Elsevier

Preventive Medicine

Volume 49, Issues 2–3, August–September 2009, Pages 142-147
Preventive Medicine

Engagement in cultural activities and cause-specific mortality: Prospective cohort study

https://doi.org/10.1016/j.ypmed.2009.06.026Get rights and content

Abstract

Objective

To determine the relation between engagement in cultural activities and main causes of mortality among full-time employees.

Methods

Finnish industrial employees (N = 7922) completed a questionnaire about engagement in cultural activities (arts and culture, activities in associations, societal action, reading literature, and studying) in 1986 and were followed-up for mortality rates until 1986–2004.

Results

High engagement in cultural activities was independently associated with decreased all-cause mortality (hazard ratio 0.71, 95% CI 0.57–0.88) and external causes of death (hazard ratio 0.46, 95% CI 0.24–0.90) after adjustment for socio-demographic factors, socio-economic status, work stress, social characteristics, diabetes, and hypertension. High engagement was also associated with a reduced risk of cardiovascular mortality after controlling for socio-demographic factors and stress (hazard ratio 0.68, 95% CI 0.49–0.95). The associations with all-cause mortality and deaths from external causes remained after further adjustment for behavioral risk factors. Of the forms of engagement, solitary cultural activities were related to all-cause mortality while socially shared cultural activities were more closely linked to external mortality.

Conclusion

Better overall survival of culturally engaged employees is largely attributable to their lower risk of death from external causes.

Introduction

It is widely acknowledged that engagement in a physically active lifestyle is related to better health (Ferrucci et al. 1999) and longer survival (Andersen et al., 2000, Hakim et al., 1998). However, there is growing literature showing that there are other forms of activity such as social participation (Kiely et al., 2000), volunteering (Oman et al., 1999), and customary activities (Sun and Liu, 2006) that may also offer important health benefits (Bassuk et al., 1999, Fabrigoule et al., 1995, Kaplan et al., 1988, Mendes de Leon et al., 2003, Welin et al., 1985 ) and lower the overall mortality (Bygren et al., 1996, Fry and Debats, 2006, House et al., 1982, Kiely and Flacker, 2003, Rowe and Kahn, 1998, Welin et al., 1992).

Despite these findings, interpretation of available empirical data on cultural engagement and survival is hampered by several limitations. First, evidence on the impact of cultural and social engagement on survival has mainly focused on elderly populations (Baker et al., 2005, Bassuk et al., 1999, Fry and Debats, 2006, Kiely and Flacker, 2003, Kiely et al., 2000, Lennartson and Silverstein, 2001, Glass et al., 1999 Morrow-Howell et al., 2003, Nakanishi et al., 1998, Sun and Liu, 2006, Walter-Ginsburg et al., 2002) while no prospective studies on engagement in cultural activities and mortality has been conducted among working populations. Younger populations may also benefit from cultural and intellectual activities (Hyyppä and Mäki, 2001, Hyyppä and Mäki, 2003).

Second, most studies have focused on all-cause mortality and therefore evidence is lacking as to what extent different causes of mortality are affected by engagement in cultural activities. Cultural engagement may alleviate chronic stress and improve psychological well-being (Cohen et al., 2006, Kiely and Flacker, 2003) by providing various coping resources (e.g., emotional, cognitive, social) that are likely to be important to many forms of mortality through the functioning of biological regulatory systems (e.g., endocrine, immune) and behavioral choices (Everson-Rose and Lewis, 2005, Gruenewald et al., 2006, Loucks et al., 2006, Moore, 1997). It is important to examine whether engagement in cultural activities is more closely linked to risk of some forms of death as compared to others. This might provide clues as to the underlying mechanisms that link cultural engagement to longer survival.

Third, most prospective evidence from various countries on non-physical engagement and mortality has focused on the benefits of socially shared activities (Barefoot et al., 2005, Berkman et al., 2004, Glass et al., 1999, Iwasaki et al., 2002, Sundquist et al., 2006). Both socially shared and solitary cultural activities may potentially extend lifespan through various pathways (Bygren et al., 1996, Viswanath et al., 2006, Wang et al., 2002). A further question requiring study is the independent role of socially shared cultural activities (e.g., arts performances and associations) vs. solitary cultural/intellectual activities (e.g., reading books, studying) in mortality.

In this prospective cohort study we test whether engagement in cultural activities – both socially shared and solitary – is associated with a reduced risk of various causes of mortality independent of conventional risk factors during an 18-year follow-up in a population of industrial workers aged less than 65 years at entry to the study.

Section snippets

Study population

The data were drawn from an ongoing Still Working prospective cohort study coordinated by the Finnish Institute of Occupational Health (Väänänen et al., 2008). In 1986, all domestic employees (n = 12,173) of Enso Gutzeit, a forest industry enterprise, that is situated in various localities in Finland were invited to participate in a survey on demographic, psychosocial and health-related factors. The work tasks of those invited varied from production line and maintenance work to clerical and

Results

During the mean follow-up of 18.1 (range 0.3–18.8) years, there were 309 deaths from cardiovascular causes, 223 deaths from cancer, 64 deaths from alcohol-related causes, 111 deaths from external causes (40 suicides, 64 accidents, 7 violence-related deaths), and 74 deaths from other causes among the participants (the total number of events = 781). As Appendix shows, the participants were frequently engaged in reading, while other forms of cultural activities were rather uncommon.

Table 1 shows

Discussion

We found that engagement in cultural activities was independently associated with reduced deaths from external causes among initially healthy full-time employees and that the association between cultural activities and all-cause mortality was largely attributable to the robust link between cultural activities and the reduction in deaths from external causes.

The detected association between reduced mortality from external causes and engagement in cultural activities is in line with previously

Conclusions

We conclude that among the working population cultural activities outside of work life may considerably increase the likelihood of overall survival, leading especially to the avoidance of accidents, violence and suicide. It seems that public policy measures that reduce barriers to engage cultural activities would be important interventions for full-time employees. For many employees, being culturally engaged and having intellectually and emotionally meaningful activities in one's life, is a

Conflict of interest statement

None declared.

Acknowledgments

This study was financially supported by the Academy of Finland (#110451, #117607, #124271, #124322, and #128089) and the Finnish Work Environment Fund (grant #106417). We thank those employees who kindly volunteered to participate in our study.

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