Religious service attendance and mortality in southern Sweden

AIMS: This study aims to investigate associations between attendance in religious service at least once during the past year and all-cause and cause-specific mortality. Study design: Prospective cohort study design. METHODS: A public health survey conducted by Region Skåne in southern Sweden in the autumn of 2008 was sent to a stratified random sample of the adult 18-80 year population with a participation rate of 54.1%. A total of 24,855 participants were included in the present study. The baseline survey was connected to prospective mortality data with 8.3-year follow-up. Analyses were conducted in survival (Cox regression) models. RESULTS: A total 14% had attended religious service at least once during the past year, while 86% were non-attenders. The religious service attenders were women, high and medium position non-manual employees, born outside Sweden, never alcohol consumers and participants with high generalized trust to a higher extent than non-attenders. They also displayed lower proportions with daily smoking and low physical activity compared to non-attenders. The group of religious service attenders had significantly lower hazard rate ratios (HRRs) of all-cause mortality compared to non-attenders in all multiple models. Cardiovascular (CVD) mortality was significantly lower for religious service attenders in the multiple models until BMI, physical activity, daily smoking and alcohol consumption were entered in the survival model. No significant results for cancer and other cause mortality were found. CONCLUSIONS: Religious service attendance in Sweden, a highly secularized and individualized high-income country, is significantly associated with lower all-cause mortality. This may to some extent be by explained lower CVD mortality partly mediated by protective health-related behaviors. KEY MESSAGES: • Religious service attendance and health has mostly been investigated in the USA, and much less in more secularized countries like Sweden. • Religious service attendance was associated with lower all-cause and CVD mortality, partly mediated by protective health-behaviors.