The Ecological Effects of Religion on Health and Mortality in China

Public health research is only beginning to recognize that the demographic presence and socio-cultural influence of religion in local geographic areas affect population health and mortality. This dissertation project expands this work to mainland China where I investigate the ecological effect of religion on the physical health and mortality of China's rapidly aging population. I emphasize religion as a socio-cultural characteristic of communities and incorporate theoretical explanations for the religion-health connection into social epidemiological frameworks. Using geographic data of religious sites in China merged with population census reports and a longitudinal survey of older adults, I apply statistical methods for analyzing spatial and multilevel data to identify patterns in health and mortality associated with the religious composition of local Chinese areas. Overall, these patterns indicate that religion is an important ecological factor affecting the health and mortality of Chinese people. Results show that the presence of Buddhism and Islam in Chinese counties and prefectures are associated with lower mortality rates but that this association is due to common links with ethnic minority populations. The presence of Buddhism and Islam in Chinese prefectures is associated with worse self-rated health, whereas the presence of Christianity and Daoism in prefectures is associated with better self-rated health. Daoism is also associated with fewer chronic illnesses. Mediation analyses, however, do not provide evidence that social participation, social support, and health behaviors link these associations. Using China as a comparative case, this study draws attention to the religious environment as an important socio-cultural health factor, even in one of the least religious and most highly regulated societies in the world. Understanding factors associated with who gets sick and where can help reduce health inequalities, identify opportunities for disease prevention, and determine where more resources are needed.