Cause-specific mortality by partnership status: simultaneous analysis using longitudinal data from England and Wales

Partnership Status, Health, and Mortality: Selection or Protection?

Married individuals have better health and lower mortality than nonmarried people. Studies show that when cohabitants are distinguished from other nonmarried groups, health differences between partnered and nonpartnered individuals become even more pronounced. Some researchers have argued that partnered individuals have better health and lower mortality because a partnership offers protective effects (protection); others have posited that partnered people have better health and lower mortality because healthy persons are more likely to form a union and less likely to dissolve it (selection). This study contributes to this debate by investigating health and mortality by partnership status in England and Wales and analyzing the causes of mortality differences. We use combined data from the British Household Panel Survey and the UK Household Longitudinal Study and apply a simultaneous-equations hazard model to control for observed and unobserved selection into partnerships. We develop a novel approach to identify frailty based on self-rated health. Our analysis shows that partnered individuals have significantly lower mortality than nonpartnered people. We observe some selection into and out of unions on unobserved health characteristics, but the mortality differences by partnership status persist. The study offers strong support for the marital protection hypothesis and extends it to nonmarital partnerships.

Union Status and Disability Pension

A lot is known about the association between marital status and mortality, and some of these studies have included data on cohabitation. Studies on the association with health problems, rather than mortality, are often based on self-reported health outcomes, and results from these studies are mixed. As cohabitation is now widespread, more studies that include data on cohabitation are needed. We use Norwegian register data that include detailed information about union status and all cases of disability pensioning from 2005 to 2016. We employ Cox regression analysis and a within-family design in order to control for hard to measure childhood characteristics. Compared to the married, the cohabiting have a somewhat higher risk of receiving disability pension due to mental disorders, and for men also due to physical disorders. Receipt of disability pension is most common among the never married, especially for men. The association between union status and disability pensioning is stronger for mental than for physical disorders.

Mental health benefits of cohabitation and marriage: A longitudinal analysis of Norwegian register data

The aim is to examine how mental health is affected by cohabitation and marriage. Individual fixed-effects models are estimated from Norwegian register data containing information about consultations with a general practitioner because of mental health conditions in 2006-19. Mental health, as indicated by annual number of consultations, improves over several years before cohabitation. For those marrying their cohabiting partner, there is a weak further reduction in consultations until the wedding, but no decline afterwards. In other words, formalization of the union does not seem to confer additional mental health benefits. However, marriage may be considered a marker of favourable earlier development in mental health. In contrast, there is further improvement after direct marriage, as well as stronger improvement over the years just preceding direct marriage. Patterns are quite similar for women and men. Overall, the results suggest that the mental health benefits of cohabitation and marriage are similar.Supplementary material for this article is available at: https://dx.doi.org/10.1080/00324728.2022.2063933. Note: numbers in brackets refer to supplementary notes that can be found at the end of the supplementary material.

Effect of Marital Status on Depression and Mortality among Patients with Chronic Kidney Disease from National Health and Nutrition Examination Survey 2005-2014

BACKGROUND

The relationship between marital status and CKD is rarely studied. We aimed to explore the effect of marital status on the depression and mortality of patients with CKD.

METHODS

The data sources came from the NHANES database during 2005-2014 and 3,865 participants were included in this study. We used logistic regression models to examine the relationship between marital status and depression of CKD patients. The Cox proportional hazard models were used to evaluate the association between marital status and mortality of CKD patients.

RESULTS

In terms of depression in CKD patients, unmarried patients had a worse situation than married patients. Meanwhile, after adjusting the covariables, unmarried patients had increased risk of depression (OR = 1.26, 95% CI: 1.01-1.57) compared with married CKD patients, especially in males (OR = 1.45, 95% CI: 1.02-2.06) and patients with more than college education level (OR = 12.4, 95% CI: 3.75-41.02). There was a significant relationship between marital status and mortality of general CKD patients (HR = 1.36, 95% CI: 1.17-1.58). Moreover, marriage showed a protective effect against death among male patients, patients with school graduate or less and more than college educational level, patients with high income, and patients in different estimated glomerular filtration rate groups.

CONCLUSIONS

The use of large numbers of participants has revealed the effect of marital status on CKD patients. Unmarried ones had a higher risk of depression than married ones among CKD patients. Meanwhile, the risk of death was higher in unmarried ones than married ones among CKD patients in this study.

A global test for competing risks survival analysis

Standard tests for the Cox model, such as the likelihood ratio test or the Wald test, do not perform well in situations, where the number of covariates is substantially higher than the number of observed events. This issue is perpetuated in competing risks settings, where the number of observed occurrences for each event type is usually rather small. Yet, appropriate testing methodology for competing risks survival analysis with few events per variable is missing. In this article, we show how to extend the global test for survival by Goeman et al. to competing risks and multistate models[Per journal style, abstracts should not have reference citations. Therefore, can you kindly delete this reference citation.]. Conducting detailed simulation studies, we show that both for type I error control and for power, the novel test outperforms the likelihood ratio test and the Wald test based on the cause-specific hazards model in settings where the number of events is small compared to the number of covariates. The benefit of the global tests for competing risks survival analysis and multistate models is further demonstrated in real data examples of cancer patients from the European Society for Blood and Marrow Transplantation.

Alcohol-related mortality following the loss of a child: a register-based follow-up study from Norway

OBJECTIVES

The death of one's child is one of the most stressful events a person can experience. Research has shown that bereaved parents have a higher mortality than non-bereaved parents. This increased mortality might partly be caused directly by long-term stress. However, changes in health behaviour such as an increase in alcohol consumption might also play a role. This study examines the association between losing a child and alcohol-related mortality. In addition to Cox regression models using data covering the entire Norwegian adult population, we employ sibling fixed-effect models in order to partly control for genes and childhood experiences that might be associated with both losing a child and alcohol-related mortality.

DESIGN

A follow-up study between 1986 and 2014 based on Norwegian register data.

SETTING

Norway.

PARTICIPANTS

The entire Norwegian adult population.

PRIMARY OUTCOME MEASURE

Alcohol-related mortality.

RESULTS

An increased alcohol-related mortality was found among parents who had experienced the death of a child. The HR of alcohol-related mortality among those bereaved of a child was 1.59 (95% CI 1.48 to 1.71) compared with non-bereaved parents, for women 2.03 (95% CI 1.78 to 2.32) and for men 1.46 (95% CI 1.34 to 1.59). After including sibling fixed effects, the HR of alcohol-related mortality among parents who had lost a child was 1.30 (95% CI 1.03 to 1.64).

CONCLUSIONS

This study provides evidence of an elevated alcohol-related mortality among parents who have lost a child compared with non-bereaved parents. Although strongly attenuated, there is still an association when adjusting for genetic predisposition for alcohol problems as well as childhood environment using sibling fixed-effect models.

Marital status and 5-year mortality: A population-based prospective cohort study

OBJECTIVES

The aim was to investigate the association between baseline marital status and mortality using survival (Cox-regression) analysis.

STUDY DESIGN

This is a prospective cohort study.

METHODS

The public health survey by Scania in 2008 was linked to the Swedish cause of death register. This prospective cohort study includes 12,245 men and 14,969 women aged 18-80 years, and 538 men and 362 women of them died during the 5.3-year follow-up.

RESULTS

Unmarried, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than married/cohabitating men. For women, the HRRs of these groups did not significantly differ from those of the married/cohabitating reference group.

CONCLUSIONS

The results are in accordance with a previous study that only compared those living alone with those cohabitating.