Abstract
Background: The aim of this study was to test the hypothesis that people with a strong sense of coherence (SOC) have decreased all-cause mortality. Methods: The effect of occupation and the SOC on all-cause mortality was studied among 4405 Finnish middle-aged employed men in a prospective 8-year follow-up study. Results: Using Cox proportional hazards models the crude relative risk for all-cause mortality for the low SOC tertile when compared to the high SOC tertile was 1.23 (95% CI: 0.90–1.68). Adjusting for age, smoking, alcohol and occupation increased the risk slightly to 1.35. Occupation was an effect modifier, since among white-collar workers the corresponding relative risk of the low SOC tertile was 2.27 (95% CI: 1.12–4.59, p = 0.02) and among blue-collar workers the relative risk for all-cause mortality was stable (1.33–1.52) in each SOC tertile. The classic risk factors, smoking and alcohol, showed higher relative risks than the SOC. Conclusions: The effect of the health-promoting qualities of the SOC upon all-cause mortality was significant among white-collar workers, but not among blue-collar workers.
References
Antonovsky A. Health, Stress and Coping: New Perspectives on Mental and Physical Well-being. San Francisco: Jossey-Bass, 1979.
Antonovsky A. Unraveling the Mystery of Health. San Francisco: Jossey-Bass, 1987.
Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: Primary prevention trial with gemfibrozil in middle-aged men with dyslipidaemia. Safety of treatment changes in risk factors, and incidence of coronary heart disease. N Engl J Med 1987; 317: 1237–1245.
Manninen V, Elo O, Frick MH, et al. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA 1988; 260: 641–651.
Antonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med 1993; 36: 725–733.
Simpura J. Scandinavian drinking survey: Construction of indices of alcohol intake. Report 46. Oslo: National Institute of Alcohol Research, 1981.
Kunst AE, Groenhof F, Mackenbach JP. Occupational class and cause-specific mortality in middle-aged men in 11 European countries: Comparison of population based studies. Br Med J 1998; 316: 1636–1642.
Hemingway H, Shipley M, Macfarlane P, Marmot M. Impact of socio-economic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: The original Whitehall study 25 year follow up. J Epidemiol Community Health 2000; 54: 510–516.
van Rossum CT, Shipley MJ, van de Mheen H, Grobbee DE, Marmot MG. Employment differences in cause-specific mortality. 25-year follow up of civil servants from the first Whitehall study. J Epidemiol Community Health 2000; 54: 178–184.
Rosengren A, Orth-Gomer K, Wilhelmsen L. Socioeconomic differences in health indices, social network and mortality among Swedish men. A study of men born in 1933. Scand J Soc Med 1998; 26: 272–280.
Poppius E, Tenkanen L, Kalimo R, Heinsalmi P. The sense of coherence, occupation and the risk of coronary heart disease in the Helsinki Heart Study. Soc Sci Med 1999; 49: 109–120.
Doll R, Peto R. The causes of cancer. J Natl Cancer Inst 1981; 66: 1197–1312.
Makela P, Valkonen T, Martelin T. Contribution of deaths related to alcohol use to socioeconomic variation in mortality: Register based follow-up study. Br Med J 1997; 315: 211–216.
Makela P. Alcohol-related mortality as a function of socio-economic status. Addiction 1999; 94: 867–886.
Siegrist J. Sense of coherence and sociology of emotions. Soc Sci Med 1993; 37: 978–979.
Geyer S. Some conceptual considerations on the sense of coherence. Soc Sci Med 1997; 44: 1771–1779.
Smith GD, Egger M. Changes in population distribution of sense of coherence do not explain changes in overall mortality. Br Med J 1997; 315: 490.
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Poppius, E., Tenkanen, L., Hakama, M. et al. The sense of coherence, occupation and all-cause mortality in the Helsinki Heart Study. Eur J Epidemiol 18, 389–393 (2003). https://doi.org/10.1023/A:1024213427147
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DOI: https://doi.org/10.1023/A:1024213427147