Race, Marital History, and Risks for Stroke in US Older Adults

Abstract

Stroke is among the leading causes of disability and death in the United States, and racial differences are greater for stroke than for all other major chronic diseases. Considering the equally sizeable racial disparities in marital life and associated risks across adulthood, the current study hypothesizes that black-white differences in marital history play an important role in the large racial inequalities in the incidence of stroke. The major objective are to (i) demonstrate how marital history is associated with the incidence of stroke, (ii) examine how marital factors mediate and/or moderate racial disparities in stroke, and (iii) examine the factors that may explain the associations. Using retrospective and prospective data from the Health and Retirement Study (n = 23,289), the results show that non-Hispanic (NH) blacks have significantly higher rates of marital instability, greater numbers of health-risk factors, and substantially higher rates of stroke compared with NH whites. Contrary to the cumulative disadvantage hypothesis, findings from discrete-time-hazard models show that the effects of marital history are more pronounced for NH whites than for NH blacks. Risks for stroke were significantly higher in NH whites who were currently divorced, remarried, and widowed, as well as in those with a history of divorce or widowhood, compared with NH whites who were continuously married. In NH blacks, risks for stroke were elevated only in those who had either never married or had been widowed—with no significant risks attributable to divorce. The potential mechanisms underlying the associations are assessed, and the implications of the findings are discussed.

Married, unmarried, divorced, and widowed and the risk of stroke

“…This association is also evidenced by other studies 2,11,12,[22][23][24] and points to a healthier lifestyle associated with marriage as a likely cause of the lower risk of stroke. Nonetheless, there seems to be sufficient evidence for assuming that marriage is the superior form of living arrangement when it comes to risk of stroke.…”

“…In studies from USA 11,12 with adjustments similar to those in our study, the never-married and widowed but not the TA B L E 1 Number of person-years, incident events, and incidence of stroke by marital status divorced had higher risk of stroke in one study 11 while in another 12 risks of stroke were higher in persons who were currently divorced, remarried, and widowed. In studies from USA 11,12 with adjustments similar to those in our study, the never-married and widowed but not the TA B L E 1 Number of person-years, incident events, and incidence of stroke by marital status divorced had higher risk of stroke in one study 11 while in another 12 risks of stroke were higher in persons who were currently divorced, remarried, and widowed.…”

“…Incidence of stroke was lower among unmarried 5 or unaffected by marital status 6 in some studies while in others the incidence was lower for married persons. 8,11,12 Based on the entire Danish population with 5.5 million inhabitants and 58 807 hospital admissions for a first stroke during the years 2003-2012, we studied risk of stroke and its association with marital status categories: married, unmarried, divorced, and widowed. Risk is consistently reported to be increased for widowed persons while being divorced or never-married has been associated with as well as without increased risk of stroke.…”

Marital history and survival after a heart attack

“…A second notable finding is that marital timing has no association with survival after a heart attack. Other studies have demonstrated significant risks associated with early marriage and disease incidence (Dupre 2016; Zhang and Hayward, 2006); however, this study suggests that marriage timing does not influence the likelihood of dying following the onset of a major cardiovascular event. Although more research is needed to further substantiate these results, this finding is consistent with demonstrating the importance of marital factors that are most proximate to the health event.…”

“…Divorce and widowhood also bring a decline in the availability of social and financial resources (Ross, Mirowsky, and Goldsteen, 1990; Wilmoth and Koso, 2002). Indeed, studies show that divorce and widowhood transitions increase a person’s risk of disease, disability, and death (Hemström, 1996; Pienta, Hayward, and Jenkins, 2000; Zick and Smith, 1991) and that repeated marital losses can be especially detrimental to health and well-being (Barret, 2000; Dupre, 2016; Marks and Lambert, 1998). …”