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.