Sundquist et al, 2004

This research team – which overlaps with the Bygren team by virtue of its use of the same dataset and the involvement of Johansson – sought to explore the longitudinal relationship between social participation and coronary heart disease.

A sample of 6,861 women and men aged 35–74 who had taken part in the 1990–1 Swedish Survey of Living Conditions was followed up for hospital admissions and deaths due to coronary heart disease to 31 December 2000. As has been seen, the baseline survey collected data about attendance at the cinema, theatre, concerts, art exhibitions and museums. Eighteen such variables were used to make up a social participation index, and respondents were grouped into low, medium and high social participation. This evinces a reversion to social measures from which Bygren et al had been departing. A Cox regression model was used to estimate the hazard ratio for the different variables. Socio-economic and educational status, housing tenure and smoking were controlled for, along with age, gender, marital status and geographical region.

As might be expected, social participation was negatively associated with advanced age and low socio-economic and educational levels, corresponding with a higher risk of coronary heart disease, as did smoking. After adjustment for all the variables, an association was found between low social participation and increased incidence of coronary heart disease morbidity and mortality. The relevance of this study to the present analysis is that, of the eighteen variables in the social participation index subjected to factor analysis (with a higher coefficient corresponding to greater importance in the index), the highest scores were seen in relation to the five cultural factors listed above. In other words, attendance at the cinema, theatre, concerts, art exhibitions and museums had (by far, in most cases) the most significance within the social participation index.

Kristina Sundquist, Martin Lindström, Marianne Malmström, Sven-Erik Johansson and Jan Sundquist, ‘Social Participation and Coronary Heart Disease: A Follow-up Study of 6900 Women and Men in Sweden, Social Science & Medicine, 58, 2004, pp. 615–22.


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