Meditation Practice and Long-Term Mortality in US Adults: A Doubly Robust Analysis of Pooled National Health Interview Survey Cohorts with a Trial-Informed Bayesian Subgroup Analysis

ABSTRACT Introduction: Trial evidence in older adults with hypertension suggests that meditation may lower mortality, but this association has not been tested in a nationally representative study with linked-mortality data. This study estimated meditation's association with mortality among US adults, examined variation by family income, and synthesized trial and survey evidence for the population matched to the trial evidence base. Methods: We pooled four National Health Interview Survey cohorts (2002 to 2017) with mortality follow-up through 2019 (N=90,041; 8,402 [9.3%] reported meditation practice in the past 12 months). Doubly robust survey-weighted Cox models combined stabilized inverse-probability weights with covariate adjustment, overall and by income stratum; 15 year risks were standardized using g computation, and probabilistic bias analysis addressed exposure misclassification, including a scenario by income strata. For non Hispanic Black adults ≥55 years with hypertension (n=2,786), Bayesian synthesis combined subgroup estimates with a pooled randomized trial prior. Results: Over 818,248 person years of follow up, 10,027 all cause and 3,040 cardiovascular deaths occurred. Doubly robust hazard ratios (HR) were 1.02 (95% CI 0.90, 1.16) for all cause and 0.96 (95% CI 0.79, 1.16) for cardiovascular mortality. Among individuals below 200% of the federal poverty level, HRs were 0.85 (All cause: 95% CI 0.71, 1.03) and 0.80 (Cardiovascular mortality: 95% CI 0.57, 1.10), compared with 1.10 (95% CI 0.93, 1.30) and 1.02 (95% CI 0.80, 1.30) among those at/above that threshold (interaction p=0.19 and p=0.62). In the subgroup analysis, posteriors under a 50%-discounted trial prior were 0.84 (All-cause mortality: Pr[HR<1]=0.89) and 0.70 (Cardiovascular mortality: Pr[HR<1]=0.96). Conclusions: Meditation practice showed no overall association with mortality after doubly robust adjustment. However, estimates suggesting a protective effect were concentrated among adults below 200% of the federal poverty level, and trial-informed synthesis indicated probable benefit in cardiovascular mortality in the high-risk subgroup most comparable to trial participants. These hypothesis-generating findings motivate further study of effect modification using more detailed exposure measurement.