Happiness and all-cause mortality: the HAPIEE study

Abstract Background The evidence on the association between happiness and mortality is mixed. Similarly, the role of covariates in this association is not clear. Almost no evidence on the topic comes from the Central and Eastern Europe (CEE). This analysis aims to evaluate such association in longitudinal data from three CEE countries, and to investigate the role of other variables in this association. Methods The analysis is based on data from 18,362 men and women from the longitudinal Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study conducted in the Czech Republic, Lithuania and Poland who were 45-70 years old at the start of the study. Happiness was based on 4-points Likert scale answers ‘Very happy’, ‘Quite happy’, ‘Not very happy’, and ‘Not at all happy’ to the question ‘Taking all things together, would you say you are ...’. All-cause mortality was obtained from local or national mortality registers. Cox proportional hazards regression was used to estimate the hazard ratios (HRs). Results 2,718 deaths have been observed during the 11 years of follow-up. The mortality rates were 13.0, 14.1 and 20.7/1000 person years in very happy, quite happy and unhappy groups. After adjustment for country and age the HR comparing very happy and unhappy was 0.53 (95%CI: 0.43-0.67) in men and 0.66 (0.48-0.91) in women. This association was reduced after adjusting for socioeconomic characteristics, health behaviours and conventional risk factors (HR 0.78 in men and 0.84 in women); and was further reduced after controlling for health conditions at baseline. No strong evidence for country interaction was identified although the association was slightly stronger in Polish men than in other two countries. Conclusions Happiness has been shown to predict all-cause mortality in these three countries from CEE although it may be (at least partly) explained by established risk factors and underlying health conditions. This work was supported by the NPO SYRI (LX22NPO5101). #NGEU Key messages • Happiness is shown to predict all-cause mortality in this CEE population. • The association seems stronger in men than in women.