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

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.