Marked Disparities in Cardiovascular Disease Mortality by Levels of Happiness and Life Satisfaction in the United States

Abstract

Background: The impact of happiness and life satisfaction on cardiovascular disease (CVD) mortality is not well-studied. Using a longitudinal dataset, we examined the association between levels of happiness/life satisfaction and CVD mortality in the United States. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,933). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral characteristics. Results: In Cox models with 14 years of mortality follow-up, CVD mortality risk was 59% higher (hazard ratio [HR]=1.59; 95% CI=1.26,2.02) in adults with little or no happiness, controlling for age, and 30% higher (HR=1.30; 95% CI=1.01,1.67) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness most or all of the time. Mortality risk was 81% higher (HR=1.81; 95% CI=1.40,2.34) in adults who were very dissatisfied with their life, controlling for age, and 39% higher (HR=1.39; 95% CI=1.05,1.82) in adults who were very dissatisfied, controlling for all covariates, when compared with adults who were very satisfied. Conclusions and Implications for Translation: Adults with lower happiness and life satisfaction levels had significantly higher CVD mortality risks than those with higher happiness and life satisfaction levels. Subjective well-being is an important determinant of CVD mortality.