Satisfação com a vida, saúde cardiovascular e mortalidade: resultados do Estudo Longitudinal de Saúde do Adulto – ELSA-Brasil

Abstract

Life satisfaction involves a comprehensive evaluation of of one's own life, based on personal standards. Generally, individualswith higher life satisfaction tend to have better health conditions. It is conjectured that life satisfaction not only lowers the risk of disease, but also positively impacts cardiovascular health and general health, leading to increased longevity. This thesis investigated the association of life satisfaction with ideal cardiovascular health (article 1) and all-cause mortality (article 2). Three primary hypotheses were investigated: (i) higher levels of life satisfaction are associated with a greater chances of ideal cardiovascular health (ii) life dissatisfaction increases mortality and (iii) the magnitude of the association of life dissatisfaction is stronger among in adults than in elderly individuals. This studt utilized data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil) cohort, including participants from interviews and exams during visit 2 (2012-2014). In the cross-sectional analysis (article 1), life satisfaction, measured by the Satisfaction With Life Scale, was treated as a continuous variable; the response variables were the ideal global, behavioral and biological cardiovascular health (SCV) scores on the American Heart Association - Life’s Simple 7, categorized as low, intermediate and optimal. Multinomial logistic regression was used to estimate the magnitude of associations. In the longitudinal analysis (article 2), life satisfaction was categorized as satisfied and dissatisfied, and the response variable was the time until death from all causes (measured from 2009 to 2021), with Cox models used to estimate the magnitude of association in adults (<65 years) and elderly individuals (≥65 years) separately. Cross-sectional analyzes included 12,936 participants (mean age = 55.2). The results indicated that a one-standard deviation increase in the life satisfaction score was associated with an odds ratio of 1.05 (95% CI=1.01-1.09) and 1.15 (95% CI=1.07-1.23) for, intermediate and optimal SCV score, respectively, after adjustment for sociodemographic characteristics and depression. Additionally, an increase of one standard deviation in life satisfaction was related to an odds ratio of 1.11 (95% CI 1.06-1.15) and 1.22 (95% CI 1.14- 1.31) for intermediate and optimal ideal behavior scores, respectively. Life satisfaction was not associated with the ideal biological score. The longitudinal analyzes included 13,925 participants (11,475 adults and 2,450 elderly individuals). The prevalence of life dissatisfaction was 9.6% in adults and 5.4%; the elderly with and average follow-up time of 5.8 and 5.6 years, respectively. Dissatisfied adults exhibited a lower cumulative survival than satisfied counterparts. After adjustment for sociodemographic characteristics, chronic diseases and depression, dissastisfied adults had 57% higher mortality (HR=1.57 95% CI: 1.03-2.37) than satisfied adults. However, life dissatisfaction was not associated with mortality in the elderly. The results of this thesis suggest that satisfaction with life promotes better cardiovascular health and and dissatisfaction reduces mortality in adults up to 65 years of age. These results confirm the importance of life satisfaction as a relevant indicator of health and quality of life.