Psychosocial factors as strong predictors of mortality from cancer, ischaemic heart disease and stroke: The Yugoslav prospective study

We investigated the relation of psychosocial risk factors to mortality in a prospective study of 1353 inhabitants of Crvenka, 619 of whom died between 1966 and 1976. All 38 lung cancer deaths occurred in those with high scores for rationality and antiemotionality (R/A), a factor related to suppression of aggression. Compared with lower R/A, high R/A was also associated with a relative risk of mortality of 29 for other cancer, 4.3 for ischaemic heart disease and 6.5 for stroke. Standardising for R/A reduced the smoking/lung cancer association, virtually eliminated the smoking/other cancer and smoking/heart disease relationships and reduced the association of heart disease with blood cholesterol, blood sugar and hypertension. Long lasting hopelesness was also independently associated with cancer as was anger with heart disease, though not so strongly as for R/A. Psychosocial variables are important predictors of mortality and decisively modify the effect of physical risk factors such as smoking.