Spirituality and Cardiovascular Health in the HANDLS Study: Evidence for Within-race Differences

Abstract

Objective: This cross-sectional study explored the associations between spiritual transcendence (ST)-prayer/meditation fulfillment, connectedness, and universality- and the American Heart Association's Life's Simple 7 (LS7), and if variations across and within racial and socioeconomic groups emerged.

Methods: Data were taken from the Healthy Aging in Neighborhoods of Diversity across the Life Span study and included 1110 midlife and older African American and white adults [mean (SD) age=56.13 (8.91) y; 65.0% above poverty; 78.1% ≥high school education]. ST was self-reported. LS7 comprised physical activity, smoking, diet, body mass index, cholesterol, glucose, and blood pressure. Higher LS7 reflects better cardiovascular health (CVH). Multiple linear regression estimated associations between ST and LS7. A 3-way interaction term (ST, race, and either education or poverty status) was included in models adjusted for sex and age.

Results: A 3-way interaction was observed for ST, race, and poverty status ( b =1.29, SE=0.35, p <.001). Simple slopes showed a positive association for white adults living above poverty only ( b =0.54, SE=0.15, p <.001). Exploratory analyses found a nonlinear 3-way interactive effect including ST, race, and age (ie, U-shaped; b =0.04, SE=0.02, p =.048). Both lesser and greater ST were associated with higher LS7 for older African American adults exclusively ( b =0.03, SE=0.01, p =.024).

Conclusions: Although spirituality was associated with overall CVH, it was not beneficial for everyone equally. If tailored appropriately, the integration of spirituality into care practices may promote better CVH.

Abbreviations: AA: African American, AHA: American Heart Association, BMI: body mass index, BP: blood pressure, CVD(s): cardiovascular disease(s), CVH: cardiovascular health, HANDLS: Healthy Aging in Neighborhoods of Diversity across the Life Span, LS7: Life's Simple 7, M: mean, PTSD: posttraumatic stress disorder, SES: socioeconomic status, ST: spiritual transcendence.

Keywords: cardiovascular health; racial health disparities; socioeconomic status; spirituality.