Purpose in life (Ikigai) and employment status in relation to cardiovascular mortality: the Japan Collaborative Cohort Study

OBJECTIVES: To investigate whether having a purpose in life (Ikigai) is associated with risk of cardiovascular disease (CVD) mortality and whether the association varies by employment status. DESIGN: Prospective cohort study. SETTING: Residents in 45 municipalities, Japan. PARTICIPANTS: 29 517 men and 41 984 women aged 40–79 years, free of CVD and cancer at baseline from 1988 to 1990. PRIMARY OUTCOME MEASURES: CVD mortality. RESULTS: During the median follow-up of 19.1 years, 4680 deaths (2393 men and 2287 women) from total CVD were observed. Greater Ikigai was associated with a lower risk of CVD mortality, and the result was stronger for men than for women. Stratified by employment status, the inverse association was confined to unemployed persons. Among unemployed persons, the multivariable HRs of total CVD were higher for moderate and high versus low levels of Ikigai. Multivariable HRs (95% CIs) were 0.74 (0.57 to 0.97) and 0.69 (0.52 to 0.93), P for trend <0.044, respectively in men, and 0.78 (0.64 to 0.95) and 0.77 (0.61 to 0.97), P for trend=0.039 in women. No association was observed among the employed, including part-time workers, self-employed and homemakers for both men and women. Such an inverse association remained even after excluding early deaths within 5 years from the baseline survey. CONCLUSION: Higher levels of Ikigai were associated with a lower risk of CVD mortality, especially for unemployed men and women.