Association of community level social trust and reciprocity with mortality: a retrospective cohort study
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RESEARCH ARTICLE
Open Access
Association of community level social trust and reciprocity with mortality: a retrospective cohort study Seulggie Choi1, Juhwan Oh2,3,4*, Sang Min Park1,5* , Seo Eun Hwang2,5, Hwa-Young Lee6,7, Kyuwoong Kim1, Yugo Shobugawa8, Ichiro Kawachi3 and Jong-Koo Lee5,6
Abstract Background: Whether community level social capital is associated with mortality within an Asian population is yet unclear. Methods: The study population was derived from the Korean National Health Insurance Service-National Sample Cohort. A total of 636,055 participants were followed-up during 2012–2013 for deaths from all causes, cardiovascular disease (CVD), cancer, and other causes. Community level social trust and reciprocity at the administrative district level were derived from the Korean Community Health Survey. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality according to levels of community level social trust and reciprocity. Results: Compared to participants who reside in areas within the lower half of community level social trust, those who reside in areas within the upper half had lower risk of death from all causes (aHR 0.84, 95% CI 0.78–0.89), CVD (aHR 0.82, 95% CI 0.67–0.99), and cancer (aHR 0.85, 95% CI 0.73–0.98). Similarly, residing in areas in the upper half of community level social reciprocity was associated with reduced risk for all-cause mortality (aHR 0.80, 95% CI 0.75– 0.86). The protective association of high community level social trust and reciprocity on mortality remained after additional adjustments for smoking, alcohol intake, and physical activity. Conclusions: Residing in areas with high community level social trust and reciprocity may be associated with better population health status. Keywords: Social trust, Social reciprocity, Mortality
Background Social capital is increasingly recognized as a social determinant of population health, including morbidity and mortality. While the definition of social capital varies [1, 2], one school of thought (the social cohesion approach) describes social capital as a community level asset that * Correspondence: [email protected]; [email protected] 2 Center for Healthy Society and Education, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, South Korea 1 Department of Biomedical Sciences, Seoul National University Graduate School, 101 Daehak-ro, Jongno-gu, Seoul, South Korea Full list of author information is available at the end of the article
can enhance cooperation for mutual benefit [3]. While multiple components of social capital exist, trust and reciprocity are considered two essential elements of social capital. Social trust may facilitate social interactions and the dissemination of information while also enhancing other components of social capital such as volunteering and participation [4]. Likewise, high levels of reciprocity in relationships, which is based on the assumption that sharing resources will be repaid,
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