Steptoe, A; Jackson, SE; (2020) Association of Noncognitive Life Skills With Mortality at Middle and Older Ages in England. JAMA Network Open. , 3 (5) , Article e204808. 10.1001/jamanetworkopen.2020.4808.

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Abstract

Importance: Noncognitive life skills are patterns of behavior, thoughts, and feelings that complement cognitive ability in promoting positive economic and educational outcomes. These positive attributes have been associated with favorable social and health outcomes at older ages, but their combined association with survival is not known. Objectives: To evaluate the association of the combination of 5 noncognitive life skills with mortality, and to explore the role of sociodemographic, health, cognitive, and behavioral factors in explaining associations. Design, Setting, and Participants: This cohort study used data from wave 5 of the English Longitudinal Study of Ageing, conducted in 2010. Participants included adults 52 years and older. Associations of scores on 5 noncognitive life skills, including conscientiousness, perseverance, emotional stability, optimism, and control, with all-cause mortality were analyzed for a mean (SD) of 7.2 (1.3) years. Data analyses were completed in November 2019. Exposures: Response to wave 5 of the English Longitudinal Study of Ageing. Main Outcomes and Measures: Noncognitive life skills scores, including conscientiousness, perseverance, emotional stability, optimism, and control, were measured by questionnaire. The main outcome was all-cause mortality, and the associations with noncognitive life skills scores were analyzed using Cox proportional hazards regressions models to estimate hazard ratios per 1-SD increase in score. Results: A total of 7850 participants (mean [SD] age, 66.5 [9.0] years; 4333 [55.2%] women) were included. Combined life skill score was positively associated with survival, with a hazard ratio of 0.81 (95% CI, 0.72-0.90) per 1-SD increase in positive attributes after adjustment for age, sex, race/ethnicity, childhood socioeconomic status, educational attainment, baseline chronic disease, depressive symptoms, cognitive function, mobility impairment, social isolation, smoking, physical activity, alcohol intake, and fruit and vegetable consumption (P < .001). Excluding deaths during 24 months after baseline as a check for reverse causation showed the same pattern (adjusted hazard ratio, 0.79; 95% CI, 0.70-0.89; P < .001). Associations were maintained after each life skill was omitted in turn from the aggregate score, indicating that no single positive attribute accounted for the protective association. Conclusions and Relevance: These findings suggest that noncognitive life skills are associated with survival at older ages. Whether training and education programs could enhance these attributes and influence mortality risk is not known, but fostering and maintaining life skills may be important in later life.

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