Marital and cohabitation status as predictors of mortality: a 10-year follow-up of an Italian elderly cohort

The relationship between mortality and marital status has long been recognized, but only a small number of investigations consider also the association with cohabitation status. Moreover, age and gender differences have not been sufficiently clarified. In addition, little is known on this matter about the Italian elderly population. The aim of this study is to examine differentials in survival with respect to marital status and cohabitation status in order to evaluate their possible predictive value on mortality of an Italian elderly cohort. This paper employs data from the Italian Longitudinal Study on Aging (ILSA), an extensive epidemiologic project on subjects aged 65-84 years. Of the 5376 individuals followed-up from 1992 to 2002, 1977 died, and 1492 were lost during follow-up period. The baseline interview was administered to 84% of the 5376 individuals and 65% of them underwent biological and instrumental examination. Relative risks of mortality for marital (married vs. non-married) and cohabitation (not living alone vs. living alone) categories are estimated through hazard ratios (HR), obtained by means of the Cox proportional hazards regression model, adjusting for age and several other potentially confounding variables. Non-married men (HR=1.25; 95% CI: 1.03-1.52) and those living alone (HR=1.42; 95% CI: 1.05-1.92) show a statistically significant increased mortality risk compared to their married or cohabiting counterparts. After age-adjustment, women's survival is influenced neither by marital status nor by cohabitation status. None of the other covariates significantly alters the observed differences in mortality, in either gender. Neither marital nor cohabitation status are independent predictors of mortality among Italian women 65+, while among men living alone is a predictor of mortality even stronger than not being married. These results suggest that Italian men benefit more than women from the protective effect of living with someone.     

Marital status and mortality in the elderly: a systematic review and meta-analysis

Although a relationship between marital status and mortality has long been recognized, no summary estimates of the strength of the association are available. A meta-analysis of cohort studies was conducted to produce an overall estimate of the excess mortality associated with being unmarried in aged individuals as well as to evaluate whether and to what degree the effect of marriage differs with respect to gender, geographical/cultural context, type of non-married condition and study methodological quality. All included studies were published after the year 1994, used multivariate analyses and were written in English. Pooling 53 independent comparisons, consisting of more than 250,000 elderly subjects, the overall relative risk (RR) for married versus non-married individuals (including widowed, divorced/separated and never married) was 0.88 (95% Confidence Interval: 0.85-0.91). This estimate did not vary by gender, study quality, or between Europe and North America. Compared to married individuals, the widowed had a RR of death of 1.11 (1.08-1.14), divorced/separated 1.16 (1.09-1.23), never married 1.11 (1.07-1.15). Although some evidence of publication bias was found, the overall estimate of the effect of marriage was robust to several statistical approaches and sensitivity analyses. When the overall meta-analysis was repeated with an extremely conservative approach and including eight non-significant comparisons, which were initially excluded because of data unavailable, the marriage protective influence remained significant, although the effect size was reduced (RR=0.94; 0.92-0.95). Despite some methodological and conceptual limitations, these findings might be important to support health care providers in identifying individuals "at risk" and could be integrated into the current programs of mortality risk estimation for the elderly.     

The association between gender,family status and mortality

Aim  To analyse marital and gender differentials in mortality.Subjects and methods  The causes of death in Germany were analyzed in detail to determine odds ratios (OR) for all causes and the four main causes of death.Results  Mortality rates were nearly twice as high for men as for women. Mortality rates for unmarried men were more than twice as high as those for married men (OR 2.43–2.50); the ORs for women were considerably lower (1.74 to 1.75). For men, the ORs were higher for those causes of death influenced by health-risk behaviour.Conclusion  In terms of health gains, marriage seems to be more beneficial to men than to women. Particularly for men, marriage provides stronger protection against causes of death that are related to health-risk behaviour (smoking, drinking, risky driving) and to unhealthy working conditions.

Marital status and smoking in Korea: the influence of gender and age

Few studies have examined the influence of marriage on health-related behavior in Asian populations. The present study examined the effect of marital status on smoking in Korea. Data from two rounds of a nationally representative survey (1999 and 2003) were analyzed (57,246 women and 52,769 men). Marital status-specific prevalence ratios for smoking were estimated using log binomial regression after adjusting for age, survey year, occupation and education level. Smoking prevalence declined with age for men, but rose for women. Smoking rates were higher for unmarried men and women compared to their married counterparts. However, the gap in smoking rates between unmarried and married women (especially younger women <45 years) was much greater than the gap between unmarried and married men. The study found that marital status had a stronger protective influence on smoking in women than men, which contrasts with the gender pattern reported previously in western studies. The findings suggest the influence of a culture which discourages married women from smoking, and "liberates" divorced women from cultural sanctions against smoking in marriage.     

QTc间期在扩张性心肌病中的临床意义

目的研究QTc间期在扩张型心肌病（DCM）患者中可能存在的临床意义。方法分析91例DCM患者和85例健康检查者心电图,分析其QTc间期的差异。91例DCM患者按QTc间期分为QTc间期〈450ms组和QTc间期／〉450ms组,比较左室舒张末内径（LVEDD）和左室射血分数（LVEF）的差异。结果与健康对照组比较,DCM患者QTc间期也明显增宽（454．88±4．67vs409．95±1．93,P〈0．05）。QTc间期I〉450ms组DCM患者相比于QTc间期〈450ms组,LVEDD明显增大（66．42±1．04vs61．95±1．10,P〈0．05）,LVEF明显降低（32．79±0．79Y．S35．72±0．69,P〈0．05）。结论DCM患者QTc间期有显著改变,QTc问期与LVEDD以及心功能有一定关系,可能对临床诊断、治疗选择以及判断预后有一定参考价值。     

Cross-level interaction between individual socioeconomic status and regional deprivation on overall survival after onset of ischemic stroke: National health insurance cohort sample data from 2002 to 2013

Introduction

The literature on stroke mortality and neighborhood effect is characterized by studies that are often Western society-oriented, with a lack of racial and cultural diversity. We estimated the effect of cross-level interaction between individual and regional socioeconomic status on the survival after onset of ischemic stroke.

Marital status, intergenerational co-residence and cardiovascular and all-cause mortality among middle-aged and older men and women during wartime in Beirut: gains and liabilities

Studies from the West have shown an increased risk of mortality with various indicators of social isolation. In this study, we examine associations of marital status and intergenerational co-residence with mortality in Lebanon, a country that suffered wars and atrocities for almost 16 years. Using data from a retrospective 10-year follow-up study (1984-1994) among 1567 adults aged 50 years and older in Beirut, cardiovascular disease and all-cause mortality rates (per 1000 person-years) were computed for men and women separately. Age-adjusted Mantel-Haenszel rate ratios (RR) and their 95% confidence intervals (CI) were estimated, and associations were examined using multivariate Poisson regression analysis. Most men (91.3%) were married at baseline, in contrast to only 55.4% of women. Compared to men, women were more likely to be living in one- and three-generation households and with a married child at baseline. While widowhood was associated with an increased risk of all-cause mortality among men only, being never married was associated with a higher CVD mortality risk among men and women. The presence of an adult married child was associated with a significantly higher mortality risk for men and women, even after adjusting for household socioeconomic indicators, marital status, lifestyle variables or pre-existing health-related conditions (hypertension, cholesterol, and diabetes) at baseline. The popular belief that co-residence with adult children reflects greater support networks and an avenue for old age security may not be a valid presumption in the Lebanese context during times of war.     

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

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.     

Marital status,gender, and depression: Analysis of the baseline survey of the Korean Longitudinal Study of Ageing (KLoSA)

Marital status is a robust predictor of health outcomes in Western populations. However, data from Asian cultures remain sparse, and some studies suggest marked gender differences in the health benefits of marriage among Asian populations. We investigated the influence of marital status on depressive symptoms in older adult Koreans. Data were obtained from a sample of adults aged 45 to 85 years (4016 men, 5003 women) who participated in the 2006 cross-sectional baseline survey of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured by the 10-item Center for Epidemiological Studies–Depression scale. A multiple regression model was used to examine the association between marital status and depressive symptoms, controlling for socioeconomic status, living arrangement, disability, and number of chronic diseases. In women aged 75 to 85 years, no significant differences were found between women who were married versus those who were widowed, divorced, or separated with regard to depressive symptoms. These findings were driven by increasing depressive symptoms among married women with age. Whereas divorced and widowed men in the sample reported higher rates of depressive symptoms than did married men, the difference between married vs. widowed/divorced women converged as they aged. This pattern of depressive symptoms by gender and life stage may reflect the distinctive influence of the Asian context on relations between men and women, such as traditional gender roles and patriarchal norms for older generation.     

The epidemiology of idiopathic dilated cardiomyopathy in a biracial community

An epidemiologic study of idiopathic dilated cardiomyopathy was carried out in order to identify possible risk factors for this often fatal cause of heart failure in young adults. Possible associations with black race and other genetic and environmental factors were examined by comparing newly diagnosed cases ascertained from four Baltimore hospitals (n = 95) with neighborhood controls (n = 95), matched on sex and 5-year age intervals. Matched and unmatched relative odds and conditional logistic regression coefficients were obtained to describe the associations. Statistically significant, independent associations were observed between idiopathic dilated cardiomyopathy and black race, low annual income, and history of asthma (p less than 0.05). The black predominance (relative odds = 2.7, 95% confidence interval 2.0-3.4) was not explained by income, alcohol consumption, cigarette usage, body mass index, hypertension, or asthma. A possible interactive effect was observed between black race and history of asthma and other atopic diseases. Thus, blacks, especially those with a history of hypersensitivity, may represent a high-risk subgroup in need of preventive care or early intervention.     

Effectiveness of a community organizing intervention on mortality and its equity among older residents in Japan: A JAGES quasi-experimental study

Interventions that involve key aspects of community organizing, such as quantitative community assessments and organizational partnership support for the community, may promote residents' health. We evaluated the effectiveness of this form of intervention on mortality and its variability across individual-level household equivalized income tertiles, comparing 52,858 residents aged 65 and above in 12 intervention municipalities to 39,006 residents in nine control municipalities in Japan. During 1,166 days of follow-up, the adjusted hazard ratio for cumulative mortality among men in the intervention municipalities was 0.92 (95% confidence interval: 0.86, 0.99) compared to those in the control group, with similar results being observed across all income levels. Active utilization of data to evaluate communities and building intersectoral partnerships might lower older male residents’ mortality risk, regardless of their income status.     

Marital status and gender differences in managing a chronic illness: the function of health-related social control

The attempts of social network members to regulate individuals' health behaviors, or health-related social control, is one mechanism by which social relationships influence health. Little is known, however, about whether this process varies in married versus unmarried individuals managing a chronic illness in which health behaviors are a key component. Researchers have proposed that social control attempts may have dual effects on recipients' well-being, such that improved health behaviors may occur at the cost of increased emotional distress. The current study accordingly sought to examine marital status differences in the sources, frequency, and responses to health-related social control in an ethnically diverse sample of 1477 patients with type 2 diabetes from southern California, USA. Results from two-way ANCOVAs revealed that married individuals reported their spouses most frequently as sources of social control, with unmarried women naming children and unmarried men naming friends/neighbors most frequently as sources of social control. Married men reported receiving social control most often, whereas unmarried men reported receiving social control least often. Regression analyses that examined behavioral and emotional responses to social control revealed that social control using persuasion was associated with better dietary behavior among married patients. Results also revealed a complex pattern of emotional responses, such that social control was associated with both appreciation and hostility, with the effect for appreciation most pronounced among women. Findings from this study highlight the importance of marital status and gender differences in social network members' involvement in the management of a chronic illness.     

Cooccurrence of lifestyle risk factors and the explanation of education inequalities in mortality: results from the GLOBE study

BACKGROUND: To investigate whether the cooccurrence of two lifestyle risk factors (smoking, excessive alcohol consumption, physical inactivity in leisure time) has an additional contribution to the explanation of education inequalities in mortality, over and above the contribution of single risk factors. METHODS: Prospective cohort study, 1991-1998, in the South East of the Netherlands. Participants were 16,980 men and women aged 15-74 years at baseline. RESULTS: Education differences in the cooccurrence of risk factors were of a similar magnitude as education inequalities seen for single risk factors. A significant (P = 0.04) interaction effect on mortality was found between smoking and physical inactivity. Adjustment for both smoking and inactivity reduced the mortality hazard ratio of the lowest level of education by 30% (from 1.66 to 1.46). Further adjustment for the interaction between the two risk factors did not change the hazard ratio significantly. CONCLUSION: The cooccurrence of lifestyle risk factors did not provide any additional contribution to the explanation of education inequalities in mortality, over and above that of single risk factors. However, because risk factors tend to cooccur and have a higher prevalence among lower-educated people, it is still useful to focus interventions on more than one risk factor.     

Area deprivation amplifies racial inequities in premature mortality: Analysis of 242,667 deaths in Washington State,USA 2011-15

Racial and socioeconomic inequalities in health are consistently reported, but less is known about the interplay between racial and deprivation-related inequities. We used geographically-localized data on all deaths recorded in Washington state 2011 to 2015 (n = 242,667 decedents) and multi-level regression models to examine premature (<65 years) mortality by race and neighborhood deprivation separately and in combination. White versus non-white inequities in premature mortality did not vary substantially with increasing levels of deprivation. However, most non-white races from deprived neighborhoods had odds of premature mortality between three and eight times that of more-affluent whites. These findings may reflect the compounding of disadvantage stemming from social and environmental risk factors.     

2012年中国新报告男男性行为HIV感染者随访1年婚姻行为情况分析

目的 分析我国男男性行为HIV感染者（MSM感染者）确证后婚姻及危险行为变化情况,为有针对性地开展干预,预防二代传播提供依据。方法 使用截至2012年12月31日的艾滋病网络直报病例报告卡和2013年12月31日艾滋病随访管理定时数据库,对2012年新报告MSM感染者的基本人口学特征、婚姻状况和高危行为及其变化情况进行分析。结果 2012年新报告MSM感染者中,66.1%（10 426/15 768）为未婚,69.6%（10 970/15 768）为高中及以上文化程度。2012年随访到的MSM感染者中,1年后有96.0%（14 451/15 049）仍接受随访,其安全性行为比例从首次随访前的67.7%（9 779/14 451）上升到91.1%（13 277/14 451）;发现感染HIV时已婚有配偶的MSM感染者中,64.1%在1年后仍维持有配偶状态;高中及以上文化程度（OR=1.540,95%CI：1.138～2.085）、职业为工人（OR=1.430,95%CI：1.131～1.808）、干部职员（OR=1.610,95%CI：1.236～2.098）和农民（OR=1.661,95%CI：1.214～2.271）相对于小学及以下文化程度和职业为商业服务的MSM感染者更易采取安全性行为。始终无配偶（OR=0.563,95%CI：0.439～0.722）、有配偶变无配偶（OR=0.624,95%CI：0.448～0.870）和无配偶变有配偶（OR=0.444,95%CI：0.288～0.687）较始终有配偶的MSM感染者更易发生危险性行为。结论 规范化的随访管理有助于MSM感染者采取安全性行为,随访过程中需针对无配偶/固定性伴、低文化程度、职业为商业服务的MSM感染者采取有效的干预措施,预防HIV的二代传播。     

Alcohol consumption and biological markers for alcoholism in idiopathic dilated cardiomyopathy: a case-controlled study.

The aim of this study was to compare alcohol consumption and biological markers for alcoholism in a population of 23 men (57 +/- 8 years) admitted to hospital with idiopathic dilated cardiomyopathy (DCM), and a control group of 46 men (54 +/- 8 years) with coronary artery disease, matched for age. The DCM group had a higher daily alcohol consumption (82 g/day vs. 30 g/day, P < 0.0002). This difference was greater for the consumption of wine (63 g/day in the DCM group vs. 24 g/day in the control group, P < 0.002). Duration of regular daily alcohol consumption was longer in DCM patients (34 years vs. 22 years, P < 0.01) as well as duration of heavy alcohol consumption (> 60 g/day) (25 years vs. 10 years, P < 0.001). Among the biological markers, only the serum levels of immunoglobulin A were significantly increased in the DCM group (3.7 g/l vs. 2.7 g/l, P < 0.03). In this French population, alcohol is strongly linked to DCM. Biological markers appear to be poor predictors of alcohol intoxication in this so-called 'idiopathic' myocardial disease.     

海南百岁老人营养状况对全因死亡影响的前瞻性队列研究

目的探讨海南百岁老人营养状况与全因死亡风险之间的关系。方法利用中国海南百岁老人队列研究2014-2021年调查数据, 本研究共纳入1 002名基线资料完整的海南百岁老人, 随访其生存与死亡结局。根据简易营养评估量表将百岁老人的营养状况分为营养良好(12～14分)、营养不良风险(8～11分)和营养不良(0～7分)3组。利用Kaplan-Meier曲线评估百岁老人的生存状况;利用Cox比例风险回归模型评估营养状况与全因死亡之间的关联。结果 2021年5月31日随访结束后, 共发现522名百岁老人死亡, 7年全因死亡率为52.10%(522/1 002)。与营养良好组相比, 营养不良导致的平均减寿为0.62年。生存分析显示, 营养不良组全因死亡率高于其他组(χ2=16.45, P<0.001)。多因素Cox比例风险回归分析结果显示, 与营养良好的百岁老人相比, 营养不良组全因死亡风险更高(HR=1.65, 95%CI:1.18～2.31)。亚组分析发现女性百岁老人该关联更为显著。结论营养不良与海南百岁老人高全因死亡风险相关, 提示应及时评估和关注百岁老人特别是女性老人营养状况对其健康长...