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Sense of coherence, lifestyle choices and mortality
  1. N W J Wainwright1,
  2. P G Surtees1,
  3. A A Welch1,
  4. R N Luben1,
  5. K-T Khaw2,
  6. S A Bingham3,4
  1. 1
    Strangeways Research Laboratory and University of Cambridge Department of Public Health and Primary Care, Cambridge
  2. 2
    Clinical Gerontology Unit, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge
  3. 3
    Medical Research Council Dunn Human Nutrition Unit, Cambridge
  4. 4
    MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, Cambridge, UK
  1. Dr N Wainwright, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK; nick.wainwright{at}


Background: Based on data from the European Prospective Investigation into Cancer, Norfolk (EPIC-Norfolk) study, we have previously shown a strong sense of coherence (SOC) to be associated with a reduced rate of all-cause mortality.

Objectives: To investigate the extent to which the SOC mortality association can be explained by socioeconomic status and lifestyle choices.

Design and setting: Prospective population-based cohort study.

Participants: 18 287 study participants aged 41–80 years who reported no pre-existing chronic disease at baseline and who completed an assessment of SOC.

Results: Based on 1599 deaths during a mean follow-up of 8.3 years, a strong SOC was associated with a 20% reduced risk of all-cause mortality. Measures of lifestyle choice (cigarette smoking, physical activity, dietary intakes of fruit, vegetables and fibre) and socioeconomic status (social class and education) explained 23% of this association.

Conclusions: The SOC concept embraces multiple sets of chronic disease risk factors that include lifestyle choices and those associated with socioeconomic status, and is a potential aid in understanding differences in health outcomes in similar individuals.

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  • Funding: EPIC-Norfolk is supported by programme grants from the Medical Research Council UK (G9502233, G0300128) and Cancer Research UK (C865/A2883) with additional support from the European Union, Stroke Association, British Heart Foundation, Department of Health and the Wellcome Trust.

  • Competing interests: None.

  • Ethics approval: The study was approved by the Norwich District Health Authority ethics committee, and all participants gave signed informed consent.

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