Marital status, gender and cardiovascular mortality: Behavioural, psychological distress and metabolic explanations

Abstract

The intermediate processes through which the various unmarried states can increase the risk of subsequent cardiovascular disease mortality are incompletely understood. An understanding of these processes and how they may vary by gender is important for understanding why marital status is strongly and robustly associated with subsequent cardiovascular disease. In a prospective study of 13,889 Scottish men and women (mean age 52.3, Standard Deviation: 11.8 yrs, range 35–95, 56.1% female) without a history of clinically diagnosed cardiovascular disease, we examined the extent to which health behaviours (smoking, alcohol, physical activity), psychological distress (General Health Questionnaire-12 item) and metabolic dysregulation (obesity levels, and the presence of hypertension and diabetes) account for the association between marital status and cardiovascular mortality. There were 258 cardiovascular deaths over an average follow up of 7.1 (Standard Deviation = 3.3) years. The risk of cardiovascular mortality was greatest in single, never married men and separated/divorced women compared with those that were married in gender stratified models that were adjusted for age and socio-economic group. In models that were separately adjusted, behavioural factors explained up to 33%, psychological distress explained up to 10% and metabolic dysregulation up to 16% of the relative change in the hazard ratios in the observed significant associations between marital status and cardiovascular mortality. Behavioural factors were particularly important in accounting for the relationship between being separated/divorced and cardiovascular mortality in both men and women (33% and 21% of the relative change in the hazard ratios, respectively). The findings suggest that health behaviour, psychological distress and metabolic dysregulation data have varying explanatory power for understanding the observed relationship between cardiovascular disease mortality and unmarried states.

The Effect of Marital Status on the Presentation and Outcomes of Elderly Male Veterans Hospitalized for Pneumonia

“…24 In general, although socioeconomic status and substance abuse appeared to play a role in the worsened outcomes of unmarried patients, these factors did not explain all of the differences. 14,23,24 could explain the lower mortality rate of married men and would be consistent with prior data demonstrating improved mortality associated with more rapid initiation of antibiotic therapy. 10 These results also suggest that lives could be saved by educating patients at risk for pneumonia to seek treatment early when they develop suggestive symptoms, as has been suggested by Ewig and Torres, 21 similar to campaigns teaching patients to avoid delays in treatment if they develop symptoms suggesting myocardial infarction or stroke.…”

“…Married patients had a signifi cantly lower in-hospital mortality rate (9.4% vs 10.6%, study of outcomes of sepsis, in which patients with a pulmonary source composed approximately 45%, single patients had a higher incidence and higher risk-adjusted hospital mortality rate compared with married and widowed patients. 22 There have also been several studies on the effect of marital status on the outcomes of conditions such as cardiovascular disease, 23 lung cancer, 24 and heart failure. 14 In some studies, all categories of unmarried men did worse, 14 whereas in others only specifi c subcategories, such as widowed men, did worse.…”

Marital status and outcomes after myocardial infarction: Observations from the Canadian Observational Antiplatelet Study (COAPT)

“…4,9,10,[15][16][17][18][19][20] We grouped patients who were separated, divorced, or widowed based on publications suggesting that this group was often at a higher risk for CV events. 9,[19][20][21][22][23][24] The primary outcome of this analysis was MACE 4 at 15 months, defined as a composite of all-cause death, repeat MI, stroke, or urgent coronary revascularization (UCR). The outcomes for MI and stroke were reported as first fatal or nonfatal events.…”

“…In married vs unmarried men and women, past studies highlighted differences in outcomes following an MI. 21,24,25,[29][30][31] It was observed that women receive less informal caregiver support than do men, with worse outcomes, 1 to 12 months following an MI. 25 However, in contrast with many of the prior studies that controlled simply for certain socioeconomic determinants of health, such as income and education, we additionally adjusted for differences in baseline comorbidities that may have attenuated any association with marital status.…”

Socio-Economic Risk Factors for Cardiovascular Death: Data From 12-Year Prospective Epidemiologic Study

“…Также доказано, что женатые мужчины испытывают меньший уровень эмоционального стресса и ведут более здоровый образ жизни по сравнению с одинокими мужчинами [15]. В то же время считается, что замужние женщины имеют более высокий уровень стресса, связанный с семейной жизнью.…”