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Impact of perceived control on all-cause and cardiovascular disease mortality in three urban populations of Central and Eastern Europe: the HAPIEE study
  1. Magdalena Kozela1,
  2. Andrzej Pająk1,
  3. Agnieszka Micek1,
  4. Agnieszka Besala1,
  5. Ruzena Kubinova2,
  6. Sofia Malyutina3,4,
  7. Abdonas Tamosiunas5,
  8. Hynek Pikhart6,
  9. Anne Peasey6,
  10. Yuri Nikitin3,
  11. Michael Marmot6,
  12. Martin Bobak6
  1. 1 Chair of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
  2. 2 National Institute of Public Health, Prague, Czech Republic
  3. 3 Institute of Internal and Preventive Medicine, Novosibirsk, Russia
  4. 4 Novosibirsk State Medical University, Novosibirsk, Russia
  5. 5 Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  6. 6 Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Magdalena Kozela, Chair of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, 20, Grzegorzecka St, Krakow 31–531, Poland; mmkozela{at}


Background Inverse associations between perceived control and cardiovascular disease (CVD) have been reported in studies from Western Europe and the USA. To assess this relationship across different populations, we investigated the association between perceived control and all-cause and CVD mortality in three population-based cohorts of Eastern European countries.

Methods We analysed data from a prospective cohort study in random population samples in Krakow (Poland), Novosibirsk (Russia) and six Czech towns. Baseline survey included structured questionnaire and objective examination in a clinic. Perceived control was assessed using an 11-item scale developed by the MacArthur Foundation Programme on Successful Midlife. Information on vital status was obtained from death registers. Effect of perceived control on mortality was assessed using Cox proportional hazards models.

Results A total of 2377 deaths (1003 from CVD) occurred among 27 249 participants over a median 7-year follow-up. In the Czech and Polish cohorts, perceived control was inversely associated with mortality; the adjusted HRs for the lowest versus highest control quintiles were 1.71 (1.34 to 2.19) in men and 1.63 (1.14 to 2.35) in women for all-cause mortality and 2.31 (1.48 to 3.59) and 5.50 (2.14 to 14.13) for CVD deaths. There was no association between perceived control and mortality in Russia; the adjusted HRs for all-cause mortality were 1.03 (0.79 to 1.34) in men and 1.29 (0.82 to 2.02) in women.

Conclusions Low perceived control was associated with increased risk of all-cause and CVD mortality in Czech and Polish cohorts but not in Russia. It is possible that this inconsistency may partly reflect a different sociocultural understanding of the concept of control in Russia.

  • Cardiovascular disease

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  • Contributors MK and AP drafted the manuscript, contributed to the conception, analysis and interpretation. AM and AB contributed to the analysis, interpretation and critically revised the manuscript. RK, SM, AT, HP, AP, YN and MM contributed to the conception and design and critically revised the manuscript. MB drafted the manuscript, contributed to the conception, design and interpretation. All authors accepted the final version of the manuscript.

  • Funding This work was supported by the Wellcome Trust (grant number WT081081); the US National Institute of Ageing (grant number R01AG23522); and the Russian Scientific Foundation (grant number 14–45–00030).

  • Competing interests None declared.

  • Ethics approval The study was approved by ethical committees in all participating centres and at University College London.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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