How Tattoos Correlate With Early Mortality
How Tattoos Correlate With Early Mortality
Tattoos have a long history in many societies, including ancient Egypt, pre-Columbian America, China, and Polynesia, among others. The name of the practice as we use it today comes from the Polynesian word tau-tau, meaning the tapping of the skin to create a permanent marking. The term entered the Western lexicon through the travels of European sailors as they explored the Pacific and encountered and then adopted the practice. Indeed, the so-called tribal tattoo in current use is named after the designs that Polynesian tribes used in rites of passage.
The present data are unavoidably confounded. Young people are more likely to have tattoos than are older people, and the leading causes of death in the United States in the young age group are accidents, homicides, and suicides, which are all nonnatural manners of death. So is the presence of a tattoo or the presence of youth the primary "risk factor" for these deaths? The Cox proportional hazards regression analysis helps to evaluate the relative contributions of the different factors that may be involved, but acknowledgment of the limitations of the present findings is prudent. Still, the present study identifies a significant difference between the ages of persons who die with tattoos compared with those without tattoos. The difference is 14 years and appears to be independent of sex, race, or manner of death. When manner of death is factored in, the survival difference is even more appreciable: 20 years for a tattoo with a nonnegative message and 32 years for a tattoo with a negative message. African Americans in the study group appear more likely to be tattooed. They also appear to die at a younger age than do whites. The confounded data are clarified a bit by the Cox analysis. The presence of any tattoo, a negative message, use of illicit drugs, and alcohol appear to contribute to death at a younger age in violent cases, while the presence of a tattoo and nonwhite race contribute to death at a younger age in natural cases. Persons who die from gunshot wounds or overdose are also more likely to be tattooed, while those who die from atherosclerotic cardiovascular disease are more likely not to be tattooed. The presence of a tattoo with negative content may be associated with death by a nonnatural manner, and as a group, tattoos with negative messages contribute to the risk of mortality by a nonnatural manner. Images of gang signs and weapons may be particularly prone to this risk.
Specific correlations between race and cause of death were found in other studies. For example, a large study of tattoos and mortality based on a New Mexico population found that Hispanic ethnicity was significantly associated with the presence of a religious tattoo and that homicide victims were significantly more likely to have tattoos than were victims of accidents and were more likely to have a gang tattoo than others. The significant difference in age of death was observed in that study, as in this one. Similarly, a small study of an Australian population found an association between the presence of a tattoo of an antiestablishment folk hero and violent death from suicide or homicide among relatively young white men.
Differences between study groups likely reflect differences in the populations that are studied. According to the US Census Bureau, the estimated population of Iowa is 3,074,186 people, of whom 92.8% are white, 3.2% are African American, 5.3% are Hispanic, and 2.0% are Asian. By comparison, of 313,914,040 people in the United States overall, 77.9% are white, 13.1% are African American, 16.9% are Hispanic, and 5.5% are Asian. It is likely that the substantially lower proportion of African Americans and Hispanics in Iowa prevents detection of some correlates that may be confirmed in larger, more diverse populations. Religious iconography and messages, or folk heroes, may be culturally dependent and thus might not be reproducible in different populations. This article's study group is based in a culture and sensibility of the Midwestern United States and may have too much homogeneity to discern specific ethnic or racial differences in expressions of tattoo art.
Still, the association between tattoos and relatively early death by any manner, not necessarily violent, was striking. However, the presence of a tattoo is not de facto a predictor or marker of a poor outcome in health and survival but rather may represent an epiphenomenon. The association between having tattoos and risk-taking behavior has long been observed clinically, especially with people who obtain tattoos at younger ages. There is an indication of this observation at autopsy, in that persons with tattoos are significantly more likely to have an illicit drug detected than persons without tattoos and are more likely to die by a nonnatural manner with drugs or alcohol. These correlations may be associated with the greater incidence of fatality from overdose in this group.
Regarding the message or imagery of the tattoo, there may be trends suggesting that some types of tattoos may have some kind of association with certain outcomes, and some of the messages that people imprint in their skin, including negative ones, appear to be related to a violent or nonnatural death. However, the remarkable finding in these data was that tattoos of any kind may be associated with earlier death from many causes and manners.
There have always been inherent risks in the process of tattooing, such as bleeding, tears, infections, allergic or inflammatory reaction, flare reaction within the tattoo area ("koebnerization"), activation of native disease such as lupus, pseudolymphomatous reaction, or pseudoepitheliomatous hyperplasia. Some of these risks have been mitigated by federal regulation of inks and state or local requirements for sterile instruments and clean procedures. The rate of clinical complications from tattoos presently is approximately 2%.
The behavioral risks that may accompany the mind-set that welcomes a tattoo have been described. They may include a "live for today" attitude, in which long-term consequences of personal decisions may not be considered in detail. Indeed, tattooing may be a paradigm of this phenomenon: while one embraces a certain tattoo at the time he or she receives it, the person may feel differently about the tattoo later; removal is fairly common some years after the original procedure. Such an inclination to commit to a permanent body marking could be related to a predisposition to make other short-term decisions that may have fatal consequences in serious situations that could lead to accidents, suicide, or homicide. This behavioral model is less clear for death by natural causes, however, which is also correlated with death at a younger age for many tattooed persons in the data shown herein. The exception to this trend is death from atherosclerotic cardiovascular disease, which remained predominantly an affliction of nontattooed persons. This difference may simply be a result of overall survival, however; possibly people with tattoos did not live late enough into middle or elderly age to develop complications of atherosclerosis.
Discussion
Tattoos have a long history in many societies, including ancient Egypt, pre-Columbian America, China, and Polynesia, among others. The name of the practice as we use it today comes from the Polynesian word tau-tau, meaning the tapping of the skin to create a permanent marking. The term entered the Western lexicon through the travels of European sailors as they explored the Pacific and encountered and then adopted the practice. Indeed, the so-called tribal tattoo in current use is named after the designs that Polynesian tribes used in rites of passage.
The present data are unavoidably confounded. Young people are more likely to have tattoos than are older people, and the leading causes of death in the United States in the young age group are accidents, homicides, and suicides, which are all nonnatural manners of death. So is the presence of a tattoo or the presence of youth the primary "risk factor" for these deaths? The Cox proportional hazards regression analysis helps to evaluate the relative contributions of the different factors that may be involved, but acknowledgment of the limitations of the present findings is prudent. Still, the present study identifies a significant difference between the ages of persons who die with tattoos compared with those without tattoos. The difference is 14 years and appears to be independent of sex, race, or manner of death. When manner of death is factored in, the survival difference is even more appreciable: 20 years for a tattoo with a nonnegative message and 32 years for a tattoo with a negative message. African Americans in the study group appear more likely to be tattooed. They also appear to die at a younger age than do whites. The confounded data are clarified a bit by the Cox analysis. The presence of any tattoo, a negative message, use of illicit drugs, and alcohol appear to contribute to death at a younger age in violent cases, while the presence of a tattoo and nonwhite race contribute to death at a younger age in natural cases. Persons who die from gunshot wounds or overdose are also more likely to be tattooed, while those who die from atherosclerotic cardiovascular disease are more likely not to be tattooed. The presence of a tattoo with negative content may be associated with death by a nonnatural manner, and as a group, tattoos with negative messages contribute to the risk of mortality by a nonnatural manner. Images of gang signs and weapons may be particularly prone to this risk.
Specific correlations between race and cause of death were found in other studies. For example, a large study of tattoos and mortality based on a New Mexico population found that Hispanic ethnicity was significantly associated with the presence of a religious tattoo and that homicide victims were significantly more likely to have tattoos than were victims of accidents and were more likely to have a gang tattoo than others. The significant difference in age of death was observed in that study, as in this one. Similarly, a small study of an Australian population found an association between the presence of a tattoo of an antiestablishment folk hero and violent death from suicide or homicide among relatively young white men.
Differences between study groups likely reflect differences in the populations that are studied. According to the US Census Bureau, the estimated population of Iowa is 3,074,186 people, of whom 92.8% are white, 3.2% are African American, 5.3% are Hispanic, and 2.0% are Asian. By comparison, of 313,914,040 people in the United States overall, 77.9% are white, 13.1% are African American, 16.9% are Hispanic, and 5.5% are Asian. It is likely that the substantially lower proportion of African Americans and Hispanics in Iowa prevents detection of some correlates that may be confirmed in larger, more diverse populations. Religious iconography and messages, or folk heroes, may be culturally dependent and thus might not be reproducible in different populations. This article's study group is based in a culture and sensibility of the Midwestern United States and may have too much homogeneity to discern specific ethnic or racial differences in expressions of tattoo art.
Still, the association between tattoos and relatively early death by any manner, not necessarily violent, was striking. However, the presence of a tattoo is not de facto a predictor or marker of a poor outcome in health and survival but rather may represent an epiphenomenon. The association between having tattoos and risk-taking behavior has long been observed clinically, especially with people who obtain tattoos at younger ages. There is an indication of this observation at autopsy, in that persons with tattoos are significantly more likely to have an illicit drug detected than persons without tattoos and are more likely to die by a nonnatural manner with drugs or alcohol. These correlations may be associated with the greater incidence of fatality from overdose in this group.
Regarding the message or imagery of the tattoo, there may be trends suggesting that some types of tattoos may have some kind of association with certain outcomes, and some of the messages that people imprint in their skin, including negative ones, appear to be related to a violent or nonnatural death. However, the remarkable finding in these data was that tattoos of any kind may be associated with earlier death from many causes and manners.
There have always been inherent risks in the process of tattooing, such as bleeding, tears, infections, allergic or inflammatory reaction, flare reaction within the tattoo area ("koebnerization"), activation of native disease such as lupus, pseudolymphomatous reaction, or pseudoepitheliomatous hyperplasia. Some of these risks have been mitigated by federal regulation of inks and state or local requirements for sterile instruments and clean procedures. The rate of clinical complications from tattoos presently is approximately 2%.
The behavioral risks that may accompany the mind-set that welcomes a tattoo have been described. They may include a "live for today" attitude, in which long-term consequences of personal decisions may not be considered in detail. Indeed, tattooing may be a paradigm of this phenomenon: while one embraces a certain tattoo at the time he or she receives it, the person may feel differently about the tattoo later; removal is fairly common some years after the original procedure. Such an inclination to commit to a permanent body marking could be related to a predisposition to make other short-term decisions that may have fatal consequences in serious situations that could lead to accidents, suicide, or homicide. This behavioral model is less clear for death by natural causes, however, which is also correlated with death at a younger age for many tattooed persons in the data shown herein. The exception to this trend is death from atherosclerotic cardiovascular disease, which remained predominantly an affliction of nontattooed persons. This difference may simply be a result of overall survival, however; possibly people with tattoos did not live late enough into middle or elderly age to develop complications of atherosclerosis.
