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Mormon mortality rates in Canada George K. Jarvis
a
a
Department of Sociology , University of Alberta , Edmonton, Canada Published online: 23 Aug 2010.
To cite this article: George K. Jarvis (1977) Mormon mortality rates in Canada, Biodemography and Social Biology, 24:4, 294-302, DOI: 10.1080/19485565.1977.9988300 To link to this article: http://dx.doi.org/10.1080/19485565.1977.9988300
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Mormon Mortality Rates in Canada
George K. Jarvis
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Department of Sociology University of Alberta Edmonton, Canada
In the United States, Mormons have been shown to have lower incidence and mortality rates of cancer and other diseases than the general population, a fact which has been attributed to the life style prescribed by the Mormon Church, including abstinence from tobacco, alcohol, coffee, and tea. This study examines Mormon cause-specific mortality rates in Alberta, Canada, compared to rates for the general population of Alberta and of all Canada. Mormon death rates for most causes were lower than those for Alberta, which are themselves lower than Canadian rates. Mormon death rates for males were higher than for females for most causes, but male and female death rates were more similar among Mormons than in the general population. Causes of death for which Mormons have an average or higher than average risk are either less frequent causes or are less clearly related to dietary habits. Mormons have disproportionately low death rates for many causes which are not clearly related to the use of tobacco, alcohol, coffee, or tea. Further research is needed on the specific effects of different life-style components and on the possible biological selectivity of the group. ABSTRACT:
Recent studies in the United States (Smart et al., 1974; Enstrom, 1975; Lyon et al., 1976) have shown that members of the Church of Jesus Christ of Latter-day Saints (Mormon) have lower incidence and mortality rates of cancer and other diseases than the general population. The superior health and longer life which these findings document are attributed to the life style prescribed by the Mormon Church: abstinence from tobacco, alcohol, coffee, and tea; maintenance of a balanced and regular diet, including roughage foods such as whole grains; moderation in the eating of meat; strong emphasis on regular family life, including prohibition of multiple sex partners; regular and frequent social contacts with programs that include emphasis on music, dancing, drama, and athletics. They believe that the human body is the temple of God and subscribe to the idea that it should be preserved in fit condition. It is implied that if others looked after their bodies with the care
suggested by Mormon teachings and were the beneficiaries of such a supportive social structure, they would enjoy the same level of good health. Similar findings emerged from earlier research on two other religious groups, Jews and Seventh Day Adventists. After Newhill (1961) showed Jewish males in New York City to have unusually low rates of lung cancer mortality, Seidman (1966) and Wynder and Mantel (1966) in New York as well as Horowitz and Enterline (1960) in Montreal produced data which confirmed this finding and which also showed heavy smoking to be less frequent among Jewish males than among Catholics and Protestants. They concluded that Jews had less lung cancer because they smoked less. Seventh Day Adventists, a group which forbids tobacco, alcohol, and to some extent the eating of meat, were found to have unusually low rates of cancer, myocardial infarction, and other serious
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diseases (Wynder et al., 1959; Lemon et al., 1964; Lemon and Walden, 1966). Again it was concluded that a life style relatively free from tobacco and alcohol was responsible for their lower health and mortality risks. Although these studies claimed to establish a link between smoking and cancer, in every study Jews, Seventh Day Adventists, and Mormons were found to have low incidence and mortality rates for a wide range of diseases, not only those diseases believed to be related to tobacco and alcohol use. It is possible, though untested as yet, that other aspects of life style besides smoking and drinking may be significantly related to the good health enjoyed by Mormons and other groups with superior health (Enstrom, 197S; Lyon, 1976).
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total for the country as a whole. They constituted less than 2 per cent of the Alberta population in that year. Although they were originally concentrated in the rural south of Alberta, they now are distributed more than SO per cent in the major centers of Edmonton, Calgary, and Lethbridge. They have become urbanized in approximately the same proportion as the rest of Alberta's population. According to the studies of Mormons conducted in the United States (Enstrom, 197S), Latter-day Saints are about average in socioeconomic status, as opposed to Seventh Day Adventists and Jews who are markedly above average. This fact allows the research to avoid the confusing effect of higher socioeconomic status on health. In studies of Seventh Day Adventists and Jews we do not know whether their better This study examines mortality patterns health is due to life style related to their of Mormons in the province of Alberta, religion or to the advantages of higher inCanada, and is the first research on Morcome, education, and occupational status. mon mortality in a setting outside the United States. It examines a broader range MATERIALS AND METHODS of causes of death than did earlier studies, which tended to focus on cancer and to a This study examines all Mormon deaths lesser extent on coronary artery and re- occurring in Alberta during the years 1967 spiratory diseases. It should be noted that through 197S. They were located by examthe results of the study are contaminated ination of annual reports of all Mormon by the fact that not all Mormons of record ecclesiastical units in the province of Alare practicing Mormons. There is little berta. Names and identifying information published information on Mormons' ob- such as date and place of death were then servance of their church's teachings. En- linked with vital statistics records in Alstrom (197S) estimates that from one-half berta. The number of deaths which octo two-thirds of Mormons adhere to Mor- curred during this period was 1,169, of mon regulations forbidding the use of al- which all but 4.2 per cent could be linked cohol, tobacco, coffee, and tea, but that in with official death certificates so as to obother aspects of diet they may not be much tain the cause of death. For calculations of different from the rest of the population. rates, the base population was reduced Further research is required to ascertain proportionately by the proportion that differential health risks experienced by could not be linked. Of the 49 deaths that Mormons at various commitment and could not be linked, 26 are known to have participation levels. occurred outside the province. Provincial Mormons have lived in Alberta since reporting of cause of death is underthe 1890's. In 1971 the census of Canada standably less likely if the death occurred counted approximately 31,000 members of out of the province, although some deaths the church in Alberta, about half of the are reported from other jurisdictions.
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A particular advantage of this study is that the census of Canada includes religious membership. Thus, one can compute an accurate age and sex composition of the Latter-day Saint population in Alberta. The 1971 reported population of Mormons from Latter-day Saint records is slightly smaller (29,356) than the census Latter-day Saint population (31,085). The difference can be explained in two ways. First, the Latter-day Saint category as compiled by the census of Canada includes certain separate smaller sects not organizationally under the direction of Salt Lake City but historically related to the origins of Mormonism. They do not follow exactly the same dietary rules as the larger church nor do they live precisely the same life style in other ways. In Alberta they constitute a very small proportion of the total Latter-day Saint group, but they could account for the difference between reported and census Mormon populations. Their inclusion should not create substantial proportional shifts in the age and sex structure of the population. Second, in any given year there may have been a small proportion of Latter-day Saint units which did not report either population or death totals. For these two reasons, the smaller reported population was used, which necessitated a proportional reduction of census sex and age categories to conform to the reported total Mormon population. There may also have been a few individuals who are not listed on church records but who respond in the census that they are Latter-day Saints. As their names are not recorded as church members, their deaths will also not be recorded.
RESULTS
The results of the analysis are presented in two tables. In Table 1 crude death rates are presented for the major causes of death, comparing rates for Canada, Al-
Social Biology
berta, and the Latter-day Saints (in Alberta) per 100,000 population. Because the Mormon birth rate is higher than that for the rest of the population, with corresponding alterations in the age structure, indirect standardization was performed on the Alberta population so as to generate age-standardized mortality ratios for the major causes of death for the Latter-day Saint population. Many diseases are selective by age, as is death in general. As there are major differences between the age structures of the Alberta and the Mormon population, the crude death rates are biased by age-structure differences, and standardization is necessary. Some categories of death include very small numbers of Latter-day Saint deaths. For this reason, chance fluctuations may have affected the results. Although statistical significance was calculated, the small numbers also make statistical significance difficult to attain. Therefore, special attention should be given to the general pattern of results. Canadian crude death rates are higher than Alberta rates for almost all causes of death reported here except for cancer of the prostate, endocrine and metabolic diseases, diseases of the musculoskeletal system and connective tissues, causes of perinatal mortality and morbidity, accidental deaths and suicides for men; and cancer of the rectum, diseases of the nervous system and sense organs, perinatal mortality, and accidents for women. Most of the results hold up when the rates are standardized (see Table 2).1 The differences are largely unexplained and reflect the generally more favorable pattern of 1 In Table 2 are found standardized mortality rates for various causes of death. If the ratio is 1.00, then the observed deaths among Mormons are exactly the same as would be expected when age-specific rates of death from a particular disease are applied to the Mormon age distribution. The ratio indicates the proportional under- or overrepresentation of deaths from a specific cause among Mormons.
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TABLE 1 CRUDE DEATH RATES PER 100,000 POPULATION FOR SELECTED CAUSES OF DEATH FOR CANADA, PROVINCE OF ALBERTA, AND LATTER-DAY SAINT POPULATION OF ALBERTA
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CAUSE or DEATH
Infective and parasitic diseases All cancer Cancer of stomach Cancer of intestine Cancer of rectum Cancer of trachea, bronchus, lung . . . Cancer of breast Cancer of cervix Cancer of prostate Cancer of ovary, fallopian tubes Cancer of bladder Cancer of pancreas Leukemia Endocrine and metabolic diseases Diseases of nervous system and sense organs Diseases of circulatory system Chronic rheumatic heart disease Hypertensive disease Ischaemic heart disease Cerebrovascular disease Disease of respiratory system Pneumonia Bronchitis, emphysema, and asthma , Disease of digestive system Cirrhosis of liver . . . . . ' Diseases of genitourinary system Diseases of musculosketal and connective tissues Congenital anomalies Causes of perinatal mortality and morbidity Accidents and other violent deaths All accidents Motor vehicle accidents Suicide and self-inflicted injury All causes
Canada 1970-72
Alberta 1970-72
L.D.S. 1967-75
Canada 1970-72
Alberta 1970-72
L.D.S. 1967-7S
6.9 162.7 IS.2 IS. 5 7.2 42.3 0.2
5.7 137.8 13.9 11.9 5.5 33.0 0.0
S.9 76.6 6.7 2.S 3.4 10.9 0.0
4.9 129.5 8.7 18.2 5.0 7.8 26.6 5.8
4.3 101.1 6.7 11.9 5.7 6.8 19.2 4.1
8.0 71.4 4.0 10.4 0.8 4.0 18.S 1.6
15.6
16.1
11.8
6.0 9.6 7.2 15.8
4.3 9.3 6.9 16.5
0.8 2.5 7.6 12.6
8.3 2.2 6.4 5.2 18.9
7.4 1.2 6.1 4.7 16.0
3.2 0.8 4.8 1.6 15.2
8.9 413.2 5.6 7.1 281.8 71.1 62.8 26.7 25.3 30.8 12.3 11.7
8.0 345.0 4.5 4.9 224.7 63.0 58.0 22.5 22.2 27.7 8.7 10.2
8.4 212.2 5.9 4.2 117.9 38.7 37.1 19.3 12.6 21.1 3.4 14.3
7.4 312.1 6.4 8.6 176.0 78.4 35.3 20.9 6.7 21.1 6.1 7.8
7.5 223.7 5.1 5.7 112.6 62.1 31.6 17.1 S.3 20.1 5.0 6.8
2.4 174.9 11.2 12.8 66.6 53.8 29.7 17.7 4.0 16.1 0.0 3.2
1.9 9.7
1.9 9.6
4.2 5.9
3.1 8.5
3.0 6.9
4.0 11.2
18.3 100.7 79.4 38.8 17.0 8.6
21.3 111.1 86.8 39.3 19.2 7.8
16.0 88.4 71.4 37.9 12.6 5.1
12.6 41.7 32.5 14.4 6.6 6.1
15.9 42.0 32.8 14.2 5.5 5.0
8.8 42.5 32.9 20.1 S.6 4.0
mortality and longer life expectancy in the prairie provinces of Saskatchewan, Alberta, and Manitoba. These provinces, in that order, have lower rates of death from the major killer diseases and longer life expectancies than the other provinces. It is important to show these differences in order to understand that the Alberta population, from which the Mormons in our study have been selected, is a low-risk population compared to the country as a whole. Further comparisons should be be-
tween the Latter-day Saints and the Alberta population from which they are drawn. The contrast between Mormon death rates and those for the Alberta population is even more striking than the difference between Canadians and Albertans. Rates of death from cancer of all sites except leukemia are drastically lower for Mormon men. Even cancer of the prostate, which Enstrom (1975) found to be higher than average for Mormon men, was lower
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TABLE 2 STANDARDIZED MORTALITY RATIOS FOR SELECTED CAUSES OF DEATH FOR LATTER-DAY POPULATION OF ALBERTA, 1967-1975*
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Cause of Death
SAINT
Male SMR
Deaths
Female SMR
Infective and parasitic diseases All cancer Cancer of stomach Cancer of trachea, bronchus, lung Cancer of cervix, uteri Cancer of bladder Leukemia Endocrine and metabolic diseases
1.12 0.64t 0.S6 0.41t — 0.23 1.08 0.78
7 91 8 13 — 1 9 14 1 1
1.96 O.78t 0.6S 0.64 0.41 0.74 0.32 0.87
10 89 5 5 2 1 2 16 0 1
Diseases of nervous system and sense organs Diseases of circulatory system Ischaemic heart disease Cerebrovascular disease Disease of respiratory system Bronchitis, emphysema, asthma Disease of digestive system Cirrhosis of liver Diseases of genitourinary system
1.11 O.72t O.62t 0.71J 0.73$ 0.63 0.90 0.44 1.63
10 272 140 46 44 IS 25 4 17 — 0
0.39 0.93 0.71f 1.03 1.09 0.84 0.90 0.00 0.54
3 218 83 67 37 5 20 0 4 1 0
Diseases of musculoskeletal system and connective tissues Congenital anomalies Causes of perinatal mortality and morbidity Symptoms and other ill-defined conditions Injury from accidents and other violent deaths Motor vehicle accidents Suicide and self-inflicted injury All causes
Deaths
2.48 0.53
5 7
1.47 1.51
5 14
O.64t 0.50$
19 11
0.50$ 0.75
11 9
1.06 1.33 1.07 O90
S3 25 7 489
0.83 0.97 0.72 0.76
105 45 15 627
* Ratios standardized by age on the Alberta population, 1971. Age- and sex-specific rates of death by cause for Alberta were computed by Ashraf Kayani for Province of Alberta Department of Social Services and Community Health. t Significant at the 0.01 level using a Poisson distribution (Bailar and Ederer, 1964). t Significant at the 0.05 level by the same criterion as above.
than average for Alberta Mormons. Although Mormon men contrast more sharply with the balance of Alberta men than do Mormon women, Mormon females also have lower rates of cancer death for all sites than other women in Alberta. Mormon standardized mortality ratios are low for all cancers except leukemia among men, following the pattern for crude death rates. Deaths from all cancers are only 64 per cent of the expected number for Latter-day Saint men and 78 per cent of expected deaths for Mormon women. Not all of these sites of cancer are identified
with the effects of tobacco and alcohol. The low rates of death from cancer at these other sites suggest the need for further investigation of the effects of Mormon life style on health. Mormons also enjoy a preferential risk position with regard to diseases of the circulatory system. Latter-day Saint men and women do not die as often from these diseases, although again Mormon males are more different from other Albertans than are Mormon women. Mormon women have lower rates of death from circulatory disease than Mormon men, but the differ-
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Mormon Mortality Rates
ence in favor of Mormon women is much less than that for the Alberta population as a whole. Among specific circulatory diseases, the most notable difference may be in the leading cause of death, ischaemic heart disease. Mormon crude rates for both men and women are just over half the Alberta rates. When age structure is taken into account, Mormon men have 62 per cent the risk of death in any given year from ischaemic heart disease, and Mormon women die 71 per cent as often as Alberta women of the same age. When one reflects that the Alberta population has substantially lower rates of death from ischaemic heart disease than the rest of Canada, these findings are all the more remarkable. Crude death rates for cerebrovascular disease are lower for Latter-day Saints than for other Albertans, although when standardized, rates for Mormon women are about average. Mormon males die of strokes only 71 per cent as often as do other males in Alberta. Results for other forms of circulatory diseases are more equivocal. Respiratory diseases such as emphysema, bronchitis, asthma, and to a lesser extent, pneumonia and influenza should be less frequent among a population that smokes less than average. Although crude death rates for respiratory diseases for Mormon males are substantially lower than Alberta rates, they are only slightly lower than average for Mormon females. Standardized ratios operate to decrease the Mormon advantage in this regard. Mormon males die of respiratory diseases 73 per cent as often as expected, and female Mormons actually have a slightly greater than average risk. Among specific ailments in this category, Latter-day Saints enjoy the greatest protection from bronchitis, emphysema, and asthma. Males (SMR = 0.63) show a greater deficit of deaths than do females (SMR = 0.84),
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probably related to their greater propensity for smoking and their longer smoking histories. Diseases of the digestive system are also slightly underrepresented among Mormons. One such disease, cirrhosis of the liver, is quite rare among Mormons. Only 44 per cent as many Mormon males as would be expected died of this disease, and no Mormon females died of cirrhosis during the nine years of the study. It is well known that cirrhosis of the liver is closely related to heavy alcohol consumption. Mormons also fall prey less often than others to endocrine and metabolic diseases (male SMR = 0.78; female SMR = 0.87), such as diabetes mellitus, which is not likely to be due to not smoking but is probably due to some other life-style factor such as drinking or diet. Other causes of death present patterns not so clearly in favor of Mormons. It can be argued that all persons must die of some cause. If a group avoids some of the causes of death that kill in early life or in middle age, then sooner or later its members must die of other causes, which may explain in part the propensity of Mormon males (SMR = 1.63) to die of genitourinary diseases such as hyperplasia of the prostate. Female Latter-day Saints are not similarly afflicted, indicating a lower than average (SMR = 0.S4) risk of dying of genitourinary diseases. Mormons have somewhat greater than average risks of death from infective and parasitic diseases and musculoskeletal system and connective tissue diseases. The causes for these higher risks are not known, although the numbers involved are small; and as with all of the minor causes of death, chance variation may be a factor. Diseases of the nervous system and sense organs show slightly greater than average risks for Mormon males but low rates of death for women.
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Deaths among infants present an unusual picture. Mormons have a substantially higher than average birth rate. Moreover, Mormon women continue to have children longer than other women. Although these factors may contribute to a lower incidence of breast cancer, they may increase the chances of birth defects for Mormon children. Assuming a proportionate number of these are fatal birth defects, Mormons should have a greater than expected number of deaths due to congenital anomalies. The findings do not provide clear support for this hypothesis. Deaths due to congenital anomalies are more frequent than average for Mormon females (SMR = 1.51), but less frequent for Mormon males (SMR = 0.S3). For both sexes combined, the rate of death due to congenital anomalies is about average. For other causes of perinatal morbidity and mortality, such as birth injury and various anoxic and hypoxic conditions, Mormon infants of both sexes are substantially protected from fatality. All causes of death considered, the fatal-risk position of Latter-day Saint infants is as good as average and probably better, a fact which runs counter to the hypothesis indicated by the fertility patterns of the group. Accidental and other violent deaths are the principal cause of death for children and young adults in Canada. One would expect Mormons to have lower rates of death from these causes if only for the reason that many of them abstain from alcohol. Alcohol is well known as a contributory factor in many accidental deaths. In this case, however, the findings are contrary to expectation. Mormon males were killed in motor vehicle accidents at approximately the same rate as other Alberta males. Mormon females died in such accidents at higher than average rates (SMR = 1.33), although this result is not statistically significant at the 0.0S level. However, the rates may be
Social Biology
even higher than reported here. Mormon records indicate that a substantial proportion of untraceable and out-of-province deaths occur as the result of motor vehicle accidents. The reason for these unexpectedly high rates is not known. Although further research would be necessary to move beyond conjecture, it is possible that Mormons drive automobiles more than others. The extensive commitment to meetings during the week, several times on Sunday, trips to the temple on a regular basis, and rather frequent trips to Salt Lake City for conferences and other reasons would all subject the Latter-day Saint population to increased risk, especially as these trips are made at all times of the year. When accidents. other than motor vehicle accidents are considered, the high rates are somewhat reduced. Mormon males have a lower than average risk of committing suicide (SMR = 0.72), but the same is not true for Latterday Saint females (SMR = 1.07). As in many other causes of death, the mortality advantage experienced by Mormon males is greater than that enjoyed by Mormon females. The finding is reminiscent of the work of Gove (1972) who found that men benefit more than women from the preferential mortality risks associated with being married. These results suggest that with higher mortality and greater numbers of preventable deaths, males are more likely to benefit from any environmental or social condition which improves mortality in general. SUMMARY AND CONCLUSIONS Mormon cause-specific mortality rates were calculated and standardized by age for both males and females by compiling lists of Mormon deaths from Latter-day Saint church records and linking them with province of Alberta death certificates to obtain the official cause of death. A
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greater proportion of deaths was traceable than in previous studies. The research was also aided by the availability of census information on religion which permitted the computation of a relatively accurate sex and age distribution of the Alberta Mormon population. Cause-specific death rates for Mormons in Alberta were compared to those for the general population of Alberta and of all Canada. In general, the findings were as follows: 1. Mormon death rates for most causes are lower than those for Alberta, even though the Alberta rates are lower than those for all Canada. 2. Mormon death rates for males are higher than those for females for most causes. 3. Male and female death rates are more similar among Mormons than among the general population. 4. Causes of death for which Mormons have an average or higher than average risk are either less frequent causes of death or are less clearly related to dietary habits of Mormons. 5. Mormons have disproportionately low rates of death for many causes of death which are not clearly related to the use of tobacco, alcohol, coffee, or tea. These findings suggest the need for further research on what actually constitutes the life style of Mormons, as well as what the specific effects of different life-style components are. For instance, more research is needed to ascertain the effects of the use of meat, coffee, tea, and other dietary elements as well as the possible effects of athletic fitness programs, family solidarity, extensive social participation, and stress-reducing religious ideology. Research may also be needed to investigate possible causes for higher rates of death among Mormons from motor vehicle accidents. Moreover, future studies should ex-
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amine health and mortality of Mormons at various church-activity or participation levels rather than in gross mixed populations as have all Mormon studies to this date. A possible explanation of decreased Mormon mortality risks lies in the biological selectivity of the group. Many Mormons in Alberta are related to each other, claiming descent from the small number of families that colonized southern Alberta over eighty years ago. It is conceivable that these families were markedly healthy and that modern Mormons have only inherited those characteristics. The biological explanation must contend with the fact, however, that a substantial but unknown proportion of Mormons in Alberta have migrated from elsewhere or have joined the church as converts through missionary activity. In the future, studies need to relate Mormon health and mortality to the years of exposure to Mormon life style. For example, it would be interesting to compare the mortality of converts to those who are descended from early Mormon families. The above considerations aside, the findings of this research strongly indicate the possibility of saving a great many lives from cancer, heart disease, respiratory diseases, and other illnesses by alteration in life style. Such alteration could be begun by a combination of childhood education discouraging the use of alcohol and tobacco and by changes in the advertising of such commodities. Moreover, social structural changes may be required in order to alter the social meanings of contexts in which such commodities are regularly used.
ACKNOWLEDGMENTS This research project was funded by the Bureau of Human Ecology, Laboratory Centre for Disease Control, Health Protection Branch,
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Health and Welfare Canada. Special thanks are also due to the L.D.S. Church Historical Department and the Research and Planning
Branch, Province of Alberta Department of Social Services and Community Health, for their cooperation and special assistance.
REFERENCES mons and non-Mormons in Utah, 1966-1970. New Significance factors for the ratio of a Poisson variEng. J. Med. 294 (January):129-133. able to its expectation. Biometrics 20:639-644. NEWHILL, V. A. 1961. Distribution of cancer morENSTROM, J. E. 1975. Cancer mortality among tality among ethnic subgroups of the white popuMormons. Cancer 36:825-841. lation of New York City, 1953-1958. J. Natl. GOVE, WALTER R. 1972. Sex, marital status and Cancer Instit. 26:405-417. suicide. J. Hlth. Soc. Behav. 13 (June):204-213. SEIDMAN, H. 1966. Lung cancer among Jewish, HOROWITZ, I., and P. E. ENTERLINE. 1970. Lung Catholic and Protestant males in New York City. cancer among the Tews. Amer. J. Publ. Hlth. Cancer 19:185-190. 60:275-282. SMART, J. L., et al., 1974. Cancer of the head and neck in Utah. Amer. J. Surg. 128:463-465. LEMON, F. R., R. T. WALDEN, and R. W. WOODS. 1964. Cancer of the lung and mouth in Seventh Day WYNDER, E. L., F. R. LEMON, and I. J. BROSS. 1959. Adventists. Cancer 17:486-497. Cancer and coronary artery disease among Seventh LYON, J. L., et al., 1976. Cancer incidence in MorDay Adventists. Cancer 12:1016-1028. BAILAR, J. C., and F. EDERER. 1964. Note 202:
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Mormon mortality rates in Canada George K. Jarvis
a
a
Department of Sociology , University of Alberta , Edmonton, Canada Published online: 23 Aug 2010.
To cite this article: George K. Jarvis (1977) Mormon mortality rates in Canada, Biodemography and Social Biology, 24:4, 294-302, DOI: 10.1080/19485565.1977.9988300 To link to this article: http://dx.doi.org/10.1080/19485565.1977.9988300
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sublicensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Mormon Mortality Rates in Canada
George K. Jarvis
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Department of Sociology University of Alberta Edmonton, Canada
In the United States, Mormons have been shown to have lower incidence and mortality rates of cancer and other diseases than the general population, a fact which has been attributed to the life style prescribed by the Mormon Church, including abstinence from tobacco, alcohol, coffee, and tea. This study examines Mormon cause-specific mortality rates in Alberta, Canada, compared to rates for the general population of Alberta and of all Canada. Mormon death rates for most causes were lower than those for Alberta, which are themselves lower than Canadian rates. Mormon death rates for males were higher than for females for most causes, but male and female death rates were more similar among Mormons than in the general population. Causes of death for which Mormons have an average or higher than average risk are either less frequent causes or are less clearly related to dietary habits. Mormons have disproportionately low death rates for many causes which are not clearly related to the use of tobacco, alcohol, coffee, or tea. Further research is needed on the specific effects of different life-style components and on the possible biological selectivity of the group. ABSTRACT:
Recent studies in the United States (Smart et al., 1974; Enstrom, 1975; Lyon et al., 1976) have shown that members of the Church of Jesus Christ of Latter-day Saints (Mormon) have lower incidence and mortality rates of cancer and other diseases than the general population. The superior health and longer life which these findings document are attributed to the life style prescribed by the Mormon Church: abstinence from tobacco, alcohol, coffee, and tea; maintenance of a balanced and regular diet, including roughage foods such as whole grains; moderation in the eating of meat; strong emphasis on regular family life, including prohibition of multiple sex partners; regular and frequent social contacts with programs that include emphasis on music, dancing, drama, and athletics. They believe that the human body is the temple of God and subscribe to the idea that it should be preserved in fit condition. It is implied that if others looked after their bodies with the care
suggested by Mormon teachings and were the beneficiaries of such a supportive social structure, they would enjoy the same level of good health. Similar findings emerged from earlier research on two other religious groups, Jews and Seventh Day Adventists. After Newhill (1961) showed Jewish males in New York City to have unusually low rates of lung cancer mortality, Seidman (1966) and Wynder and Mantel (1966) in New York as well as Horowitz and Enterline (1960) in Montreal produced data which confirmed this finding and which also showed heavy smoking to be less frequent among Jewish males than among Catholics and Protestants. They concluded that Jews had less lung cancer because they smoked less. Seventh Day Adventists, a group which forbids tobacco, alcohol, and to some extent the eating of meat, were found to have unusually low rates of cancer, myocardial infarction, and other serious
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diseases (Wynder et al., 1959; Lemon et al., 1964; Lemon and Walden, 1966). Again it was concluded that a life style relatively free from tobacco and alcohol was responsible for their lower health and mortality risks. Although these studies claimed to establish a link between smoking and cancer, in every study Jews, Seventh Day Adventists, and Mormons were found to have low incidence and mortality rates for a wide range of diseases, not only those diseases believed to be related to tobacco and alcohol use. It is possible, though untested as yet, that other aspects of life style besides smoking and drinking may be significantly related to the good health enjoyed by Mormons and other groups with superior health (Enstrom, 197S; Lyon, 1976).
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total for the country as a whole. They constituted less than 2 per cent of the Alberta population in that year. Although they were originally concentrated in the rural south of Alberta, they now are distributed more than SO per cent in the major centers of Edmonton, Calgary, and Lethbridge. They have become urbanized in approximately the same proportion as the rest of Alberta's population. According to the studies of Mormons conducted in the United States (Enstrom, 197S), Latter-day Saints are about average in socioeconomic status, as opposed to Seventh Day Adventists and Jews who are markedly above average. This fact allows the research to avoid the confusing effect of higher socioeconomic status on health. In studies of Seventh Day Adventists and Jews we do not know whether their better This study examines mortality patterns health is due to life style related to their of Mormons in the province of Alberta, religion or to the advantages of higher inCanada, and is the first research on Morcome, education, and occupational status. mon mortality in a setting outside the United States. It examines a broader range MATERIALS AND METHODS of causes of death than did earlier studies, which tended to focus on cancer and to a This study examines all Mormon deaths lesser extent on coronary artery and re- occurring in Alberta during the years 1967 spiratory diseases. It should be noted that through 197S. They were located by examthe results of the study are contaminated ination of annual reports of all Mormon by the fact that not all Mormons of record ecclesiastical units in the province of Alare practicing Mormons. There is little berta. Names and identifying information published information on Mormons' ob- such as date and place of death were then servance of their church's teachings. En- linked with vital statistics records in Alstrom (197S) estimates that from one-half berta. The number of deaths which octo two-thirds of Mormons adhere to Mor- curred during this period was 1,169, of mon regulations forbidding the use of al- which all but 4.2 per cent could be linked cohol, tobacco, coffee, and tea, but that in with official death certificates so as to obother aspects of diet they may not be much tain the cause of death. For calculations of different from the rest of the population. rates, the base population was reduced Further research is required to ascertain proportionately by the proportion that differential health risks experienced by could not be linked. Of the 49 deaths that Mormons at various commitment and could not be linked, 26 are known to have participation levels. occurred outside the province. Provincial Mormons have lived in Alberta since reporting of cause of death is underthe 1890's. In 1971 the census of Canada standably less likely if the death occurred counted approximately 31,000 members of out of the province, although some deaths the church in Alberta, about half of the are reported from other jurisdictions.
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A particular advantage of this study is that the census of Canada includes religious membership. Thus, one can compute an accurate age and sex composition of the Latter-day Saint population in Alberta. The 1971 reported population of Mormons from Latter-day Saint records is slightly smaller (29,356) than the census Latter-day Saint population (31,085). The difference can be explained in two ways. First, the Latter-day Saint category as compiled by the census of Canada includes certain separate smaller sects not organizationally under the direction of Salt Lake City but historically related to the origins of Mormonism. They do not follow exactly the same dietary rules as the larger church nor do they live precisely the same life style in other ways. In Alberta they constitute a very small proportion of the total Latter-day Saint group, but they could account for the difference between reported and census Mormon populations. Their inclusion should not create substantial proportional shifts in the age and sex structure of the population. Second, in any given year there may have been a small proportion of Latter-day Saint units which did not report either population or death totals. For these two reasons, the smaller reported population was used, which necessitated a proportional reduction of census sex and age categories to conform to the reported total Mormon population. There may also have been a few individuals who are not listed on church records but who respond in the census that they are Latter-day Saints. As their names are not recorded as church members, their deaths will also not be recorded.
RESULTS
The results of the analysis are presented in two tables. In Table 1 crude death rates are presented for the major causes of death, comparing rates for Canada, Al-
Social Biology
berta, and the Latter-day Saints (in Alberta) per 100,000 population. Because the Mormon birth rate is higher than that for the rest of the population, with corresponding alterations in the age structure, indirect standardization was performed on the Alberta population so as to generate age-standardized mortality ratios for the major causes of death for the Latter-day Saint population. Many diseases are selective by age, as is death in general. As there are major differences between the age structures of the Alberta and the Mormon population, the crude death rates are biased by age-structure differences, and standardization is necessary. Some categories of death include very small numbers of Latter-day Saint deaths. For this reason, chance fluctuations may have affected the results. Although statistical significance was calculated, the small numbers also make statistical significance difficult to attain. Therefore, special attention should be given to the general pattern of results. Canadian crude death rates are higher than Alberta rates for almost all causes of death reported here except for cancer of the prostate, endocrine and metabolic diseases, diseases of the musculoskeletal system and connective tissues, causes of perinatal mortality and morbidity, accidental deaths and suicides for men; and cancer of the rectum, diseases of the nervous system and sense organs, perinatal mortality, and accidents for women. Most of the results hold up when the rates are standardized (see Table 2).1 The differences are largely unexplained and reflect the generally more favorable pattern of 1 In Table 2 are found standardized mortality rates for various causes of death. If the ratio is 1.00, then the observed deaths among Mormons are exactly the same as would be expected when age-specific rates of death from a particular disease are applied to the Mormon age distribution. The ratio indicates the proportional under- or overrepresentation of deaths from a specific cause among Mormons.
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TABLE 1 CRUDE DEATH RATES PER 100,000 POPULATION FOR SELECTED CAUSES OF DEATH FOR CANADA, PROVINCE OF ALBERTA, AND LATTER-DAY SAINT POPULATION OF ALBERTA
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CAUSE or DEATH
Infective and parasitic diseases All cancer Cancer of stomach Cancer of intestine Cancer of rectum Cancer of trachea, bronchus, lung . . . Cancer of breast Cancer of cervix Cancer of prostate Cancer of ovary, fallopian tubes Cancer of bladder Cancer of pancreas Leukemia Endocrine and metabolic diseases Diseases of nervous system and sense organs Diseases of circulatory system Chronic rheumatic heart disease Hypertensive disease Ischaemic heart disease Cerebrovascular disease Disease of respiratory system Pneumonia Bronchitis, emphysema, and asthma , Disease of digestive system Cirrhosis of liver . . . . . ' Diseases of genitourinary system Diseases of musculosketal and connective tissues Congenital anomalies Causes of perinatal mortality and morbidity Accidents and other violent deaths All accidents Motor vehicle accidents Suicide and self-inflicted injury All causes
Canada 1970-72
Alberta 1970-72
L.D.S. 1967-75
Canada 1970-72
Alberta 1970-72
L.D.S. 1967-7S
6.9 162.7 IS.2 IS. 5 7.2 42.3 0.2
5.7 137.8 13.9 11.9 5.5 33.0 0.0
S.9 76.6 6.7 2.S 3.4 10.9 0.0
4.9 129.5 8.7 18.2 5.0 7.8 26.6 5.8
4.3 101.1 6.7 11.9 5.7 6.8 19.2 4.1
8.0 71.4 4.0 10.4 0.8 4.0 18.S 1.6
15.6
16.1
11.8
6.0 9.6 7.2 15.8
4.3 9.3 6.9 16.5
0.8 2.5 7.6 12.6
8.3 2.2 6.4 5.2 18.9
7.4 1.2 6.1 4.7 16.0
3.2 0.8 4.8 1.6 15.2
8.9 413.2 5.6 7.1 281.8 71.1 62.8 26.7 25.3 30.8 12.3 11.7
8.0 345.0 4.5 4.9 224.7 63.0 58.0 22.5 22.2 27.7 8.7 10.2
8.4 212.2 5.9 4.2 117.9 38.7 37.1 19.3 12.6 21.1 3.4 14.3
7.4 312.1 6.4 8.6 176.0 78.4 35.3 20.9 6.7 21.1 6.1 7.8
7.5 223.7 5.1 5.7 112.6 62.1 31.6 17.1 S.3 20.1 5.0 6.8
2.4 174.9 11.2 12.8 66.6 53.8 29.7 17.7 4.0 16.1 0.0 3.2
1.9 9.7
1.9 9.6
4.2 5.9
3.1 8.5
3.0 6.9
4.0 11.2
18.3 100.7 79.4 38.8 17.0 8.6
21.3 111.1 86.8 39.3 19.2 7.8
16.0 88.4 71.4 37.9 12.6 5.1
12.6 41.7 32.5 14.4 6.6 6.1
15.9 42.0 32.8 14.2 5.5 5.0
8.8 42.5 32.9 20.1 S.6 4.0
mortality and longer life expectancy in the prairie provinces of Saskatchewan, Alberta, and Manitoba. These provinces, in that order, have lower rates of death from the major killer diseases and longer life expectancies than the other provinces. It is important to show these differences in order to understand that the Alberta population, from which the Mormons in our study have been selected, is a low-risk population compared to the country as a whole. Further comparisons should be be-
tween the Latter-day Saints and the Alberta population from which they are drawn. The contrast between Mormon death rates and those for the Alberta population is even more striking than the difference between Canadians and Albertans. Rates of death from cancer of all sites except leukemia are drastically lower for Mormon men. Even cancer of the prostate, which Enstrom (1975) found to be higher than average for Mormon men, was lower
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TABLE 2 STANDARDIZED MORTALITY RATIOS FOR SELECTED CAUSES OF DEATH FOR LATTER-DAY POPULATION OF ALBERTA, 1967-1975*
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Cause of Death
SAINT
Male SMR
Deaths
Female SMR
Infective and parasitic diseases All cancer Cancer of stomach Cancer of trachea, bronchus, lung Cancer of cervix, uteri Cancer of bladder Leukemia Endocrine and metabolic diseases
1.12 0.64t 0.S6 0.41t — 0.23 1.08 0.78
7 91 8 13 — 1 9 14 1 1
1.96 O.78t 0.6S 0.64 0.41 0.74 0.32 0.87
10 89 5 5 2 1 2 16 0 1
Diseases of nervous system and sense organs Diseases of circulatory system Ischaemic heart disease Cerebrovascular disease Disease of respiratory system Bronchitis, emphysema, asthma Disease of digestive system Cirrhosis of liver Diseases of genitourinary system
1.11 O.72t O.62t 0.71J 0.73$ 0.63 0.90 0.44 1.63
10 272 140 46 44 IS 25 4 17 — 0
0.39 0.93 0.71f 1.03 1.09 0.84 0.90 0.00 0.54
3 218 83 67 37 5 20 0 4 1 0
Diseases of musculoskeletal system and connective tissues Congenital anomalies Causes of perinatal mortality and morbidity Symptoms and other ill-defined conditions Injury from accidents and other violent deaths Motor vehicle accidents Suicide and self-inflicted injury All causes
Deaths
2.48 0.53
5 7
1.47 1.51
5 14
O.64t 0.50$
19 11
0.50$ 0.75
11 9
1.06 1.33 1.07 O90
S3 25 7 489
0.83 0.97 0.72 0.76
105 45 15 627
* Ratios standardized by age on the Alberta population, 1971. Age- and sex-specific rates of death by cause for Alberta were computed by Ashraf Kayani for Province of Alberta Department of Social Services and Community Health. t Significant at the 0.01 level using a Poisson distribution (Bailar and Ederer, 1964). t Significant at the 0.05 level by the same criterion as above.
than average for Alberta Mormons. Although Mormon men contrast more sharply with the balance of Alberta men than do Mormon women, Mormon females also have lower rates of cancer death for all sites than other women in Alberta. Mormon standardized mortality ratios are low for all cancers except leukemia among men, following the pattern for crude death rates. Deaths from all cancers are only 64 per cent of the expected number for Latter-day Saint men and 78 per cent of expected deaths for Mormon women. Not all of these sites of cancer are identified
with the effects of tobacco and alcohol. The low rates of death from cancer at these other sites suggest the need for further investigation of the effects of Mormon life style on health. Mormons also enjoy a preferential risk position with regard to diseases of the circulatory system. Latter-day Saint men and women do not die as often from these diseases, although again Mormon males are more different from other Albertans than are Mormon women. Mormon women have lower rates of death from circulatory disease than Mormon men, but the differ-
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Mormon Mortality Rates
ence in favor of Mormon women is much less than that for the Alberta population as a whole. Among specific circulatory diseases, the most notable difference may be in the leading cause of death, ischaemic heart disease. Mormon crude rates for both men and women are just over half the Alberta rates. When age structure is taken into account, Mormon men have 62 per cent the risk of death in any given year from ischaemic heart disease, and Mormon women die 71 per cent as often as Alberta women of the same age. When one reflects that the Alberta population has substantially lower rates of death from ischaemic heart disease than the rest of Canada, these findings are all the more remarkable. Crude death rates for cerebrovascular disease are lower for Latter-day Saints than for other Albertans, although when standardized, rates for Mormon women are about average. Mormon males die of strokes only 71 per cent as often as do other males in Alberta. Results for other forms of circulatory diseases are more equivocal. Respiratory diseases such as emphysema, bronchitis, asthma, and to a lesser extent, pneumonia and influenza should be less frequent among a population that smokes less than average. Although crude death rates for respiratory diseases for Mormon males are substantially lower than Alberta rates, they are only slightly lower than average for Mormon females. Standardized ratios operate to decrease the Mormon advantage in this regard. Mormon males die of respiratory diseases 73 per cent as often as expected, and female Mormons actually have a slightly greater than average risk. Among specific ailments in this category, Latter-day Saints enjoy the greatest protection from bronchitis, emphysema, and asthma. Males (SMR = 0.63) show a greater deficit of deaths than do females (SMR = 0.84),
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probably related to their greater propensity for smoking and their longer smoking histories. Diseases of the digestive system are also slightly underrepresented among Mormons. One such disease, cirrhosis of the liver, is quite rare among Mormons. Only 44 per cent as many Mormon males as would be expected died of this disease, and no Mormon females died of cirrhosis during the nine years of the study. It is well known that cirrhosis of the liver is closely related to heavy alcohol consumption. Mormons also fall prey less often than others to endocrine and metabolic diseases (male SMR = 0.78; female SMR = 0.87), such as diabetes mellitus, which is not likely to be due to not smoking but is probably due to some other life-style factor such as drinking or diet. Other causes of death present patterns not so clearly in favor of Mormons. It can be argued that all persons must die of some cause. If a group avoids some of the causes of death that kill in early life or in middle age, then sooner or later its members must die of other causes, which may explain in part the propensity of Mormon males (SMR = 1.63) to die of genitourinary diseases such as hyperplasia of the prostate. Female Latter-day Saints are not similarly afflicted, indicating a lower than average (SMR = 0.S4) risk of dying of genitourinary diseases. Mormons have somewhat greater than average risks of death from infective and parasitic diseases and musculoskeletal system and connective tissue diseases. The causes for these higher risks are not known, although the numbers involved are small; and as with all of the minor causes of death, chance variation may be a factor. Diseases of the nervous system and sense organs show slightly greater than average risks for Mormon males but low rates of death for women.
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Deaths among infants present an unusual picture. Mormons have a substantially higher than average birth rate. Moreover, Mormon women continue to have children longer than other women. Although these factors may contribute to a lower incidence of breast cancer, they may increase the chances of birth defects for Mormon children. Assuming a proportionate number of these are fatal birth defects, Mormons should have a greater than expected number of deaths due to congenital anomalies. The findings do not provide clear support for this hypothesis. Deaths due to congenital anomalies are more frequent than average for Mormon females (SMR = 1.51), but less frequent for Mormon males (SMR = 0.S3). For both sexes combined, the rate of death due to congenital anomalies is about average. For other causes of perinatal morbidity and mortality, such as birth injury and various anoxic and hypoxic conditions, Mormon infants of both sexes are substantially protected from fatality. All causes of death considered, the fatal-risk position of Latter-day Saint infants is as good as average and probably better, a fact which runs counter to the hypothesis indicated by the fertility patterns of the group. Accidental and other violent deaths are the principal cause of death for children and young adults in Canada. One would expect Mormons to have lower rates of death from these causes if only for the reason that many of them abstain from alcohol. Alcohol is well known as a contributory factor in many accidental deaths. In this case, however, the findings are contrary to expectation. Mormon males were killed in motor vehicle accidents at approximately the same rate as other Alberta males. Mormon females died in such accidents at higher than average rates (SMR = 1.33), although this result is not statistically significant at the 0.0S level. However, the rates may be
Social Biology
even higher than reported here. Mormon records indicate that a substantial proportion of untraceable and out-of-province deaths occur as the result of motor vehicle accidents. The reason for these unexpectedly high rates is not known. Although further research would be necessary to move beyond conjecture, it is possible that Mormons drive automobiles more than others. The extensive commitment to meetings during the week, several times on Sunday, trips to the temple on a regular basis, and rather frequent trips to Salt Lake City for conferences and other reasons would all subject the Latter-day Saint population to increased risk, especially as these trips are made at all times of the year. When accidents. other than motor vehicle accidents are considered, the high rates are somewhat reduced. Mormon males have a lower than average risk of committing suicide (SMR = 0.72), but the same is not true for Latterday Saint females (SMR = 1.07). As in many other causes of death, the mortality advantage experienced by Mormon males is greater than that enjoyed by Mormon females. The finding is reminiscent of the work of Gove (1972) who found that men benefit more than women from the preferential mortality risks associated with being married. These results suggest that with higher mortality and greater numbers of preventable deaths, males are more likely to benefit from any environmental or social condition which improves mortality in general. SUMMARY AND CONCLUSIONS Mormon cause-specific mortality rates were calculated and standardized by age for both males and females by compiling lists of Mormon deaths from Latter-day Saint church records and linking them with province of Alberta death certificates to obtain the official cause of death. A
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greater proportion of deaths was traceable than in previous studies. The research was also aided by the availability of census information on religion which permitted the computation of a relatively accurate sex and age distribution of the Alberta Mormon population. Cause-specific death rates for Mormons in Alberta were compared to those for the general population of Alberta and of all Canada. In general, the findings were as follows: 1. Mormon death rates for most causes are lower than those for Alberta, even though the Alberta rates are lower than those for all Canada. 2. Mormon death rates for males are higher than those for females for most causes. 3. Male and female death rates are more similar among Mormons than among the general population. 4. Causes of death for which Mormons have an average or higher than average risk are either less frequent causes of death or are less clearly related to dietary habits of Mormons. 5. Mormons have disproportionately low rates of death for many causes of death which are not clearly related to the use of tobacco, alcohol, coffee, or tea. These findings suggest the need for further research on what actually constitutes the life style of Mormons, as well as what the specific effects of different life-style components are. For instance, more research is needed to ascertain the effects of the use of meat, coffee, tea, and other dietary elements as well as the possible effects of athletic fitness programs, family solidarity, extensive social participation, and stress-reducing religious ideology. Research may also be needed to investigate possible causes for higher rates of death among Mormons from motor vehicle accidents. Moreover, future studies should ex-
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amine health and mortality of Mormons at various church-activity or participation levels rather than in gross mixed populations as have all Mormon studies to this date. A possible explanation of decreased Mormon mortality risks lies in the biological selectivity of the group. Many Mormons in Alberta are related to each other, claiming descent from the small number of families that colonized southern Alberta over eighty years ago. It is conceivable that these families were markedly healthy and that modern Mormons have only inherited those characteristics. The biological explanation must contend with the fact, however, that a substantial but unknown proportion of Mormons in Alberta have migrated from elsewhere or have joined the church as converts through missionary activity. In the future, studies need to relate Mormon health and mortality to the years of exposure to Mormon life style. For example, it would be interesting to compare the mortality of converts to those who are descended from early Mormon families. The above considerations aside, the findings of this research strongly indicate the possibility of saving a great many lives from cancer, heart disease, respiratory diseases, and other illnesses by alteration in life style. Such alteration could be begun by a combination of childhood education discouraging the use of alcohol and tobacco and by changes in the advertising of such commodities. Moreover, social structural changes may be required in order to alter the social meanings of contexts in which such commodities are regularly used.
ACKNOWLEDGMENTS This research project was funded by the Bureau of Human Ecology, Laboratory Centre for Disease Control, Health Protection Branch,
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Health and Welfare Canada. Special thanks are also due to the L.D.S. Church Historical Department and the Research and Planning
Branch, Province of Alberta Department of Social Services and Community Health, for their cooperation and special assistance.
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