{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T16:31:22Z","timestamp":1793637082327,"version":"4.5.1"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T00:00:00Z","timestamp":1578960000000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NAU Southwest Health Equity Research Collaborative","award":["NIH\/NIMHD #U54MD012388"],"award-info":[{"award-number":["NIH\/NIMHD #U54MD012388"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,12,2]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine whether the inverse association of subjective well-being with mortality is independent of self-rated health and socioeconomic status in healthy adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A population-based prospective cohort study based on an in-person interview. Cox regression was used to examine mortality hazards for happiness alone and for a standardised summary well-being measure that included happiness, life satisfaction and negative emotions. Using prespecified analyses, we first adjusted for age and then additionally adjusted for self-rated health and then race\/ethnicity, marital status, smoking and socioeconomic status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Probability sample of adult US residents interviewed in their homes in 2001.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>25 139 adults free of cardiovascular disease and cancer at baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary outcome measure<\/jats:title><jats:p>All-cause mortality 14 years after the baseline interview as assessed by probabilistic matching using the National Death Index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Age-adjusted unhappiness was associated with mortality (HR 1.27; 95% CI 1.11 to 1.45, p=0.001) but the association attenuated after adjusting for self-rated health (HR 1.01; 95% CI 0.88 to 1.16, p=0.85). A similar pattern was seen for the summary well-being measure in fully adjusted models (HR 1.00; 95% CI 0.99 to 1.00, p=0.30). In contrast, self-rated health was strongly associated with mortality. In the fully adjusted model with the summary well-being measure the hazards for good, very good and excellent self-rated health were 0.71 (95% CI 0.62 to 0.80, p&lt;0.001), 0.63 (95% CI 0.55 to 0.71, p&lt;0.001) and 0.45 (95% CI 0.39 to 0.51, p&lt;0.001), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this representative sample of US adults, the association between well-being and mortality was strongly attenuated by self-rated health and to a lesser extent socioeconomic status.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2019-031776","type":"journal-article","created":{"date-parts":[[2020,1,15]],"date-time":"2020-01-15T10:05:14Z","timestamp":1579082714000},"page":"e031776","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Is subjective well-being independently associated with mortality? 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