Bygren et al, 2009

Building on the observed association between attendance at cultural events, survival and self-rated health, this research aimed to investigate the link between cultural attendance and cancer-related mortality.

A cohort of 9,011 cancer-free participants from the randomly selected 1990–1 Swedish Survey of Living Conditions was followed up to 31 December 2003. During this time, according to the Swedish National Death Register, 290 participants had died of cancer, 630 of other causes. The main outcome measure was cancer-related mortality and the main independent variable was cultural attendance. Participants were asked about the regularity of their previous year’s attendance at: cinemas, theatres, art galleries, live music concerts and museums. Frequency was categorised on a four-point scale ranging from fewer than five to more than twenty visits per year, and a cumulative score (a cultural participation index, or CPI) was generated across the cultural activities assayed. Demographic co-variables subjected to a proportional hazards analysis included: age, sex, chronic conditions, disposable income, educational attainment, smoking, exercise and urban/non-urban residency.

Low cultural attendance was found among older, less well educated participants with a lower disposable income, who were often current or former smokers and reported more chronic conditions than frequent attenders. Cancer mortality was also found to be associated with the demographic and behavioural variables in the expected directions. After adjusting for potential confounders, it was suggested that, in urban areas only, ‘rare attendees at cultural events had higher cancer-related mortality than frequent attendees’ (p. 68).

In the process of explaining this result, it was acknowledged that the cultural activities assayed might not have broad appeal across all segments of society, raising the possibility of residual confounding. In the opposite direction, it was freely admitted that those of higher socio-economic status enjoyed healthier lifestyles and possessed greater cancer awareness and access to treatment, suggesting that ‘the relationship between attending cultural events and health is not causal; rather, attending cultural events serves as a proxy variable for other cancer preventative factors’ (p. 71). The urban bias was hard to explain, and was thought to arise as a result of lower concentrations of particular types of cultural activities in non-urban areas. The self-reported nature of the cancer diagnosis at baseline was also highlighted as a flaw in the study, potentially obscuring detail about the onset of cancer and raising the possibility of reverse causation. Nonetheless, it was suggested that ‘in urban areas, frequently attending cultural events is a robust predictor of cancer mortality, similar to physical activity and being a current smoker, for the vast majority of the population, regardless of current health status, socio-economic status, and behavioural risks’ (p. 69). In interpreting this result, it was suggested that engagement in meaningful activities (including culture) might play a part in counteracting the stress and negative immunological responses associated with cancer.

Lars Olov Bygren, Sven-Erik Johansson, Boinkum Benson Konlaan, Andrej M Grjibovski, Anna V Wilkinson and Michael Sjöström, ‘Attending Cultural Events and Cancer Mortality: A Swedish Cohort Study’, Arts & Health 1, no. 1 (March 2009): 64–73.


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