Association between sense of control and all-cause mortality: a prospective cohort study

Ying Li; Yilin Chen; Xiwen Ding; Yin Chen; Wei Jiang; Ying Li; Yilin Chen; Xiwen Ding; Yin Chen; Wei Jiang

doi:10.3934/publichealth.2025021

AIMS Public Health

2025, Volume 12, Issue 2: 360-377. doi: 10.3934/publichealth.2025021

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Association between sense of control and all-cause mortality: a prospective cohort study

Ying Li ^{1,2
,
,},
Yilin Chen ¹,
Xiwen Ding ¹,
Yin Chen ¹,
Wei Jiang ^{3
,
,}

1.
Department of Social Medicine, School of Public Health, Zhejiang University, Hangzhou, China
2.
School of medicine, Zhejiang University, Hangzhou, China
3.
College of Control Science and Engineering, Zhejiang University, Hangzhou, China

Received: 25 November 2024 Revised: 30 January 2025 Accepted: 06 March 2025 Published: 20 March 2025

The salutary effects of a sense of control on health are well acknowledged; however, rigorous studies evaluating its effect on mortality remain scarce. This study aimed to study the association between a sense of control and mortality and to identify the effect of changes in this sense of control on mortality risk. This prospective cohort study included 22,793 participants over age 50 and their spouses, drawn from a nationally representative U.S. sample from 2006 to 2018. Cox proportional hazard regression analyses estimated the association between sense of control and all-cause mortality. Kaplan-Meier survival curves were compared using the log-rank test, and changes in sense of control levels associated with mortality risk were evaluated using the Cox proportional hazards model. Over the 12-year follow-up period, 5027 deaths were recorded. An increased sense of control was significantly associated with decreased mortality risk, as revealed by stratified analysis according to sex and age. Hazard ratios (HRs) for the second, third, and fourth quartiles of sense of control levels were 0.91 (95% CI, 0.84–0.98), 0.83 (95% CI, 0.77–0.92), and 0.79 (95% CI, 0.72–0.87), respectively, relative to the first quartile. Compared to individuals with stable sense of control scores from baseline to study conclusion, the HR was 0.58 (95% CI, 0.48–0.70) for those with increased scores and 1.81 (95% CI, 1.53–2.13) for those with decreased scores. High levels of sense of control were significantly associated with reduced mortality risk. These findings underscore the importance of a sense of control as a focus for public health interventions.
- sense of control,
- elderly people,
- mortality risk,
- prospective study,
- public health
Citation: Ying Li, Yilin Chen, Xiwen Ding, Yin Chen, Wei Jiang. Association between sense of control and all-cause mortality: a prospective cohort study[J]. AIMS Public Health, 2025, 12(2): 360-377. doi: 10.3934/publichealth.2025021

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Abstract

The salutary effects of a sense of control on health are well acknowledged; however, rigorous studies evaluating its effect on mortality remain scarce. This study aimed to study the association between a sense of control and mortality and to identify the effect of changes in this sense of control on mortality risk. This prospective cohort study included 22,793 participants over age 50 and their spouses, drawn from a nationally representative U.S. sample from 2006 to 2018. Cox proportional hazard regression analyses estimated the association between sense of control and all-cause mortality. Kaplan-Meier survival curves were compared using the log-rank test, and changes in sense of control levels associated with mortality risk were evaluated using the Cox proportional hazards model. Over the 12-year follow-up period, 5027 deaths were recorded. An increased sense of control was significantly associated with decreased mortality risk, as revealed by stratified analysis according to sex and age. Hazard ratios (HRs) for the second, third, and fourth quartiles of sense of control levels were 0.91 (95% CI, 0.84–0.98), 0.83 (95% CI, 0.77–0.92), and 0.79 (95% CI, 0.72–0.87), respectively, relative to the first quartile. Compared to individuals with stable sense of control scores from baseline to study conclusion, the HR was 0.58 (95% CI, 0.48–0.70) for those with increased scores and 1.81 (95% CI, 1.53–2.13) for those with decreased scores. High levels of sense of control were significantly associated with reduced mortality risk. These findings underscore the importance of a sense of control as a focus for public health interventions.

Acknowledgments

This work was supported by the National Natural Science Foundation of China under Grant (62173302), and in part by Zhejiang Provincial Natural Science Foundation of China (LZ24F030004). We thank all team members and the interviewees and their families who have contributed to the HRS. The HRS is sponsored by the National Institute on Aging (NIA U01AG009740) and is conducted by the University of Michigan.

Authors' contribution

Ying Li: Conceptualization, Writing–original draft, Formal analysis, Methodology. Yilin Chen: Conceptualization, Writing–review & editing. Xiwen Ding: Data curation, Formal analysis. Yin Chen: Methodology, Supervision. Wei Jiang: Writing–review & editing. All authors approved the final version of the manuscript.

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

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