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Background: Arts engagement has been related to diverse health outcomes in prospective cohort studies, but these have most frequently replied on self-reported diagnoses.

Objectives: This study leveraged linked hospital episode statistics to identify the relationship between arts engagement and objective data on morbidity diagnoses and mortality.

Methods: A prospective cohort study was conducted with data from the English Longitudinal Study of Ageing, using wave 4 as baseline. Mortality and 15 main ICD-10 disease chapters (82 health conditions) were ascertained by linkage to mortality registry data and the Hospital Episode Statistics up to 2024. Cox hazard regression was used, adjusting for potential confounders.

Results: Our sample comprised 8,466 people (55% women; mean age: 65.4), with 13 years of the median follow-up period. After multivariate adjustment and considering multiple testing, frequent arts engagement was associated with reduced risk of all-cause mortality, compared with no arts engagement. Among 15 main ICD disease chapters, frequent arts engagement was associated with decreased risk of 11 chapters, including mental disorders, inflammatory, haematological, endocrine diseases, respiratory, neurological, circulatory, digestive, skin, and musculoskeletal diseases, and others including circulatory/respiratory symptoms, digestive symptoms, injury and fall. Frequent arts engagement significantly decreased risk of 31 health conditions, after full adjustment (P_FDR<0.05).

Conclusions: Frequent arts engagement is associated with reduced risk of morbidities involving diverse organ systems and mortality, even when adjusting for a rich battery of likely confounding factors. These findings extend previously identified morbidity associations with more objective data and corroborate previous identification of the multifaceted salutogenic impact of arts engagement as a health-promoting behaviour.