutional review boards at the Division of the Social Sciences and NORC at the University of Chicago approved data collection procedures.
Religious Attendance and Physiological Problems
Dependent variables.—Inflammation was indicated by CRP and Epstein–Barr virus (EBV) antibody titers—both derived from high-sensitivity assays of dried blood spots collected through capillary finger sticks (Williams & McDade, 2009). Due to heavy right skew, raw CRP values were log-transformed. Metabolic status was similarly indexed by two measures, for waist circumference, and poor blood sugar control as indicated by log-transformed hemoglobin A1c (HbA1c)—glycosylated hemoglobin as a percentage of total hemoglobin. As with the two inflammation measures, HbA1c was derived from dried blood spots. Finally, three cardiovascular states were examined—systolic and diastolic BP, in mm Hg and heart rate in beats per minute. Independent variables.—Baseline associations of religious attendance with physiological states were examined through an ordinal self-report. The exact question wording was, “Thinking about the past 12 months, about how often have you attended religious services?” Responses ranged from 0 (never) to 6 (several times a week). Next, recent findings (Das, 2013b) suggest similar linkages of types of spousal loss (divorce/separation, widowhood) with these health outcomes. Moreover—especially in gender-separate models—cell-size limitations precluded separate examination of specific partnership categories. Accordingly, mitigation of loss-induced weathering by religious attendance was explored by crosscategorizing any such marital transition (through divorce, separation, or widowhood) with regular religious attendance (once a week or more). Thus, dichotomous indicators were included for (any) spousal loss and regular religious attendance and spousal loss and no regular religious attendance, with those currently married/cohabiting as the reference. Control variables.—A respondent’s age was entered linearly as a continuous variable in all analyses. Gendercombined models also included a dichotomous indicator for being female. Next, race was indicated by a set of dummy variables for Black and Hispanic/other, with non-Hispanic White as the reference category. Seventy-seven percent of women and 70% of men in the Hispanic/other category
were non-Black Hispanics, with the remainder comprised of American Indians or Alaskan natives, Asian or Pacific Islanders, and “other.” Education—proxying greater knowledge of health issues as well as long-term socioeconomic status—was an integer score ranging from 1 (less than a high school education) to 4 (a Bachelors degree or more). While NSHAP data included a participant’s self-reported net household assets in the preceding year, this factor was not included as a control variable—partly due to missing data problems. About 12% of NSHAP respondents refused to answer this set of sensitive questions. Moreover, current financial worth was perhaps too susceptible to feedback from health—especially among older adults, with increasing health care expenses (Kington & Smith, 1997). Most importantly, as argued above, declines in these assets comprise a “primary stressor”—one among the broad array of chronic pressures induced by spousal loss—and an especially important factor among women. As such, they are best conceived as a potential mediating factor rather than a confounder—such that netting out this factor would have amounted to overcontrolling. Next, all models also adjusted for any lifetime diagnosis of diabetes or hypertension by a medical doctor, as well as any history of heart failure or attack. In addition, those for the two inflammation outcomes (log CRP, EBV) controlled waist circumference and body mass index (BMI). Finally, all analyses examining mitigation of spousal-loss effects by religious attendance (Tables 5–7) adjusted for a participant’s lifetime number of marriages—ranging from 1 to 3 or more. Missing data.—NSHAP took a randomized modularization approach to blood spot collection, to reduce respondent burden while still obtaining population-representative data (O’Muircheartaigh, Eckman, & Smith, 2009). Specifically, a random subsample of 2,494 participants was assigned to this module, with an unweighted final response rate of 82.1%, including losses due to technical difficulties (Williams & McDade, 2009). Given this sampling process, the inflammation (log CRP, EBV) and blood sugar (log HbA1c) indicators were unmeasured for some participants—that is, those not assigned to the blood spot module. However, given the modularization logic (random assignment to the module), these cases were Missing-At-Random, and hence (by design) did not compromise generalizability. Moreover, among those assigned, there were no significant differences between respondents and nonresponders with respect to either demographics (gender, race, ethnicity, age, education, income, or marital status) or basic health status (self-reported mental or physical health or the number of doctor visits in the preceding 12 months). Accordingly, no values were imputed. Analytic Strategy As noted, to reduce the likelihood of feedback from health status to independent variables, all outcomes were
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variables, outcomes were restricted to direct indicators of current physiological status rather than lifetime diagnoses of medical problems. Specifically, seven biomeasures were used to tap inflammatory, metabolic, and cardiovascular states (McEwen, 1998; Seeman et al., 2008). In preliminary analysis (available on request), pairwise correlations among these variables were inconsistent, supporting a need to examine them separately rather than as a summary index. Specifically, of the 21 possible correlations, only 12 were both positive and significant at p less than .05. With the sole exception of the two BP variables, none were higher than 0.25. Moreover, as explained below, linkages of these outcomes with the study’s key predictors also diverged—a conceptually important finding.
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All analyses were through OLS regression models. A first set tested linkages of the two inflammation (Table 2), two metabolic (Table 3), and three cardiovascular (Table 4) outcomes with frequency of religious attendance—for all participants and separately for men and women. Gender differentials were examined through postestimation Wald tests. Next, mitigation of spousal-loss effects by participation in religious services was examined by first regressing the seven outcomes on loss with and without regular (weekly or higher) religious attendance—with those currently married/cohabiting as the reference (Tables 5–7). As explained above, combination of divorce/separation and widowhood into a single “spousal loss” category was designed to avoid cell-size limitations and based on previous findings that these two statuses have similar linkages with mental and physiological health (Das, 2013b). Postestimation Wald tests were then used to examine whether the association of loss with each health outcome was significantly different (at p < .10) for those with regular religious attendance
Table 2. Associations of Religious Attendance With Inflammatory States Among U.S. Adults Aged 57–85: Coefficients (SEs) All Log CRP
a
Control variables Agea Educationb Gender (ref: menc) Womenc Ethnicity (ref: Whitec) Blackc Hispanic/otherc Diagnosed conditions (lifetime) Diabetesc Hypertensionc Heart failure or attackc Obesity Waist circumferencea BMIa Independent variable Religious attendanceb N
Men EBV
a
−0.00* (0.00) −0.07*** (0.02)
0.20 (0.27) −3.35 (2.04)
0.26*** (0.04)
3.28 (4.85)
0.23*** (0.05) 0.06 (0.06)
Log CRP
a
Women EBVa
Log CRPa
EBVa
0.00 (0.00) −0.08*** (0.02)
0.31 (0.30) −3.44 (2.54)
−0.01* (0.00) −0.07** (0.03)
0.12 (0.43) −2.91 (2.89)
12.60** (5.34) −2.48 (5.88)
0.28*** (0.08) 0.09 (0.08)
20.36** (8.23) 4.75 (8.42)
0.16* (0.08) 0.00 (0.10)
8.70 (8.70) −8.94 (9.53)
0.00 (0.06) −0.01 (0.05) 0.16*** (0.06)
−1.65 (4.44) −1.02 (3.37) 7.36 (7.20)
0.05 (0.09) −0.05 (0.07) 0.22*** (0.07)
−4.17 (5.84) −5.25 (4.99) 4.15 (7.10)
−0.07 (0.08) 0.04 (0.07) 0.08 (0.11)
2.00 (8.57) 4.14 (5.48) 10.83 (10.86)
0.02** (0.01) 0.02*** (0.01)
0.89 (0.65) 0.22 (0.53)
0.02* (0.01) 0.01 (0.01)
2.52** (1.07) −0.68 (0.95)
0.02** (0.01) 0.03*** (0.01)
−0.26 (0.89) 0.75 (0.72)
−0.04*** (0.01) 1,834
−2.23** (0.96) 1,869
−0.03** (0.01) 882
−2.64** (1.22) 902
−0.04*** (0.02) 952
−1.94 (1.47) 967
Notes. Data for all analyses were from the nationally representative 2005–2006 U.S. National Social Life, Health, and Aging Project (NSHAP). Figures in bold represent associations statistically significant at at least p
