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Am J Epidemiol. 2019 Oct 8. pii: kwz222. doi: 10.1093/aje/kwz222. [Epub ahead of print]

Religious Service Attendance, Religious Coping, and Risk of Hypertension in Women Participating in the Nurses' Health Study II.

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Department of Sociology, University of Toronto, Toronto, Ontario.
Interdisciplinary Center for Health and Society, University of Toronto, Toronto, Ontario.
Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
the School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK.


The association between religious service attendance, religious coping, and hypertension is unclear. Prospective research and assessment of potential mediators is needed to understand this relationship. From 2001-2013, we prospectively followed 44,281 non-hypertensive women who provided information on religious service attendance and religious coping in the Nurses' Health Study II. Cox regression and mediation analyses were conducted to assess associations between religion and hypertension. There were 453,706 person-years of follow-up and 11,773 incident hypertension cases. Women who attended religious services were less likely to develop hypertension. In the fully adjusted model, compared to women who never or almost never attend religious meetings or services, women attending less than once/month (hazard ratio=0.97, 95% confidence interval: 0.91,1.03), 1-3 times/month (hazard ratio=0.94, 95% confidence interval: 0.88,1.00), once/week (hazard ratio=0.93, 95% confidence interval: 0.88,0.98), or more than once/week (hazard ratio=0.91, 95% confidence interval: 0.86,0.97) showed a decreased risk of hypertension (Ptrend=0.001). Body mass index was an important mediator (11.5%, P<0.001). Religious coping had a marginal association with hypertension. In conclusion, religious service attendance was modestly associated with hypertension in an inverse dose-response manner and partially mediated through body mass index. Future research is needed on biological or social reasons for the lower risk of hypertension.


Nurses Health Study II; United States; coping; hypertension; prospective studies; religion; women


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