Perceived stress and mortality in a Taiwanese older adult population

Abstract

Perceived stress is associated with poor health outcomes including negative affect, increased susceptibility to the common cold and cardiovascular disease; the consequences of perceived stress for mortality, however, have received less attention. This study characterizes the relationship between perceived stress and 11-year mortality in a population of Taiwanese adults aged 53+ years. Using the Survey of Health and Living Status of the Near Elderly and Elderly of Taiwan, we calculated a composite measure of perceived stress based on six items pertaining to the health, financial situation, and occupation of the respondents and their families. Proportional hazard models were used to determine whether perceived stress predicted mortality. After adjusting for sociodemographic factors only, we found that a one standard deviation increase in perceived stress was associated with a 19% increase in all-cause mortality risk during the 11-year follow-up period (hazard ratio, HR = 1.19, 95% confidence interval, CI 1.13–1.26). The relationship was greatly attenuated when perceptions of stress regarding health were excluded, and was not significant after adjusting for medical conditions, mobility limitations and depressive symptoms. We conclude that the association between perceived stress and mortality is explained by an individual’s current health; however, our data do not allow us to distinguish between two possible interpretations of this conclusion: (a) the relationship between perceived stress and mortality is spurious, or (b) poor health acts as the mediator.

• Aging
• all-cause mortality
• cancer mortality
• cardiovascular mortality
• perceived stress
• reverse causality

Acknowledgements

TLSA is based on data collected by the Bureau of Health Promotion (BHP), Department of Health in Taiwan. We appreciate the hard work and dedication of the staff at the Center for Population and Health Survey Research of BHP, who were instrumental in the design and implementation of the TLSA and supervised all aspects of the fieldwork and data processing. We are grateful to Germán Rodríguez for his statistical advice and to Patrick Gerland and Kate Choi for their helpful comments. An earlier version of the manuscript was presented at the 2012 Population Association of American Annual Meeting in San Francisco, CA.

Notes

¹(1) In 1999, 16 individuals were missing 1 domain, 1 individual was missing 3 domains and 307 were missing all 6 domains; (2) In 2003, 3 individuals were missing 1 domain, 1 individual was missing 3 domains and 280 individuals were missing all 6 domains; and (3) In 2007, 1 participant was missing 1 domain, 1 participant was missing 4 domains and 294 participants were missing all 6 domains.

²In calculating the full perceived stress index (range: 0–12) for individuals missing 1 or 2 domains, the following equation was used: [sum of scores (0, 1, or 2) for available perceived stress domains/(6 – #missing domains)*6].