Association of cultural participation with morbidity and mortality in the Welsh Population: An observational study

BackgroundClinical interventions based on cultural participation have consistently demonstrated improved patient outcomes. At the population level, prospective cohort studies show a protective association between cultural participation and all-cause mortality. However, the latter is limited by a narrow choice of methods and outcomes. We sought to address this by using multiple methods to investigate the effects of cultural participation on both morbidity and mortality. MethodsFirst, we conducted multivariable linear and logistic regression models using the National Survey of Wales 2015-2019. This featured attendance at cultural events/activities as an exposure and self-reported health (SRH), as well as specific health conditions, as an outcome with sequential adjustment for confounders related to demographics, socio-economic position (SEP), and lifestyle behaviours. To complement this, we conducted a multivariable panel regression model using cultural expenditure data from English and Welsh local authorities and life expectancy data from the Office for National Statistics. ResultsWhen adjusting for age, sex, SEP, and lifestyle behaviours, we found that overall cultural participation had a small positive association with SRH (4.8% improvement in SRH score, 95% confidence intervals [4.0-5.6%], p<0.0001, n=15374) and lower likelihood of cardiovascular disease, and anxiety/depression. Similar, albeit smaller, positive associations were seen between SRH and individual cultural activities, including library, museum, and heritage site visits. However, we did not identify any association between local authority cultural expenditure and local life expectancy. ConclusionWe identified new evidence for a positive association between cultural participation and morbidity. However, additional evidence will be required to better establish causal inference. What is already known on this topic?Several observational studies show that cultural participation is associated with reduced mortality and clinical trials also support the use of cultural interventions. What this study adds?This study provides evidence for beneficial associations between cultural participation, self-reported health, and certain chronic conditions even when taking account of known confounders. How this study might affect research, practice or policy?This study further emphasises the importance of arts and culture for health and the need for further research in this area of epidemiology.