New research published in the Proceedings of the National Academy of Sciences found that smoking, divorce, and alcohol abuse have the highest correlation to death among the 57 social and behavioral factors analyzed. The study analyzed survey data collected from 13,611 adults in the U.S. between 1992 and 2008 and identified which factors applied to those who died between 2008 and 2014.

It shows that a lifespan approach is needed to really understand health and mortality.  For example, instead of just asking whether people are unemployed, they looked at their history of unemployment over 16 years. If they were unemployed at any time, was that a predictor of mortality? Rather than the more conventional approach used in prior studies, this one is more than just a one-time snapshot in people’s lives, where something might be missed because it did not occur. This approach provides a look at potential long-term impacts through a lifespan lens.

This is important because life expectancy in the U.S. has stagnated for three decades relative to other industrialized countries, raising questions about which factors might be contributing. This study intentionally focused on social, psychological, economic, and behavioral factors under the control of individuals or society, rather than biological factors beyond human control, like genetics.

Of the 57 factors analyzed, the 10 most closely associated with death, in order of significance, were:

1. Being a Current smoker
2. A History of divorce
3. A History of alcohol abuse
4. A History of Recent financial difficulties
5. A History of unemployment
6. Previous history of being a smoker
7. Lower life satisfaction
8. Never being married
9. A History of using food stamps, and
10. A History of Negative affectivity (where the person regularly displays negative emotions including sadness, disgust, lethargy, fear, and distress.

The data came from the nationally representative U.S. Health and Retirement Study, whose participants ranged in age from 50 to 104, with an average age of 69.3. These surveys didn’t capture every possible adversity. For example, neither” food insecurity” nor “domestic abuse” was addressed.  However, the new findings provide an indication of where various factors stand in relation to each other.

Armed with this information, we’re better equipped to answer the question, “If we’re going to put money and effort into interventions or policy changes, how could we potentially provide the greatest return on that investment? Smoking has been understood as one of the greatest predictors of mortality for 40 years, if not more.  However, little has been done to address the problems of “people being routinely unemployed” or the “increasing prevalence of divorce.”  Can we shift these factors in a positive way and thereby have an impact on mortality rates? Similarly, can we target interventions for alcoholics and those with financial difficulties to reduce their risk?”

References
Proceedings of the National Academy of Sciences, June 22, 2020, “Predicting Mortality from 57 Economic, Behavioral, Social, and Psychological Factors,” by
Eli Puterman, et al.  © 2020 National Academy of Sciences.  All rights reserved.

To view or purchase this article, please visit:
https://www.pnas.org/content/117/28/16273