The relationship between attendance at religious services and cardiovascular inflammatory markers

Review of the Cardiovascular Implications of the Social and Religious Practices Associated with Donning Phylacteries

We previously published a manuscript suggesting that use of phylacteries, ritual straps worn during Jewish prayer services, affects cardiovascular and inflammatory function (Owens et al., Am J Physiol-Heart Circ Physiol, 315(6):H1748-H1758, 2018). Observed physiologic changes were associated with improved cardiac outcomes, though a direct link between phylactery use and improved cardiovascular outcomes is difficult to prove as there are a number of associated religious and spiritual practices that may confound the observed effects. In this review, we assess the scientific literature regarding religious and spiritual practices associated with phylactery in order to better understand the cardiovascular implications of the practice of donning phylacteries. We focus on key aspects traditionally associated with donning phylacteries including gathering in groups, meditation and prayer.

Religiosity Is Associated with Reduced Risk of All-Cause and Coronary Heart Disease Mortality among Jewish Men

Previous studies have found an inverse association between religiosity and mortality. However, most of these studies were carried out with Christian participants. This longitudinal study aimed to determine whether a composite variable based on self-reported religious education and religious practices is associated with coronary heart disease (CHD) and all-cause mortality in 9237 Jewish men aged 40-65 years at baseline, over a 32-year follow-up. Jewish men were characterized by their degree of religiosity, from the Ultra-Orthodox ("Haredim")-the strictest observers of the Jewish religious rules, and in descending order: religious, traditional, secular, and agnostic. Demographic and physical assessments were made in 1963 with a 32-year follow-up. The results indicate that Haredim participants, in comparison to the agnostic participants, had lower CHD mortality. Hazard ratio (HR) and 95% confidence interval (95% CI)-adjusted by age, cigarette smoking, systolic blood pressure, diabetes, socioeconomic status, BMI, and cholesterol, was: [HR = 0.68 (95% CI 0.58,0.80)] for Haredim; [HR = 0.82 (95% CI 0.69,0.96)] for religious; [HR = 0.85 (95% CI 0.73-1.00)] for traditional; and [HR = 0.92 (95% CI 0.79-01.06) for secular, respectively (p for trend = 0.001). The same pattern was observed for total mortality. This study shows an association between religious practice among men and a decreased rate of CHD and total mortality.

Spirituality, religiousness, and mental health: A review of the current scientific evidence

Research in the field of “Spirituality and Health” has been growing, with spirituality/religiousness (S/R) being consistently related to both physical and mental health. The objective of this article is to provide an updated review of the current scientific evidence on the relationship between S/R and mental health, highlighting the most important studies. As a secondary objective, the mechanisms that explain this relationship and the interventions that utilize this information in treating mental disorders will be discussed. The findings reveal a large body of evidence across numerous psychiatric disorders. Although solid evidence is now available for depression, suicidality, and substance use, other diagnosis, such as post-traumatic stress disorder, psychosis, and anxiety, have also shown promising results. The effects of S/R on mental health are likely bidirectional, and the manner in which religious beliefs are used to cope with distress (i.e. negative and positive), may affect mental health outcomes. Despite these findings, the mechanisms that explain these associations and the role of S/R interventions need further study. Concerning clinical practice, mental health providers should ask patients about S/R that are important in their lives to provide holistic and patient-centered care.

Religiosity/Spirituality and Physiological Markers of Health

The long-standing interest in the effects of religiosity and spirituality (R/S) on health outcomes has given rise to a large and diverse literature. We conducted a meta-analysis on research involving R/S and physiological markers of health to elucidate both the scope and mechanism(s) of this phenomenon. A combined analysis found a significant, but small, beneficial effect. Subgroup analyses found that some measures of both extrinsic and intrinsic religiosity were significantly associated with health. Several outcome measures, including blood pressure, C-reactive protein, and cardiovascular health markers, were significantly associated with R/S. Our findings suggest that R/S benefits health, perhaps through minimizing the disruptive effects of stress/depression on inflammation. We hope that researchers can use these results to guide efforts aimed at elucidating the true mechanism(s) linking religious/spiritual beliefs and physical health.

Religious Attendance and Biological Risk: A National Longitudinal Study of Older Adults

Although several studies suggest that religious involvement is associated with healthier biological functioning in later life, most of this work is cross-sectional. We extend previous research by employing a longitudinal design. Our analysis of Health and Retirement Study (2006/2010) data suggests that older adults who attended religious services weekly or more in 2006 tend to exhibit fewer high-risk biomarkers in 2010 and greater reductions in allostatic load over the 4-year study period than respondents who attended yearly or not at all. These patterns persisted with adjustments for baseline allostatic load and a range of background variables.

The Relationship Between Religious and Psychospiritual Measures and an Inflammation Marker (CRP) in Older Adults Experiencing Life Event Stress

Inflammation, often measured by C-reactive protein (CRP), is thought to be related to a number of debilitating illnesses as we age, including cardiovascular disease, cancer and diabetes. Stress has also been implicated in these processes. This study examines potential protective effects of spirituality and religion in older adults who have experienced stressful life events. As part of the nationwide Landmark Study of Spirituality and Health, a subsample of 643 middle-aged and older adults (age ≥ 50) who were at or above the median in number of life stressors (≥ 2) was included in this analysis. Psychospiritual and religious (PS/R) variables included: religious service attendance, prayer, religious meaning, religious hope, general meaning, general hope and sense of peace. Control variables included: age, gender, education, BMI, smoking, alcohol use, social support. Only church attendance predicted significantly lower CRP after controlling for covariates, even above the other PS/R variables (standardized β = - 0.14, t = - 3.23 p = 0.001). Those with frequent religious service attendance were 38% less likely to have clinically elevated CRP than those who attend rarely or never. Religious service attendance may confer protection in older adults experiencing stressful events as it was significantly associated with lower CRP, an inflammatory marker associated with illness.

Religiosity and Health: A Holistic Biopsychosocial Perspective

The resurgence of interest in the influence of religion and spirituality on health is examined within the context of the holistic paradigm and historical connection between nursing and spirituality. While nursing and spirituality often intersect with end-of-life considerations, this article presents findings from studies that demonstrate that religious involvement favors health and longevity across the life course. Examples include protective associations with stress, depression, self-rated health, and infant birth weight. Theoretical and empirical explanations for this relationship are offered, such as social and psychological resources and healthy behaviors. The effects of religion on biological functioning, including allostatic load and telomere length, are also discussed, although this area is understudied. Considerations for the "dark-side" of religious involvement are also offered. Suggestions for nurses wishing to protect and promote the health of their patients using a holistic approach include expanding knowledge of research on religion and health and advocating for patients' spiritual needs by conducting a comprehensive spiritual assessment in primary, secondary, and tertiary clinical settings.

Religious Participation and Biological Functioning in Mexico

OBJECTIVE

Although several studies suggest that religious involvement tends to favor healthy biological functioning, most of this work has been conducted in the United States. This study explores the association between religious participation and biological functioning in Mexico.

METHOD

The data are drawn from two waves of the Mexican Health and Aging Study (2003-2012) to assess continuous and categorical biomarker specifications.

RESULTS

Across specifications, religious participation in 2003 is associated with lower levels of waist-to-hip ratio, total cholesterol, pulse rate, and overall allostatic load in 2012. Respondents who increased their participation over the study period also exhibit a concurrent reduction in pulse rate. Depending on the specification, participation is also associated with lower levels of diastolic blood pressure and C-reactive protein. Participation is generally unrelated to body mass index, glycosylated hemoglobin, and systolic blood pressure.

DISCUSSION

Our results confirm that religious participation is associated with healthier biological functioning in Mexico.

Processes Linking Religious Involvement and Telomere Length

Although numerous studies suggest that religious involvement is associated with better health and longer life expectancies, it is unclear whether these general patterns extend to cellular aging. The mechanisms linking indicators of religious involvement with indicators of cellular aging are also undefined. We employed longitudinal data from the 2004 and 2008 Health and Retirement Study, a national probability sample of Americans aged 50 and older, to test whether average telomere length varied according to level of religious attendance. We also tested several potential mechanisms. Our results showed that respondents who attended religious services more frequently in 2004 also exhibited fewer stressful events, lower rates of smoking, fewer symptoms of depression, and lower levels of C-reactive protein in 2008. Respondents who increased their level of attendance from 2004 to 2008 also exhibited lower rates of smoking in 2008. Although religious attendance was not directly associated with telomere length, our mediation analyses revealed significant indirect effects through depression and smoking, but not stressful events or C-reactive protein. We conclude that religious attendance may promote telomere length indirectly by reducing symptoms of depression and the risk of smoking. There was no evidence to support stressful events or C-reactive protein as mechanisms of religious attendance.

Influence of Social Engagement on Mortality in Korea: Analysis of the Korean Longitudinal Study of Aging (2006-2012)

The objective of this study was to investigate the impact of social engagement and patterns of change in social engagement over time on mortality in a large population, aged 45 years or older. Data from the Korean Longitudinal Study of Aging from 2006 and 2012 were assessed using longitudinal data analysis. We included 8,234 research subjects at baseline (2006). The primary analysis was based on Cox proportional hazards models to examine our hypothesis. The hazard ratio of all-cause mortality for the lowest level of social engagement was 1.841-times higher (P < 0.001) compared with the highest level of social engagement. Subgroup analysis results by gender showed a similar trend. A six-class linear solution fit the data best, and class 1 (the lowest level of social engagement class, 7.6% of the sample) was significantly related to the highest mortality (HR: 4.780, P < 0.001). Our results provide scientific insight on the effects of the specificity of the level of social engagement and changes in social engagement on all-cause mortality in current practice, which are important for all-cause mortality risk. Therefore, protection from all-cause mortality may depend on avoidance of constant low-levels of social engagement.

Lifetime Trauma, Praying for Others, and C-Reactive Protein

Research indicates that praying for others may offset the effects of stress on self-rated health and psychological well-being. The purpose of the current study is to extend this literature by seeing whether praying for others moderates the effects of exposure to lifetime trauma on a key marker of inflammation: C-reactive protein. The data come from a recent nationwide survey of adults of all ages (N = 1,589). Levels of C-reactive protein were obtained from assays of blood spots drawn from a capillary fingerstick. The findings suggest that the magnitude of the relationship between lifetime trauma and C-reactive protein is completely offset for study participants who frequently pray for others. The theoretical implications of this research are discussed.

Attending religious services and its relationship with coronary heart disease and related risk factors in older adults: a qualitative study of church pastors' and parishioners' perspectives

A qualitative study was undertaken to explain findings of a cross-sectional study of Canadian Community Health Survey (CCHS) 4.1 data showing older persons who attend religious services more than once a week, compared to persons who do not attend at all, have lower prevalences of coronary heart disease (CHD), diabetes and high blood pressure. Twelve semi-structured interviews with ordained pastors and three focus groups with older parishioners from Canadian churches were conducted. Interviews were transcribed and analyzed for emergent themes through a process of direct content analysis. All participants claimed that religious service attendance (RSA): (1) enhances mental health; (2) provides social support and activities; and (3) promotes health and lifestyle behaviours that lower CHD risk. These three themes appear to be underlying mechanisms that help to explain the inverse association between RSA and the prevalence of adverse health outcomes found in the CCHS 4.1 data.

Social integration and mortality in patients with coronary heart disease: findings from the Heart and Soul Study

OBJECTIVE

To determine why lower social integration predicts higher mortality in patients with coronary heart disease (CHD).

METHODS

The association between social integration and mortality was examined prospectively in 1019 outpatients with stable CHD from the Heart and Soul Study. Baseline social integration was assessed with the Berkman Social Network Index. Cox proportional hazards models were used to determine the extent to which demographic and disease-relevant confounders and potential biological, behavioral, and psychological mediators explained the association between social integration and mortality.

RESULTS

During a mean (standard deviation) follow-up period of 6.7 (2.3) years, the age-adjusted annual rate of mortality was 6.3% among socially isolated patients and 4.1% among nonisolated patients (age-adjusted hazard ratio [HR] = 1.61, 95% confidence interval [CI] = 1.26-2.05, p < .001). After adjustment for demographic and disease-relevant confounders, socially isolated patients had a 50% greater risk of death than did nonisolated patients (HR = 1.50, 95% CI = 1.07-2.10). Separate adjustment for potential biological (HR = 1.53, CI = 1.05-2.25) and psychological mediators (HR = 1.52, CI = 1.08-2.14) did not significantly attenuate this association, whereas adjustment for potential behavioral mediators did (HR = 1.30, CI = 0.91-1.86). C-reactive protein and hemoglobin A1c were identified as important biological and omega-3 fatty acids, smoking, and medication adherence as important behavioral potential mediators, with smoking making the largest contribution.

CONCLUSIONS

In this sample of outpatients with baseline stable CHD, the association between social integration and mortality was largely explained by health-related behavioral pathways, particularly smoking.

Health benefits of religion among Black and White older adults? Race, religiosity, and C-reactive protein

The study investigates potential health benefits of religiosity to protect against chronic inflammation associated with the risk of cardiovascular diseases. The study uses longitudinal data from a representative survey of adults 57-85 years old at the beginning of the National Social Life, Health, and Aging Project. Linear regression models were used to analyze the association between religiosity, as measured by affiliation, attendance, and having a clergy confidant, and logged values of C-reactive protein (CRP) concentration (mg/L). Although religious attendance was not related to CRP among the White respondents, attendance was associated with lower CRP-and change in CRP over time-among the Black respondents. There was no evidence that religious affiliation alone had any health benefit. The study provides evidence of the salutary effects of religious engagement on chronic inflammation among older adults, especially for Black Americans, which may be useful in reducing the prevalence of hypertension and cardiovascular disease.

Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults

OBJECTIVE

The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status.

METHOD

Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders.

RESULTS

More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer. Inflammation and coagulation partially mediated the associations between attendance and function. Eight percent of the effect of attendance on ADL (p = .014), 5% of the effect on IADL (p = .003), and 8% of the effect on mobility (p = .001) limitations were due to inflammation and coagulation.

DISCUSSION

Relationships between attendance and function may be due in part to lower levels of inflammation and coagulation among elders who attend services.

Religious Attendance and Biological Functioning: A Multiple Specification Approach

OBJECTIVE

This study explores the role of religious attendance across a wide range of biological markers.

METHOD

The data are drawn from the National Social Life, Health, and Aging Project to assess continuous and categorical biomarker specifications.

RESULTS

Across specifications, higher levels of attendance are associated with lower levels of pulse rate and overall allostatic load. Depending on the specification, higher levels of attendance are also associated with lower levels of body mass, diastolic blood pressure, C-reactive protein, and Epstein-Barr virus. Attendance is unrelated to dehydroepiandrosterone, systolic blood pressure, and glycosylated hemoglobin across specifications.

DISCUSSION

The study confirms that religious attendance is associated with healthier biological functioning in later life. Additional research is needed to verify these patterns with other data sources and to test viable mediators of the association between religious attendance and biological risk.

The relationship between religious service attendance and coronary heart disease and related risk factors in Saskatchewan, Canada

Research suggests that attending religious services could provide small yet important protective benefits against coronary heart disease (CHD) and CHD risk factors (e.g., diabetes, hypertension). The extent to which these benefits apply to Canada deserves study because approximately one-third of adult Canadians attend religious services at least monthly. Therefore, the objective of this study is to examine the association between frequency of religious service attendance and prevalence of (1) CHD, (2) diabetes, and (3) hypertension in Canada. We used the Saskatchewan sample (n = 5,442) of the Canadian Community Health Survey (CCHS-4.1) and built multivariable logistic regression models to evaluate associations between religious service attendance and self-reported CHD, diabetes, and hypertension. After controlling for demographic, socioeconomic and health behavior variables, the association between religious service attendance and prevalence of CHD was not significant (OR = 0.82; 95 % CI 0.61-1.11). However, persons who attended religious services more than once a week exhibited lower prevalence odds of diabetes (OR = 0.60; 95 % CI 0.45-0.80) and hypertension (OR = 0.82; 95 % CI 0.68-0.99) compared to persons who attended less than once a year. The findings of this study are the first to suggest religious service attendance may be associated with a lower prevalence of CHD risk factors in Canada.

Religion, spirituality, and health: the research and clinical implications

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

Health promoting habits of people who pray for their health

To determine the health habits of people who pray for their health, data from the National Health Interview Survey was analyzed for health habits of people who prayed or did not pray for their health. Of the 22,314 respondents, 13,179 (59%) prayed for their health. These individuals saw a physician more frequently, participated more frequently in vigorous exercise and used more relaxation techniques, support groups, meditation and complimentary and alternative medicine therapies. People who pray for their health participate in more health promoting behaviors than people who do not pray for their health.

Frequency of attendance at religious services and mortality in a U.S. national cohort

OBJECTIVE

Few nationally representative cohort studies have appeared on frequency of attendance at religious services and mortality. We test the hypothesis that > weekly attendance compared with nonattendance at religious services is associated with lower probability of future mortality in such a study.

METHODS

Data were analyzed from a longitudinal follow-up study of 8450 American men and women age 40 years and older who were examined from 1988 to 1994 and followed an average of 8.5 years. Measurements at baseline included self-reported frequency of attendance at religious services, sociodemographics, and health, physical and biochemical measurements.

RESULTS

Death during follow-up occurred in 2058. After adjusting for confounding by baseline sociodemographics and health status, the hazards ratios (95% confidence limits) were never 1.00 (reference); < weekly 0.89 (0.75-1.04), p = 0.15; weekly 0.82 (0.71-0.94) p = 0.005; and > weekly attenders 0.70 (0.59-0.83), p < 0.001. Mediators, including health behaviors and inflammation, explained part of the association.

CONCLUSIONS

In a nationwide cohort of Americans, predominantly Christians, analyses demonstrated a lower risk of death independent of confounders among those reporting religious attendance at least weekly compared to never. The association was substantially mediated by health behaviors and other risk factors.

Spirituality and autonomic cardiac control

BACKGROUND

Spirituality has been suggested to be associated with positive health, but potential biological mediators have not been well characterized.

PURPOSE AND METHODS

The present study examined, in a population-based sample of middle-aged and older adults, the potential relationship between spirituality and patterns of cardiac autonomic control, which may have health significance. Measures of parasympathetic (high-frequency heart rate variability) and sympathetic (pre-ejection period) cardiac control were obtained from a representative sample of 229 participants. Participants completed questionnaires to assess spirituality (closeness to and satisfactory relationship with God). Personality, demographic, anthropometric, health behavior, and health status information was also obtained. A series of hierarchical regression models was used to examine the relations between spirituality, the autonomic measures, and two derived indexes--cardiac autonomic balance (CAB, reflecting parasympathetic to sympathetic balance) and cardiac autonomic regulation (CAR, reflecting total autonomic control).

RESULTS

Spirituality, net of demographics, or other variables were found to be associated with enhanced parasympathetic as well as sympathetic cardiac control (yielding a higher CAR) but was not associated with CAB. Although the number of cases was small (N = 11), both spirituality and CAR were significant negative predictors of the prior occurrence of a myocardial infarction.

CONCLUSIONS

In a population-based sample, spirituality appears to be associated with a specific pattern of CAR, characterized by a high level of cardiac autonomic control, irrespective of the relative contribution of the two autonomic branches. This pattern of autonomic control may have health significance.

Spirituality among African American cancer survivors: having a personal relationship with God

African American breast and prostate cancer survivors describe their personal relationship with God as very real, close, and intimate. During their cancer trajectory, God was there with them, healing, protecting, and in control of their lives. Participants believed that God provided types of support not available from family members or friends. In return, these participants dedicated their lives to God through service in their churches or through helping others. Findings can help healthcare professionals and others in clinical practice to understand the reliance that many African American cancer survivors have on their spirituality. These findings also suggest that many African Americans perceive their survival from cancer as a gift from God. Therefore, for them, finding a way to give back is an important component of their spirituality.

Religious service attendance and decline in pulmonary function in a high-functioning elderly cohort

BACKGROUND

Pulmonary function is an important indicator of respiratory and overall health, yet little is known about the psychosocial factors that predict pulmonary function itself. At the same time, religious activity is emerging as a potential health promoting factor, especially among the elderly. Whether there is a connection between religious activity and pulmonary function is unknown.

PURPOSE

In this study, we sought to examine the association between religious attendance and rate of decline in pulmonary function.

METHODS

The sample consisted of 1,174 healthy elderly persons enrolled in the MacArthur Study of Successful Aging who were followed for an average of 4.6 years. Information on frequency of religious service attendance and peak expiratory flow rate (PEFR) was collected over 3 waves. A linear mixed model with repeated measures was used to compare rate of decline in PEFR between those who attended religious services regularly and those who did not.

RESULTS

Regular religious service attendance was associated with a slower pulmonary function decline among men (by 3.71 L/min per year, p = .02) and women (by 3.27 L/min per year, p = .02), compared to those who never attend services. The findings could not be explained by differences in smoking or physical activity.

CONCLUSIONS

Overall findings support the hypothesis that religious activity may play a protective role in maintaining pulmonary health among the elderly.

Religious attendance and continuity of care

OBJECTIVE

The purpose of this study was to determine whether a relationship exists between religious attendance and continuity of care.

METHODS

We investigated this relationship in a large national database--the National Health and Nutrition Examination Survey III--which contains information on religious attendance, continuity of care, and potential confounders that might mediate the relationship such as health status and socioeconomic status.

RESULTS

A total of 18,162 participants 17 years of age or older were included in the analysis. People who attended religious services were more likely to have continuity with a provider than people who did not attend such services (65% vs. 35%, p < .001). This association persisted after controlling for demographic, socioeconomic, and health status variables using regression analysis.

CONCLUSION

This study documents a significant association between attendance at religious services and continuity with a usual provider. Continuity with a regular medical provider may influence the association of religious attendance and health outcomes.

Fibrinogen--marker or mediator of vascular disease?

Fibrinogen plays a key role in platelet aggregation, the final step of the coagulation cascade, i.e. the formation of fibrin, and it is a major determinant of plasma viscosity and erythrocyte aggregation. It is both constitutively expressed and inducible during an acute phase reaction. Increased plasma fibrinogen levels are associated with an increased risk of coronary heart disease and myocardial infarction. The question as to whether fibrinogen is only a marker of the inflammatory process involved in atherosclerosis or a mediator, i.e. a pathogenic factor, has not yet been answered. Human in vivo studies do not permit a conclusive answer to this question. If it is a pathogenic factor, fibrinogen lowering would be a therapeutic option. Selective fibrinogen-lowering agents do not exist however. All agents that lower fibrinogen also have other cardiovascular effects such as a decrease in cholesterol or inflammation. Newer information stems from molecular biology. Polymorphisms in the human fibrinogen gene with higher fibrinogen levels do not increase the risk for myocardial infarction. Fibrinogen knockout mice crossed with an atherosclerosis-susceptible strain (apoprotein E null mice) did not show a decreased extent of atherosclerosis despite the absence of fibrinogen, and a mouse strain over-expressing fibrinogen did not show an increased degree of atherosclerosis. Thus, fibrinogen seems to be a marker rather than a mediator of vascular disease, which would make selective fibrinogen lowering a useless preventive or therapeutic strategy.

C-reactive protein, diabetes, and attendance at religious services

OBJECTIVE

Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. People with diabetes have higher risk of cardiovascular mortality and higher C-reactive protein (CRP) levels than people without diabetes. The purpose of this study was to explore the relationship between religious attendance and CRP in people with diabetes.

RESEARCH DESIGN AND METHODS

This study used cross-sectional survey and examination of a nationally representative sample of noninstitutionalized U.S. adults aged > or = 40 years, derived from the National Health and Nutrition Examination Survey III 1988-1994 (n = 10,059). There were 556 people with diabetes. The primary outcome measure was the presence of elevated CRP.

RESULTS

There were no differences between people with diabetes compared with people without diabetes in the percentage of those who attended religious services (62.29 vs. 62.0%, P = 0.36). Religious service nonattenders with diabetes were more likely than attenders to have an elevated CRP (odds ratio [OR] 2.17 [95% CI 1.15-4.09]). In people without diabetes, the association between attendance and CRP was not significant (P > 0.05). Among people with diabetes, after adjusting for demographic variables, health status, smoking, social support, mobility, and BMI, the association between religious attendance and CRP remained significant for respondents with diabetes (1.90 [1.03-3.51]).

CONCLUSIONS

These findings revealed that people with diabetes who have not attended religious services in the previous year are more likely to have elevated levels of CRP. Further research should be conducted to evaluate this association to improve our understanding of the psychological and religious factors that influence diabetes.