The Roseto Effect: A 50-Year Comparison of Mortality Rates
BrendaEgolif MA, Judith Lasker, Potvin, PhD
Introdudion
Previous studies of social correlates of health and longevity have focused mainly on ethnic, occupational, or demo- graphic characteristics rather than on the social character and group dynamics of an identified community. An exception is the studyof Roseto,Pennsylvania, an Italian- American town in eastern Pennsylvania thatfrom1955 to1965 was found to have had a strikingly low mortality rate from myocardial infarction relative to Bangor, animmediately adjacent town, and three othernearbycommunities.1'2Theusually accepted risk factorswere atleast as prev- alent in Rosetoasinthetwocontrol com- munities that were studied indetail.3,4At thetime, Roseto,which had been settled by immigrants from a town in southern Italyin1882,stilldisplayedahighlevel of ethnicand socialhomogeneity,close fam- ilyties, and cohesive community relation- ships.
Beginning in 1962, Roseto became theobjectofdetailedinquiriesintoits his- toryand socialtraditionsand theattitudes, behavior, healthhabits, and medicalsta- tusof its residents. Forcomparison, the adjacent community of Bangor (which, throughoutwhat becamea50-yearperiod understudy,wasservedbythesame wa- tersupply,physicians,andhospitalfacil- ities asRoseto) and the nearby town of Nazarethwerestudiedinsimilarfashion.
Datafrom thesestudies andmanyyearsof participant observationyielded evidence that thediscrepancyintheprevalenceof andmortalityfrommyocardial infarction might be attributed to important differ- ences in culture and social cohesion among the threecommunities.1-5 It was
hypothesized that Roseto's stable struc- ture,itsemphasisonfamilycohesion,and the supportive nature of thecommunity
PhD, StewartWolf MD, andLouise
may have been protective against heart attacks and conducive to longevity. How- ever, by the early 1960s there were indi- cations of impending change in the com- munity.5 Interviews with many Rosetans betweenthe ages of 25 and 35 and with the teenagers indicated that they were pre- pared to largely abandon their old com- munity ways in favor of the more typically American behavior of neighboring com- munities.
In 1963, after the initial period of study,theinvestigators made a prediction that theloosening of family ties and com- munity cohesion would be accompanied by loss ofrelative protection of Rosetans fromdeath duetomyocardial infarction.4 By the late 1960s andearly 1970s the pre- dicted socialchangewasevident,aswas the predicted increase in incidence of myocardial infarction. These changes were reflected in greater prevalence of myocardial infarction among the living and inhighermortalityrates.2,13"14
Theearlier beliefs andbehaviorthat expressedthemselves in Roseto'sfamily- centered sociallife,absence of ostentation evenamongthewealthy,nearlyexclusive patronage of local business, and a pre- dominanceofintra-ethnicmarriagesgrad- ually changed toward the more familiar behaviorpattern ofneighboring commu-
BrendaEgolf and JudithLaskerarewiththe Center forSocialResearch,LehighUniversity, Bethlehem,Pa.Stewart Wolf is with the Totts Gap MedicalLaboratory, Bangor,Pa. Louise Potvin is with theUniversityofMontrealMed- icalSchool,Montreal,Quebec,Canada.
Requests forreprintsshould be sent to BrendaEgolf,MA,Center forSocialResearch, LehighUniversity,203 East PackerAve,Be- thlehem,PA18105.
This paperwassubmittedtotheJournal March8,1991, andacceptedwithrevisionsDe- cember10,1991.
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nities.Rosetowasshiftingfrom itsinitially highlyhomogeneoussocialorder-made up of three-generation householdswith strongcommitmentstoreligionand to tra- ditionalvalues andpracticestoa less co- hesive, materialistic, more "American- ized" community in which three- generation households were uncommon and inter-ethnic marriages became the norm.15
The "Roseto Effect" has been widely citedasevidencefor the positive effects of social cohesion and socialsup- port onlongevity.6-12In ordertoreexam- ine thepossibility of biasinthemortality data due tothe small population sizeof Roseto (approximately 1600 during the time of thestudy,with theBangor popu- lation numberingmorethan5000), andto testthepossibilitythat the relative differ- encesinmortalityratesfromonedecade toanotherwere dueto randomfluctua- tions in the number of deaths in each town, weexanilned3859 deathcertificates from Roseto and Bangor from 1935 to 1985.
Medwd
With thehelp of theBureauofVital Statistics in thePennsylvania Department ofHealth,we wereabletoobtain and in- dividuallyexamine all death certificates of inhabitants ofRoseto and Bangor who diedbetween1935and 1985.Becausepre- 1960certificates hadtoberetrievedman-
ualy,wewereconcernedabout the com- pleteness of our data. We therefore examinedall obituary notices in thelocal newspaperaswell aschurch death rec- ords for the entire time period ofthis study;wewerethus abletoidentifyand obtain the records ofresidents whosecer- tificates hadnotbeenfiledorretrievedap-
propriately. Obituaries and church rec- ords also made itpossibletoidentifyand obtain the death certificates for Roseto andBangor residents who had diedwhile theyweretravelingoutside of Pennsylva- nia.
DiagnosticCHieia
Thecriteria for thediagnosisof death frommyocardialinfarctionincludedallin- stanceswhenmyocardial infarctionwas listedonlineoneof the deathcertificateas
"immediate cause of death" orwhen
"sudden death"waslisted in thatspace andmyocardial infarction,ischemic heart disease, arteriosclerotic cardiovascular disease,coronary heartdisease,orsimilar phraseswereusedinthe "due to" lines.
Criteriaforthediagnosisofconges- tive heart failure included the listing of congestiveheartfailure,chronicischemic heart disease, chronic myocarditis, car-
diomyopathy, andsimilarphrases asim- mediatecauseofdeath,accompanyingthe listing ofatherosclerosisorarteriosclero- sisas acontnbutingcause.
AgeAdjustment and Standardization
Mortalityratesin thetwotownswere standardized forage,usingasthe standard population thesumineach agegroupin RosetoandBangorin 1940. Rates were computedfor deaths frommyocardialin- farction, congestiveheart failure,and all
causes. Theratio of Roseto to Bangor rates wasthencalculated, and statistical
significancewasassignedtodifferencesat the95%Confidencelevel.16
Since the focus ofourinterestwas coronary disease, age-adjusted death rateswerecomputed only for those aged 35 andolder.Rates werebasedon10-year
averages overtheperiod1935to1985,us- ing the 5years oneither side ofanofficial censuscount,with thecensusfiguresas thedenominator. Althoughtheage com- positionofthetwopopulations changed
damaticallyovertime,standardizationof theratestakes this into account.(Seethe Appendixforcompletecensusdata.)
Resuls
Table 1 presents age-adjusted mor- tality rates from myocardial infarction, congestive heart failure, the two com-
bined, andforallcausesfor thetwo com-
munitiesoverthecourseof fivedecades.
Themortalityrateformyocardialinfarc- tionamong Rosetomenandwomen was
initiallyverylowbutshowedaprogres-
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TbeRosetoEffed
sive riseoverthe30-yearperiod from 1935 to1964.TherateformeninBangor also rose during this time, while rates for Bangorwomenpeaked in the periodfrom 1955to 1964. Inthe decade 1965 to 1974 there was a sharp increase in mortality frommyocardialinfarctionamong Roseto menandwomen. Forwomen, the increase from the 1955to1964 decadewasentirely in the 65and olderpopulation,butformen itoccurred in everyagegroup and most
dramatically in all 10-year age groups youngerthan 65(seeTable2).Incontrast, ratesforcongestive heart failuregeneraly declinedoverthecourseof the five dec- ades.Totalmortalityratesdeclined in both communities,althoughthedropis consid- erablygreaterforwomenthan formen.
Table 3shows the RosetotoBangor ratios andconfidence intervals of mortal- ityratesfortotal deaths andformyocar-
dial infarction, congestive heart failure, and thetwocombined. The results indi- catethattheratesof deathfrom all causes formenaresignficantlylower inRoseto for all decadesexcept 1965to 1974. For womentheyaresignificantlylowerin 1955 to1964and 1975to1984butsignificantly higher from 1965to1974.
Although therewere no significant differences between thetwocommunities in congestive heart failure until the last decade, the mortalityratesformyocardial infarctioninbothmenandwomenin Ro- seto were significantly lower than those forBangormenandwomenoverthe ini- tialperiodofthirtyyears.After 1965 this differencedisappeared.Whenmyocardial infarction andcongestiveheartfailureare combined,Rosetomenhadamortalityad- vantage overBangormenfrom1935until 1965.
DiscussionandConclusion
After avery thorough search of all sourcesofdata for mortalityin twosmall Pennsylvania communities over the course of50years, ourexamiationofdeathcer-
tificates has confirmed the earlier infer- ence,basedon ashorterspanofyears,that the deathratefrommyocardial infarction waslower in Rosetothaninimmediately adjacentBangor in threedecadespriorto 1965. The difference between the two com- munitiesisstatisticallysignificant despite the small number ofmyocardial infarc- tions.Thesharprisethatfollowed involved mainlyyoung Rosetan men and elderly women at atime whenthepredictedde- crease in social cohesionbecame clearly manifest, as described in detail else-
where.14'15Theincreaseinmyocardialin-
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farction inRoseto was accompanied by a similarincrease in totalmortality.
This remarkable pattern suggests systematic differences between the two neighboring communitiesover the course of atleast 30 years-years forwhich there aremany indicators of greatersocial sol- idarity andhomogeneity in Roseto and no evidence of differences incoronary risk factors.15 The social changes that oc- curred in Roseto in the1960s are reflected insharplyincreased rates of heartattack among men under the age of 65. 0
Acknowledgments
Thisresearchwasfunded by the NationalIn- stitute on Aging Grant 1ROlAG04957, the EleanorNaylor Dana Charitable Trust, and The Pew Charitable Trusts.
The authors thank Donald T.Campbell and the many peopleinvolvedincollectingdata forthisprojectfor their assistance.
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