Comparative Mortality of Two College Groups, 1945 - 1983

Patterns of morbidity and mortality vary substantially among some religious groups in the United States. These variations may be associated with a wide range of factors, including lifestyle, acceptance of prevention measures (e.g., vaccination), and risks for injury (1-12). This report summarizes a study of mortality in cohorts of graduates from two colleges whose students are from different religious backgrounds.

The populations in this study included graduates of Principia College (PC) (Elsah, Illinois), a liberal arts college for Christian Scientists, and Loma Linda University (LLU) (Loma Linda, California), a Seventh-day Adventist-affiliated university with a predominantly Seventh-day Adventist student population (A. Kutzner, Loma Linda University, personal communication, 1991). The doctrines of both religious groups require abstinence from alcohol consumption and smoking. Seventh-day Adventists are also required to abstain from consuming certain foods (e.g., pork and shellfish); in addition, the church recommends that its members use primarily a lacto-ovo-vegetarian diet that limits the consumption of meat, poultry, or fish to less than once per week. The groups also differ in that Christian Scientists reject medical healing in favor of spiritual healing alone (13), whereas Seventh-day Adventists accept both spiritual and medical healing (14).

This study compared mortality between the graduating classes of PC and LLU for 1945 (the first year for which data are available) through 1983.* Data for PC were obtained from alumni directories and quarterly updates that record deaths of graduates by year of graduation. The data for LLU were obtained from a search of the alumni database of the university's Alumni Office. PC graduates whose vital status was unknown were assumed to be alive. Mortality among LLU graduates whose vital status was unknown was assumed to be the same as that for graduates whose records existed. For each school, mortality was calculated for 3-year cohorts for 1945-1983 for men and women. The analysis assumed that the mean matriculation age for students at both institutions was the same.

During the 39-year period, a total of 2421 men and 2669 women graduated from PC, and 5010 men and 3788 women graduated from the College of Liberal Arts and Sciences at LLU. Overall mortality was higher for PC graduates than for LLU graduates (for men, 40 per 1000 and 22 per 1000, respectively (p less than 0.001; Cochran-Mantel-Haenszel chi-square test), and for women, 27 per 1000 and 12 per 1000, respectively (p=0.001)) (Figures 1 and 2). Total mortality was higher among PC graduates in 22 (85%) of the 26 cohorts. However, for four of the cohorts, total mortality was higher among graduates of LLU (men: 1969-1971; women: 1963-1965, 1969-1971, and 1975-1977). Reported by: WF Simpson, PhD, Emporia State Univ, Emporia, Kansas. Div of Surveillance and Epidemiology, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Previous reports have described differences in health status and disease patterns in religious groups in the United States. For example, prolonged outbreaks of measles, rubella, and poliomyelitis have been documented among the Amish (1-3) and Christian Scientists (4,5); in 1984, of all reported cases of measles classified as ``nonpreventable,'' 89.2% occurred among persons exempt from vaccination laws for religious or philosophic reasons (6). Rates of congenital disorders are higher among the Amish (7), for whom injury related to horse-drawn buggies is also of concern (8). Perinatal and maternal mortality rates are higher for members of the Faith Assembly in Indiana who avoid prenatal and obstetric care than for other residents of the same state (9). Among Mormons, death rates are substantially lower for cancers, heart disease, and all causes combined compared with non-Mormons in Utah and whites in the United States (10,11). Finally, for male physician graduates of LLU, the age-adjusted death rate was 73% that of graduates of a nonreligiously affiliated medical school and 56% that of all white males in the United States (12).

The findings in this study indicated higher mortality among graduates of PC than among graduates of LLU's liberal arts college. Although these findings are consistent with a previous report (15), they may be subject to at least two biases. First, the assumption that PC graduates who were lost to follow-up were alive and that LLU graduates who were also lost to follow-up had the same risk for death as other graduates may have reduced the differences in mortality for the two groups. Second, because the dietary habits of Seventh-day Adventists are associated with lower risks for several chronic diseases, mortality related to chronic diseases was probably lower among LLU graduates than it would have been in other comparison populations.

For at least three potential reasons, religious affiliation may be related to health status: 1) persons with differing risk-factor profiles may seek membership in particular religious groups; 2) religions may prescribe or proscribe behavior associated with altered risk for disease (e.g., physical exercise, vaccination and other health-care practices, and prohibitions regarding smoking and diet); and 3) patterns of marriage may increase the risk for certain heritable disorders. Investigation of associations between religious affiliation and health status may assist in defining the etiology of different conditions and designing public health interventions appropriate to the health practices of specific groups.

References

1. CDC. Poliomyelitis--United States, Canada. MMWR 1979;28:229-30.

2. CDC. Increase in rubella and congenital rubella syndrome--United States, 1988-1990. MMWR 1991;40:93-9.

3. Sutter RW, Markowitz LE, Bennetch JM, Morris W, Zell ER, Preblud SR. Measles among the Amish: a comparative study of measles severity in primary and secondary cases in households. J Infect Dis 1991;163:12-6.

4. CDC. Follow-up on poliomyelitis--Connecticut, New York, Massachusetts, New Hampshire. MMWR 1972;21:365-6.

5. Novotny T, Jennings CE, Doran M, et al. Measles outbreaks in religious groups exempt from immunization laws. Public Health Rep 1988;103:49-54.

6. CDC. Measles--United States, 1984. MMWR 1985;34:308-12.

7. Khoury MJ, Cohen BH, Diamond EL, Chase GA, McKusick VA. Inbreeding and prereproductive mortality in the Old Order Amish. III. Direct and indirect effects of inbreeding. Am J Epidemiol 1987;125:473-83.

8. Jones MW. A study of trauma in an Amish Community. J Trauma 1990;30:899-902.

9. CDC. Perinatal and maternal mortality in a religious group--Indiana. MMWR 1984;33:297-8.

10. Lyon JL, Klauber MR, Gardner JW, Smart CR. Cancer incidence in Mormons and non-Mormons in Utah, 1966-1970. N Engl J Med 1976;294:129-33.

11. Enstrom JE. Cancer and total mortality among active Mormons. Cancer 1978;42:1943-51.

12. Ullmann D, Phillips RL, Beeson WL, et al. Cause-specific mortality among physicians with differing life-styles. JAMA 1991;265:2352-9.

13. Eddy MB. Science and health with key to the scriptures. Boston: Christian Science Publishing Society, 1971:400.

14. Cross FL, Livingston EA, eds. The Oxford dictionary of the Christian church. London, England: Oxford University Press, 1974:1266.

15. Simpson WF. Comparative longevity in a college cohort of Christian Scientists. JAMA 1989;262:1657-8.

*Limitations in mortality data for any cohort later than 1983 precluded statistical analysis.

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