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Pellón-Elexpuru I, Van Dijk R, Van der Valk I, Martínez-Pampliega A, Molleda A, Cormenzana S. Divorce and physical health: A three-level meta-analysis. Soc Sci Med 2024; 352:117005. [PMID: 38824838 DOI: 10.1016/j.socscimed.2024.117005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024]
Abstract
Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.
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Affiliation(s)
| | - Rianne Van Dijk
- Youth&Family Department, Utrecht University, Utrecht, the Netherlands
| | - Inge Van der Valk
- Youth&Family Department, Utrecht University, Utrecht, the Netherlands
| | | | - Asier Molleda
- Deusto FamilyPsych, Deusto University, Bilbao, Spain
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Skorochod R, Fainzilber-Goldman Y, Shumsky M, Wolf Y. What Role does Marital Status Play in the Outcome of Abdominoplasties? A Single-Surgeon Experience With 712 Cases. Aesthetic Plast Surg 2024; 48:2142-2146. [PMID: 38424306 DOI: 10.1007/s00266-024-03898-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Marital status is a commonly reported demographic variable in scientific literature. Numerous reports suggested difference in the medical outcomes of patients when stratified based on marital status. Although many reports suggested that married patient exhibit improved survival when compared to their counterparts, other reports could not replicate similar conclusions. PURPOSE determine whether marital status plays a role in the postoperative outcomes of elective abdominoplasty patients. METHODS The medical records of all abdominoplasty patients operated by a single surgeon over the course of 20 years were reviewed. Information regarding the preoperative state of patients, surgical procedure, and postoperative outcomes was evaluated in respect to the patients marital status. RESULTS Seven-hundred and twelve patients were included in this study, of whom 516 (%) were married. No difference in preoperative characteristics, medical background, surgical procedure or concomitant surgeries was found. Analysis of adverse events did not demonstrate a statistically significant association with marital status. Additionally, when all unwed patients were grouped together, the results did not differ. CONCLUSION Marital status does not play a critical role in the postoperative outcomes of patients undergoing elective abdominoplasties for cosmetic indications. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ron Skorochod
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hillel Yaffe Medical Center, Hadera, Israel.
- Ruth and Bruce Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yifat Fainzilber-Goldman
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Merav Shumsky
- Ruth and Bruce Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yoram Wolf
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Kulu H, Mikolai J, Franke S. Partnership Status, Health, and Mortality: Selection or Protection? Demography 2024; 61:189-207. [PMID: 38226410 DOI: 10.1215/00703370-11147861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
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.
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Affiliation(s)
- Hill Kulu
- Centre for Population Change, and School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Júlia Mikolai
- Centre for Population Change, and School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Sebastian Franke
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
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Lindström M, Pirouzifard M, Rosvall M, Fridh M. Marital status and cause-specific mortality: A population-based prospective cohort study in southern Sweden. Prev Med Rep 2024; 37:102542. [PMID: 38169998 PMCID: PMC10758969 DOI: 10.1016/j.pmedr.2023.102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
The aim was to investigate associations between marital status and mortality with a prospective cohort study design. A public health survey including adults aged 18-80 was conducted with a postal questionnaire in southern Sweden in 2008 (54.1% participation). The survey formed a baseline that was linked to 8.3-year follow-up all-cause, cardiovascular (CVD), cancer and other cause mortality. The present investigation entails 14,750 participants aged 45-80. Associations between marital status and mortality were investigated with multiple Cox-regression analyses. A 72.8% prevalence of respondents were married/cohabitating, 9.1% never married, 12.2% divorced and 5.9% widows/widowers. Marital status was associated with age, sex, socioeconomic status (SES) by occupation, country of birth, chronic disease, Body Mass Index (BMI), health-related behaviors and generalized trust covariates. Never married/single, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than the reference category married/cohabitating men throughout the multiple analyses. For men, CVD and other cause mortality showed similar significant results, but not cancer. No significant associations were displayed for women in the multiple analyses. Associations between marital status and mortality are stronger among men than women. Associations between marital status and cancer mortality are not statistically significant with low effect measures throughout the multiple analyses among both men and women.
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Affiliation(s)
- Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
| | - Mirnabi Pirouzifard
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
- Department of Community Medicine and Public Health, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Sweden
| | - Maria Fridh
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
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Matsukura H, Yamaoka Y, Matsuyama Y, Kondo K, Fujiwara T. Association between adverse childhood experiences and marital status among Japanese older adults. CHILD ABUSE & NEGLECT 2023; 144:106340. [PMID: 37467673 DOI: 10.1016/j.chiabu.2023.106340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/19/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Marital status is a well-known social determinant of health. Adverse childhood experiences (ACEs) affect attachment, critical to establishing and maintaining intimate relationships, such as marital status. OBJECTIVE This study examined the association between ACEs and marital status among older Japanese adults. PARTICIPANTS AND SETTING This research used data from a nationwide population-based study among functionally independent people aged 65 and above in Japan. METHODS ACEs were assessed by self-reported questionnaires on the following experiences before 18 years old: parental death, parental divorce, parental mental disease, exposure to intimate partner violence, physical abuse, psychological neglect, psychological abuse, and poverty. Marital status was asked as currently having a spouse (including common-law marriage), widowed, divorced, or unmarried. Associations between the total number of ACEs and marital status were analyzed by multinomial logistic regression. RESULTS Three or more ACEs showed higher risks of being widowed, divorced, or unmarried. Psychological neglect led to higher divorce risks among males (RRR, 95%CI = 1.41, 1.13-1.76) and females (RRR, 95%CI = 1.56, 1.28-1.89). Childhood poverty showed higher risks of unmarried among males (RRR, 95%CI = 1.25, 1.02-1.53) and females (RRR, 95%CI = 1.41, 1.18-1.69). Association between ACEs and divorce risks showed gender differences (RRR, 95%CI of having three or more ACEs in males: 2.19, 1.66-2.90; in females: 3.45, 2.71-4.38; p for interaction = 0.034). CONCLUSIONS ACEs showed higher risks of being widowed, divorced, and unmarried among older Japanese people. Policy to tackle ACEs and research investigating how ACEs, attachment, and relationship quality influence marital status are required to promote well-being in later life.
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Affiliation(s)
- Hanayo Matsukura
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Yusuke Matsuyama
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage Ward, Chiba 263-8522, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu City, Aichi 474-8511, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan.
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Vo CQ, Samuelsen PJ, Sommerseth HL, Wisløff T, Wilsgaard T, Eggen AE. Comparing the sociodemographic characteristics of participants and non-participants in the population-based Tromsø Study. BMC Public Health 2023; 23:994. [PMID: 37248482 PMCID: PMC10226228 DOI: 10.1186/s12889-023-15928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Differences in the sociodemographic characteristics of participants and non-participants in population-based studies may introduce bias and reduce the generalizability of research findings. This study aimed to compare the sociodemographic characteristics of participants and non-participants of the seventh survey of the Tromsø Study (Tromsø7, 2015-16), a population-based health survey. METHODS A total of 32,591 individuals were invited to Tromsø7. We compared the sociodemographic characteristics of participants and non-participants by linking the Tromsø7 invitation file to Statistics Norway, and explored the association between these characteristics and participation using logistic regression. Furthermore, we created a geographical socioeconomic status (area SES) index (low-SES, medium-SES, and high-SES area) based on individual educational level, individual income, total household income, and residential ownership status. We then mapped the relationship between area SES and participation in Tromsø7. RESULTS Men, people aged 40-49 and 80-89 years, those who were unmarried, widowed, separated/divorced, born outside of Norway, had lower education, had lower income, were residential renters, and lived in a low-SES area had a lower probability of participation in Tromsø7. CONCLUSIONS Sociodemographic differences in participation must be considered to avoid biased estimates in research based on population-based studies, especially when the relationship between SES and health is being explored. Particular attention should be paid to the recruitment of groups with lower SES to population-based studies.
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Affiliation(s)
- Chi Quynh Vo
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.
| | - Per-Jostein Samuelsen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), University Hospital of North Norway, Tromsø, Norway
| | - Hilde Leikny Sommerseth
- The Norwegian Historical Data Centre, Department of Archaeology, History, Religious Studies and Theology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
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Downward P, Rasciute S, Kumar H. Mental health and satisfaction with partners: a longitudinal analysis in the UK. BMC Psychol 2022; 10:15. [PMID: 35086553 PMCID: PMC8793196 DOI: 10.1186/s40359-022-00723-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current UK health policy stresses treating health as an asset to underpin and promote a more inclusive and productive society. The quality of personal relationships is essential for overall quality of life. The social determinants of health (SDH) literature shows that poor mental health and well-being are linked to weaker personal and social connections for individuals, families, and society. The causal impact that mental health has on satisfaction with partners is less understood but requires investigation. METHODS The causal relationship between mental health and satisfaction with partners is examined drawing on the United Kingdom's British Household Panel Survey from 1991 to 2008. A total sample of 9,024 individuals in dyadic couples comprising 42,464 observations was analysed using fixed-effects and instrumental variable fixed-effects panel data estimation. RESULTS Lower mental health is associated with a lower satisfaction with partners. However, some causal evidence of lower mental health reducing satisfaction with partners is present for males. DISCUSSION For females, relationship satisfaction is more likely to influence mental health. For males there is a potential 'vicious circle' between satisfaction with partners and mental health. CONCLUSIONS Investment in mental health provision can improve satisfaction with partners which in turn will further enhance health and well-being.
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Affiliation(s)
- Paul Downward
- School of Sport, Exercise and Health Sciences, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK.
| | - Simona Rasciute
- School of Business and Economics, Loughborough University, Ashby Road, Loughborough, LE11 3TU, UK
| | - Harish Kumar
- Department of Economics, Policy and International Business, Manchester Metropolitan University, Manchester, M15 6BH, UK
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Specific features of the oldest old from the Longevity Blue Zones in Ikaria and Sardinia. Mech Ageing Dev 2021; 198:111543. [PMID: 34265327 DOI: 10.1016/j.mad.2021.111543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/17/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Human longevity may be found in single individuals as well as in the population as a whole ("population longevity"). Longevity Blue Zones (LBZs), which are areas with an unusually high number of oldest old, have been identified in Sardinia and the Greek island of Ikaria. We compared the lifestyle, health status and some genetic markers of the LBZ populations with those of reference populations from Italy and Greece; the data were extracted from the GEHA database. In the LBZs, the proportion of individuals who never married or were married and still living with their spouse was significantly greater. Nonagenarians males and females with a high self‒perception of optimism and/or a high score for self-rated health were also found in larger proportions in LBZs. Among the variables with lower frequency were the proportion of the widowed, the percentage of subjects who had suffered a stroke and the frequency of Apoε4 and Apoε2 and the TT genotype of FOXO3A gene. Compared to behavioral and health indicators, the impact of genetic factors might be relatively less important in the LBZs. Nevertheless, further research is needed to identify potential epigenetic traits that might play a predominant role due to the interaction between genetics and the human and physical environments.
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Identification of risk groups for mental disorders, headache and oral behaviors in adults during the COVID-19 pandemic. Sci Rep 2021; 11:10964. [PMID: 34040132 PMCID: PMC8155093 DOI: 10.1038/s41598-021-90566-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
The dramatically changing situation during COVID-19 pandemic, is anticipated to provoke psycho-emotional disturbances and somatization arising from the current epidemiological situation that will become a significant problem for global and regional healthcare systems. The aim of this study was to identify the predictors, risk factors and factors associated with mental disorders, headache and potentially stress-modulated parafunctional oral behaviors among the adult residents of North America and Europe as indirect health effects of the COVID-19 pandemic. This may help limit the long-term effects of this and future global pandemic crises. The data were collected from 1642 respondents using an online survey. The results demonstrated increased levels of anxiety, depression, headache and parafunctional oral behaviors during the COVID-19 pandemic in both North American and European residents. The results of this study facilitated the definition of the group most predicted to experience the aforementioned secondary effects of the pandemic. This group included females younger than 28.5 years old, especially those who were single, less well educated and living in Europe. In case of this and other global crises this will allow faster defining the most vulnerable groups and providing rapid and more targeted intervention.
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Du Bois SN, Kannout L, Ramos SD. Examining partnership-health associations among full-service sex workers. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.1896697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Steve N. Du Bois
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Lynn Kannout
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Stephen D. Ramos
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Rodu B, Plurphanswat N. Mortality among male cigar and cigarette smokers in the USA. Harm Reduct J 2021; 18:7. [PMID: 33413424 PMCID: PMC7789747 DOI: 10.1186/s12954-020-00446-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Cigars and cigarettes are both smoked, but much less is known about the former’s long-term health effects, due to its low prevalence and infrequent collection of cigar information in national surveys. Purpose We conducted a follow-up mortality study of cigar-smoking men age 40–79 years in National Health Interview Surveys (NHIS). Methods We used pooled NHIS files linked to the National Death Index to obtain follow-up from year of interview to year of death or December 31, 2015. We developed categories of cigarette and cigar smoking that accommodate dual and former use of both products. We used Cox proportional hazards models, adjusted for age, race/ethnicity, marital status, education, income and region to estimate hazard ratios (HRs, 95% confidence intervals, CI) for mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, chronic lower respiratory diseases and two mutually exclusive categories: smoking-related and other diseases. Results There were 14,657 deaths from all causes, including 3426 never tobacco users, 3276 exclusive cigarette smokers and 176 exclusive cigar users. The latter had no statistically significant evidence of increased mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, smoking-related diseases or other causes. In contrast, the mortality experience of dual users of cigars and cigarettes and cigar smokers who formerly used cigarettes is similar to exclusive cigarette smokers. Conclusions This study provides evidence that male cigar smokers age 40 + years had elevated mortality risks. However, after accounting for cigarette smoking and other confounding variables, we found significantly increased mortality only among dual and former users of cigarettes.
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Affiliation(s)
- Brad Rodu
- James Graham Brown Cancer Center, University of Louisville, 505 South Hancock Street, Louisville, KY, 40202, USA. .,Department of Medicine, School of Medicine, University of Louisville, Louisville, USA.
| | - Nantaporn Plurphanswat
- James Graham Brown Cancer Center, University of Louisville, 505 South Hancock Street, Louisville, KY, 40202, USA
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Barker AR, Joynt Maddox KE, Peters E, Huang K, Politi MC. Predicting Future Utilization Using Self-Reported Health and Health Conditions in a Longitudinal Cohort Study: Implications for Health Insurance Decision Support. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211064118. [PMID: 34919462 PMCID: PMC8695746 DOI: 10.1177/00469580211064118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Decision support techniques and online algorithms aim to help individuals predict costs
and facilitate their choice of health insurance coverage. Self-reported health status
(SHS), whereby patients rate their own health, could improve cost-prediction estimates
without requiring individuals to share personal health information or know about
undiagnosed conditions. We compared the predictive accuracy of several models: (1) SHS
only, (2) a “basic” model adding health-related variables, and (3) a “full” model adding
measures of healthcare access. The Medical Expenditure Panel Survey was used to predict
2015 health expenditures from 2014 data. Relative performance was assessed by comparing
adjusted-R2 values and by reporting the predictive accuracy of the models for
a new cohort (2015–2016 data). In the SHS-only model, those with better SHS were less
likely to incur expenditures. However, after accounting for health variables, those with
better SHS were more likely to incur expenses. In the full model, SHS was no longer
predictive of incurring expenses. Variables indicating better access to care were
associated with higher likelihood of spending and higher spending. The full model
(R2 = 0.290) performed slightly better than the basic model
(R2 = 0.240), but neither performed well at the upper tail
of the cost distribution. While our SHS-based models perform well in the aggregate,
predicting population-level risk well, they are not sufficiently accurate to guide
individuals’ insurance shopping decisions in all cases. Policies that rely heavily on
health insurance consumers making individually optimal choices cannot assume that decision
tools can accurately anticipate high costs.
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Affiliation(s)
- Abigail R. Barker
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Karen E. Joynt Maddox
- Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA
| | - Kristine Huang
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Mary C. Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Lightner JS, Heinrich KM, Sanderson MR. A Population-Based Study of Coupling and Physical Activity by Sexual Orientation for Men. JOURNAL OF HOMOSEXUALITY 2020; 67:1533-1541. [PMID: 31020924 DOI: 10.1080/00918369.2019.1601435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research has suggested that men in relationships are more physically active than men who are single. This study provides a weighted analysis of physical activity by coupling status for men of different sexual orientations. Aggregated data from the United States 2013-2014 National Health Interview Survey were used to conduct multivariate logistic regression analyses. Compared to straight men (n = 29,926), gay men (n = 623) were less likely to be in a relationship (AOR 0.32, CI: 0.25-0.41). Coupled gay men did more physical activity than coupled straight men and were 1.62 (CI: 1.05-2.50) times more likely to be active, 1.67 (CI: 1.10-2.51) times more likely to be high active, 1.89 (CI: 1.24-2.89) times more likely to engage in muscle-strengthening activities, and 2.00 (CI: 1.28-3.11) times more likely to meet aerobic and muscle-strengthening recommendations. Coupling facilitates physical activity for men. However, more research is needed to help explore underlying mechanisms for differences by sexuality.
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Affiliation(s)
- Joseph S Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City , Kansas City, Missouri, USA
- Missouri Health Department , Kansas City, Missouri, USA
| | - Katie M Heinrich
- Department of Kinesiology, Kansas State University , Manhattan, Kansas, USA
| | - Matthew R Sanderson
- Department of Sociology, Anthropology, and Social Work, Kansas State University , Manhattan, Kansas, USA
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Brandão GR, Teixeira L, Araújo L, Paúl C, Ribeiro O. Self-medication in older European adults: Prevalence and predictive factors. Arch Gerontol Geriatr 2020; 91:104189. [PMID: 32717589 DOI: 10.1016/j.archger.2020.104189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors. DESIGN Cross-sectional study. SETTING Micro-data from the European Health Interview Survey (2006-2009) was used. PARTICIPANTS The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries. MEASUREMENTS The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor. RESULTS The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain). CONCLUSION Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives.
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Affiliation(s)
- Gabriela Rangel Brandão
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Universidade Federal de Ciências da Saúde de Porto Alegre. Porto Alegre, Brazil
| | - Laetitia Teixeira
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal.
| | - Lia Araújo
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal; Escola Superior de Educação, Instituto Politécnico de Viseu, Viseu, Portugal
| | - Constança Paúl
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal
| | - Oscar Ribeiro
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal; Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal
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Gender Differences in the Pattern of Socio-Demographics Relevant to Metabolic Syndrome Among Kenyan Adults with Central Obesity at a Mission Hospital in Nairobi, Kenya. High Blood Press Cardiovasc Prev 2020; 27:61-82. [PMID: 31981085 DOI: 10.1007/s40292-020-00360-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/07/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a risk factor for cardiovascular-related morbidity and mortality. Although the risk factors for MetS are well documented, differences in gender-based demographics among Kenyan adults with central obesity are lacking. AIM Determine gender differences in the pattern of socio-demographics relevant to metabolic syndrome among Kenyan adults with central obesity at a mission hospital, Nairobi. METHODS A cross-sectional baseline survey involving adults (N = 404) with central obesity aged 18-64 years, as part of a community-based lifestyle intervention study. Respondents were systematically sampled using the International Diabetes Federation definition for MetS. Lifestyle characteristics, anthropometric, clinical and biochemical markers were measured and analyzed using SPSS. RESULTS High (87.2%) MetS prevalence associated with advanced age in males (p < 0.001) and females (p = 0.002) was observed. MetS was likely among divorced/separated/widowed (p = 0.021) and high income males (p = 0.002) and females (p = 0.017) with high income. Unemployed males (p = 0.008) and females with tertiary education (p = 0.019) were less likely to have MetS. Advanced age was likely to lead to high blood pressure, fasting blood glucose and triglycerides (p < 0.05). Males were more likely (p = 0.026) to have raised triglycerides, while females (p < 0.001) had low high density lipoproteins. CONCLUSION A high prevalence of MetS associated with social and gender differences among Kenyan adults with central obesity. These underscore the need to look beyond the behavioral and biological risks and focus on every nuance of gender differences in addressing MetS and CVDs.
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Gugushvili A, Zhao Y, Bukodi E. Intergenerational educational mobility and smoking: a study of 20 European countries using diagonal reference models. Public Health 2020; 181:94-101. [PMID: 31981813 DOI: 10.1016/j.puhe.2019.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Intergenerational educational mobility can be particularly relevant for smoking because it implies moving from individuals' family background to a new position in the social hierarchy. Existing research, however, does not provide an answer as to how the process of mobility, per se, is associated with the likelihood of smoking. STUDY DESIGN We used cross-nationally comparable survey data for 20 countries collected within the health module of the European Social Survey in 2014. The analytical sample consisted of 22,336 respondents aged 25-64 years. METHODS Smoking was operationalized by daily and occasional smoking, while the intergenerational educational mobility variable was derived from a comparison of respondents' and their parents' highest levels of educational attainment. We employed diagonal reference models to examine the association of intergenerational educational mobility and smoking. RESULTS In the country- and age-adjusted analysis, intergenerational downward mobility was associated with odds ratios of 1.34 (CI95 1.07, 1.68) and 1.61 (CI95 1.34, 1.93) for smoking, respectively, among men and women. Intergenerational upward mobility, on the other hand, was negatively associated with smoking but only among women. CONCLUSION Our findings provide new evidence that the process of intergenerational educational mobility is associated with individuals' likelihood of smoking and that this effect cannot be explained by conventional covariates of smoking.
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Affiliation(s)
- A Gugushvili
- Department of Social Policy and Intervention and Nuffield College, University of Oxford, Nuffield College, New Road, Oxford OX1 1NF, UK; Department of Public Administration and Sociology, Erasmus School of Social and Behavioural Sciences, Erasmus University, Rotterdam, Postbus 1738, 3000 DR Rotterdam, the Netherlands
| | - Y Zhao
- Centre for Social Investigation, Nuffield College, University of Oxford, New Road, Oxford OX1 1NF, UK.
| | - E Bukodi
- Department of Social Policy and Intervention and Nuffield College, University of Oxford, Nuffield College, New Road, Oxford OX1 1NF, UK
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Kim A, Lee JA, Park HS. Health behaviors and illness according to marital status in middle-aged Koreans. J Public Health (Oxf) 2019; 40:e99-e106. [PMID: 30020525 DOI: 10.1093/pubmed/fdx071] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/06/2017] [Indexed: 11/13/2022] Open
Abstract
Background Marital status influences health and this association might differ by time and/or country. Divorce rates have increased abruptly in Korea. We investigated relationships between marital status and health behaviors and illness among middle-aged Koreans. Methods Data from the fifth Korean National Health and Nutrition Examination Survey 2010-12 was used. Participants were middle-aged (40-65 years) Koreans (3015 male and 4498 female) who had been married. Health behaviors and physical and mental health status were evaluated separately for each gender according to marital status (currently married versus separated, divorced or widowed) using logistic regression analyses adjusted for age, income level and region. Results About 5.4% of men and 13.0% of women lived without their spouses. Odd ratios (ORs) for smoking, binge drinking, inadequate sleep, hypertriglyceridemia and depression were significantly higher in participants not living with their spouses. ORs for non-participation in regular health examinations and cancer screenings, anemia, elevated alanine aminotransferase and suicidal ideation were significantly higher in men not living with their spouses. Conclusions Health behaviors and illness were significantly worse in middle-aged Koreans not living with their spouses. Men were more susceptible to poor health screening, nutritional deficiencies and mental illness. Preventive services are necessary to improve their health status.
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Affiliation(s)
- Areum Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olymphic-Ro 43-Gil, Songpa-gu, Seoul, South Korea
| | - Jung Ah Lee
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olymphic-Ro 43-Gil, Songpa-gu, Seoul, South Korea
| | - Hye Soon Park
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olymphic-Ro 43-Gil, Songpa-gu, Seoul, South Korea
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The Association Between Marital Status, Coronary Computed Tomography Imaging Biomarkers, and Mortality in a Lung Cancer Screening Population. J Thorac Imaging 2019; 35:204-209. [PMID: 31651690 DOI: 10.1097/rti.0000000000000457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to elucidate the impact of being unmarried on coronary computed tomography (CT) imaging biomarkers and mortality in a lung cancer screening population. MATERIALS AND METHODS In this retrospective case-control study, 5707 subjects (3777 married; mean age: 61.9±5.1 y and 1930 unmarried; mean age: 61.9±5.3 y) underwent low-dose CT as part of the National Lung Screening Trial (NLST). The median follow-up time was 6.5 (Q1-Q3: 5.6 to 6.9) years. Being unmarried was defined as never married, widowed, separated, or divorced. Being married was defined as married or living as married. Our primary endpoint was cardiovascular disease (CVD)-related death; our secondary endpoint was all-cause mortality. Coronary CT imaging biomarkers (calcium score, density, and volume) on low-dose chest CT scan were calculated using dedicated automatic software. Weighted Cox proportional-hazards regression was performed to examine the association between marital status and death. Kaplan-Meier curves were generated to visualize subject survival. RESULTS Being unmarried was significantly associated with an increased risk for CVD-related death (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.31-1.91) and all-cause mortality (HR: 1.39; 95% CI: 1.26-1.53), which remained significant even after adjusting for traditional cardiovascular risk factors (HR CVD death: 1.75; 1.44-2.12 and HR all-cause mortality: 1.58; 95% CI: 1.43-1.74) and coronary calcium score (HR CVD death: 1.58; 95% CI: 1.31-1.91 and HR all-cause mortality: 1.40; 95% CI: 1.27-1.54). CONCLUSIONS Being unmarried is associated with an increased CVD-related death and all-cause mortality mainly due to cardiovascular etiology. On the basis of this, marital status might be taken into consideration when assessing individuals' health status.
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Ahmad MI, Majeed CN, Chaudhary D, Dutta A, Jogu HR, Soliman EZ. Relation of Marital Status and QT Interval Prolongation (from the Third National Health and Nutrition Examination Survey). Am J Cardiol 2019; 124:211-215. [PMID: 31084996 DOI: 10.1016/j.amjcard.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/31/2019] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
Abstract
Although the link between marital status and mortality is well established, the pathophysiological basis is unclear. An investigation of the association of marital status with prolonged QT interval may highlight the underlying mechanism for poor outcomes associated with being unmarried. This analysis included 6,562 participants (mean age 58.6 years, 52% women, 50.1% non-Hispanic whites) without a history of cardiovascular disease from the Third National Health and Nutrition Examination Survey. QT was automatically measured from digital 12-lead electrocardiogram in a central reading center. Marital status was defined by self-report as married and unmarried (never married, divorced/separated or widowed). A multivariable logistic regression model was used to examine cross-sectional association between marital status and prolonged QT interval (≥450 ms in men, ≥460 ms in women). Compared with married, unmarried was associated with 46% higher odds of the prolonged QT interval (odds ratio [OR] 95% confidence interval [95% CI]: 1.46[1.16-1.83]). This association was stronger among men versus women (OR[95% CI]: 1.75[1.27-2.41] vs 1.26[0.92-1.73] respectively; interaction p value = 0.03) and in younger versus older participants (OR [95% CI]: 1.72[1.21-2.42] vs 1.40[1.05-1.88], respectively; interaction p value = 0.002). When the types of unmarried were compared to married, a dose-response relation with prolonged QT was observed with the highest odds in never married followed by divorced/separated, and then widowed. In conclusion, marital status is associated with a prolonged QT interval, especially among men and younger participants. Prolonged QT interval may indicate a biologic substrate through which social isolation defined by unmarried state increases the risk of poor outcomes in the future.
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Dhindsa DS, Khambhati J, Schultz WM, Tahhan AS, Quyyumi AA. Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med 2019; 30:215-220. [PMID: 31204239 DOI: 10.1016/j.tcm.2019.05.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/28/2019] [Accepted: 05/28/2019] [Indexed: 11/15/2022]
Abstract
The national burden of cardiovascular disease (CVD) continues to impose significant risk of morbidity, mortality and increased costs. While traditional risk factors have been well-established, the evolving role of non-traditional risk factors, including socioeconomic and psychosocial factors, is increasingly being recognized. Several studies have acknowledged an association between marital status and the presence of CVD and its associated adverse outcomes. Across multiple U.S. and international cohorts, patients who are unmarried, including those who are divorced, separated, widowed, or never married, have an increased rate of adverse cardiovascular events when compared to their married counterparts. Some studies suggest that marriage may have a more protective role for men compared to women. Furthermore, dissatisfaction in a marriage and marriage quality have significant impact on cardiovascular risk. Psychosocial and socioeconomic factors, as well as other acute stressors, may contribute to the association between marital status and CVD outcomes, but the underlying mechanisms are not completely clear. Further investigation is required to identify potential targets for intervention and to determine whether more aggressive targeting of standard anti-atherosclerotic therapies can favorably impact CVD risk in unmarried patients.
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Affiliation(s)
- Devinder Singh Dhindsa
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Jay Khambhati
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - William M Schultz
- Division of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Ayman Samman Tahhan
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Resaerch Institute, Emory University School of Medicine, Atlanta, GA, United States.
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Lindström M, Rosvall M. Marital status and 5-year mortality: A population-based prospective cohort study. Public Health 2019; 170:45-48. [PMID: 30928612 DOI: 10.1016/j.puhe.2019.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/12/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- M Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden.
| | - M Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden; Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden
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Du Bois SN, Legate N, Kendall AD. Examining Partnership-Health Associations Among Lesbian Women and Gay Men Using Population-Level Data. LGBT Health 2019; 6:23-33. [PMID: 30650053 DOI: 10.1089/lgbt.2018.0158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim was to provide the first broad assessment of partnership-health associations across partnership statuses among lesbian and gay individuals. METHODS Using population-level data from the 2016 U.S. Behavioral Risk Factor Surveillance System, specifically the 26 states/territories that assessed sexual orientation and gender identity, we ran analyses of covariance and logistic regressions to compare lesbian and gay individuals (N = 2963) of different partnership statuses in general health, physical health and health conditions, mental health, health behaviors, and health care access/utilization domains. RESULTS All omnibus and logistic regression models were significant (p < 0.001). Follow-up pairwise comparisons of mean differences across partnership groups revealed that in at least one variable in the general health, mental health, health behaviors, and health care access/utilization domains, married lesbian and gay individuals reported the best health, followed by partnered, single, and then divorced, separated, and widowed lesbian and gay individuals (p < 0.001). Exceptions included variables in the physical health and health conditions domain, the health behaviors of smoking and heavy drinking, and ever having an HIV test. When stratifying by sex, for both gay men and lesbian women being married or partnered related to the best health in at least one variable in each health domain, and in the majority of all outcome variables. CONCLUSION This article provides the first evidence for partnership-health associations among gay and lesbian individuals based on a large-scale, multidomain test of population-level data. Future research could examine temporal links between same-sex marriage legislation and health outcomes among sexual minority individuals.
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Affiliation(s)
- Steve N Du Bois
- 1 Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Nicole Legate
- 1 Department of Psychology, Illinois Institute of Technology, Chicago, Illinois
| | - Ashley D Kendall
- 2 Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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Alvi MA, Wahood W, Huang AE, Kerezoudis P, Lachance DH, Bydon M. Beyond Science: Effect of Marital Status and Socioeconomic Index on Outcomes of Spinal Cord Tumors: Analysis From a National Cancer Registry. World Neurosurg 2019; 121:e333-e343. [DOI: 10.1016/j.wneu.2018.09.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/26/2022]
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Social aggravation: Understanding the complex role of social relationships on stress and health-relevant physiology. Int J Psychophysiol 2018; 131:13-23. [DOI: 10.1016/j.ijpsycho.2018.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022]
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Jung YA, Kang LL, Kim HN, Park HK, Hwang HS, Park KY. Relationship between Marital Status and Metabolic Syndrome in Korean Middle-Aged Women: The Sixth Korea National Health and Nutrition Examination Survey (2013-2014). Korean J Fam Med 2018; 39:307-312. [PMID: 29976034 PMCID: PMC6166117 DOI: 10.4082/kjfm.17.0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/31/2017] [Indexed: 11/07/2022] Open
Abstract
Background This study aimed to investigate the relationship between marital status and the incidence of metabolic syndrome in Korean middle-aged women. Methods Based on data from the sixth Korea National Health and Nutrition Examination Survey (2013–2014), 3,225 women aged 40–69 years were subjected to the analysis. Marital status was categorized as married, unmarried, separated, widowed, or divorced. The odds ratios (ORs) for metabolic syndrome were calculated based on marital status. After adjustment for age, income level, education level, alcohol intake, smoking status, leisure physical activity, menopause status, daily calories, and fat intake, changes in the OR for metabolic syndrome based on marital status were examined by multivariate logistic regression analysis. Results The OR for metabolic syndrome in the widowed group to the married group was 4.818 (95% confidence interval [CI], 3.861–6.002; P<0.001) and that after adjustment of age, economic level, education level, alcohol intake, smoking status, physical activity, menopause status, total daily calories, and fat intake was 2.141 (CI, 1.432–3.199; P<0.001), both of which were statistically significant. The OR for metabolic syndrome in the unmarried group to the married group was 0.246 (CI, 0.141–0.431; P<0.001) after adjustment of all components. On the contrary, the ORs of the separated group and the divorced group to the married group were not significant. Conclusion In comparison with the married middle-aged group, the widowed middle-aged group tended to have a higher risk of metabolic syndrome, which is speculated to be related to socioeconomic factors and health behavior.
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Affiliation(s)
- Young-Ah Jung
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Li-Ly Kang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ha-Nui Kim
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
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Franke S, Kulu H. Cause-specific mortality by partnership status: simultaneous analysis using longitudinal data from England and Wales. J Epidemiol Community Health 2018; 72:838-844. [DOI: 10.1136/jech-2017-210339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 05/14/2018] [Indexed: 11/04/2022]
Abstract
BackgroundThis paper examines cause-specific mortality by partnership status. Although non-marital cohabitation has spread rapidly in industrialised countries, only a few studies have investigated mortality by partnership status and no recent study has investigated cause-specific mortality by partnership status.MethodsWe use data from the Office for National Statistics Longitudinal Study and apply competing risks survival models.ResultsThe simultaneous analysis shows that married individuals have lower mortality than non-married from circulatory, respiratory, digestive, alcohol and accident related causes of deaths, but not from cancer. The analysis by partnership status reveals that once we distinguish premarital and postmarital cohabitants from other non-married groups, the differences between partnered and non-partnered individuals become even more pronounced for all causes of death; this is largely due to similar cause-specific mortality levels between married and cohabiting individuals.ConclusionsWith declining marriage rates and the spread of cohabitation and separation, a distinction between partnered and non-partnered individuals is critical to understanding whether and how having a partner shapes the individuals’ health behaviour and mortality. The cause-specific analysis supports both the importance of selection into partnership and the protective effect of living with someone together.
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Franke S, Kulu H. Mortality Differences by Partnership Status in England and Wales: The Effect of Living Arrangements or Health Selection? EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2018; 34:87-118. [PMID: 30976244 PMCID: PMC6241022 DOI: 10.1007/s10680-017-9423-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
This article investigates the relationship between partnership status and mortality in England and Wales. Using data from the Office for National Statistics Longitudinal Study for the period between 2001 and 2011, we examine whether married people have lower mortality levels than unmarried individuals; whether individuals who cohabit have mortality levels similar to those of married or single persons; and how much the fact that married couples live with someone rather than alone explains their low mortality. Our analysis shows first that married individuals have lower mortality than unmarried persons. Second, men and women in premarital unions exhibit mortality levels similar to those of married men and women, whereas mortality levels are elevated for post-marital cohabitants. Third, controlling for household size and the presence of children reduces mortality differences between married and unmarried non-partnered individuals, but significant differences persist. The study supports both protection and selection theory. The increase in mortality differences by age between never-married cohabitants and married couples is likely a sign of the long-term accumulation of health and wealth benefits of marriage. Similar mortality levels of cohabiting and married couples at younger ages suggest that healthier individuals are more likely to find a partner.
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Affiliation(s)
- Sebastian Franke
- Department of Geography and Planning, School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, L69 7ZT UK
| | - Hill Kulu
- School of Geography and Sustainable Development, University of St Andrews, Irvine Building, North Street, St Andrews, KY16 9AL UK
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Schultz WM, Hayek SS, Samman Tahhan A, Ko YA, Sandesara P, Awad M, Mohammed KH, Patel K, Yuan M, Zheng S, Topel ML, Hartsfield J, Bhimani R, Varghese T, Kim JH, Shaw L, Wilson P, Vaccarino V, Quyyumi AA. Marital Status and Outcomes in Patients With Cardiovascular Disease. J Am Heart Assoc 2017; 6:e005890. [PMID: 29263033 PMCID: PMC5778993 DOI: 10.1161/jaha.117.005890] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Being unmarried is associated with decreased survival in the general population. Whether married, divorced, separated, widowed, or never-married status affects outcomes in patients with cardiovascular disease has not been well characterized. METHODS AND RESULTS A prospective cohort (inception period 2003-2015) of 6051 patients (mean age 63 years, 64% male, 23% black) undergoing cardiac catheterization for suspected or confirmed coronary artery disease was followed for a median of 3.7 years (interquartile range: 1.7-6.7 years). Marital status was stratified as married (n=4088) versus unmarried (n=1963), which included those who were never married (n=451), divorced or separated (n=842), or widowed (n=670). The relationship between marital status and primary outcome of cardiovascular death and myocardial infarction was examined using Cox regression models adjusted for clinical characteristics. There were 1085 (18%) deaths from all causes, 688 (11%) cardiovascular-related deaths, and 272 (4.5%) incident myocardial infarction events. Compared with married participants, being unmarried was associated with higher risk of all-cause mortality (hazard ratio [HR]: 1.24; 95% confidence interval [CI], 1.06-1.47), cardiovascular death (HR: 1.45; 95% CI, 1.18-1.78), and cardiovascular death or myocardial infarction (HR: 1.52; 95% CI, 1.27-1.83). Compared with married participants, the increase in cardiovascular death or myocardial infarction was similar for the participants who were divorced or separated (HR: 1.41; 95% CI, 1.10-1.81), widowed (HR: 1.71; 95% CI, 1.32-2.20), or never married (HR: 1.40; 95% CI, 0.97-2.03). The findings persisted after adjustment for medications and other socioeconomic factors. CONCLUSIONS Marital status is independently associated with cardiovascular outcomes in patients with or at high risk of cardiovascular disease, with higher mortality in the unmarried population. The mechanisms responsible for this increased risk require further study.
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Affiliation(s)
- William M Schultz
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ayman Samman Tahhan
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University, Atlanta, GA
| | - Pratik Sandesara
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Mosaab Awad
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Kareem H Mohammed
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Keyur Patel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Michael Yuan
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
| | - Shuai Zheng
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Matthew L Topel
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Joy Hartsfield
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Ravila Bhimani
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Tina Varghese
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jonathan H Kim
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Leslee Shaw
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Peter Wilson
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health Emory University, Atlanta, GA
- American Institutes for Research, Washington, DC
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute Emory University School of Medicine, Atlanta, GA
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Bennett-Britton I, Teyhan A, Macleod J, Sattar N, Davey Smith G, Ben-Shlomo Y. Changes in marital quality over 6 years and its association with cardiovascular disease risk factors in men: findings from the ALSPAC prospective cohort study. J Epidemiol Community Health 2017; 71:1094-1100. [PMID: 28993473 PMCID: PMC5847094 DOI: 10.1136/jech-2017-209178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Marital relationship quality has been suggested to have independent effects on cardiovascular health outcomes. This study investigates the association between changes in marital relationship quality and cardiovascular disease (CVD) risk factors in men. METHODS We used data from The Avon Longitudinal Study of Parents and Children, a prospective birth cohort study (Bristol, UK). Our baseline sample was restricted to married study fathers with baseline relationship and covariate data (n=2496). We restricted final analysis (n=620) to those with complete outcome, exposure and covariate data, who were married and confirmed the study child's father at 6.4 years and 18.8 years after baseline. Relationship quality was measured at baseline and 6.4 years and operationalised as consistently good, improving, deteriorating or consistently poor relationship. We measured CVD risk factors of blood pressure, resting heart rate, body mass index, lipid profile and fasting glucose at 18.8 years after baseline. RESULTS Improving relationships were associated with lower levels of low-density lipoprotein (-0.25 mmol/L, 95% CI -0.46 to -0.03) and relative reduction of body mass index (-1.07 kg/m2, 95% CI -1.73 to -0.42) compared with consistently good relationships, adjusting for confounders. Weaker associations were found between improving relationships and total cholesterol (-0.24 mmol/L, 95% CI -0.48 to 0.00) and diastolic blood pressure (-2.24 mm Hg, 95% CI -4.59 to +0.11). Deteriorating relationships were associated with worsening diastolic blood pressure (+2.74 mm Hg, 95% CI 0.50 to 4.98). CONCLUSIONS Improvement and deterioration of longitudinal relationship quality appears associated with respectively positive and negative associations with a range of CVD risk factors.
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Affiliation(s)
| | - Alison Teyhan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Macleod
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Control Measures and Health Effects of Air Pollution: A Survey among Public Transportation Commuters in Malaysia. SUSTAINABILITY 2017. [DOI: 10.3390/su9091616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Daoulah A, Al-kaabi S, Lotfi A, Al-Murayeh M, Nasseri SA, Ahmed W, Al-Otaibi SN, Alama MN, Elkhateeb OE, Plotkin AJ, Malak MM, Alshali K, Hamzi M, Al Khunein S, Abufayyah M, Alsheikh-Ali AA. Inter-ethnic marriages and severity of coronary artery disease: A multicenter study of Arabian Gulf States. World J Cardiol 2017; 9:371-377. [PMID: 28515856 PMCID: PMC5411972 DOI: 10.4330/wjc.v9.i4.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease (CAD) in men undergoing angiography.
METHODS We conducted a prospective multicenter, multi-ethnic, cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates, in which we used logistic regression analysis with and without adjustment for baseline differences.
RESULTS Data were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1st, 2013 to March 30th, 2014. Ethnicities of spouses were available only for male patients. Of those enrolled, 687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences, inter-ethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52 (95%CI: 0.33, 0.81)] or multi-vessel disease (MVD) [adjusted odds ratio 0.57 (95%CI: 0.37, 0.86)]. The adjusted association with left main disease showed a similar trend, but was not statistically significant [adjusted odds ratio 0.74 (95%CI: 0.41, 1.32)]. The association between inter-ethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives (P interaction > 0.05 for both).
CONCLUSION Among married men undergoing coronary angiography, inter-ethnic, as compared to intra-ethnic, marriage is associated with lower odds of significant CAD and MVD.
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Ralston K, Walsh D, Feng Z, Dibben C, McCartney G, O'Reilly D. Do differences in religious affiliation explain high levels of excess mortality in the UK? J Epidemiol Community Health 2017; 71:493-498. [PMID: 28270504 DOI: 10.1136/jech-2016-208176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/20/2016] [Accepted: 02/11/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND High levels of mortality not explained by differences in socioeconomic status (SES) have been observed for Scotland and its largest city, Glasgow, compared with elsewhere in the UK. Previous cross-sectional research highlighted potentially relevant differences in social capital, including religious social capital (the benefits of social participation in organised religion). The aim of this study was to use longitudinal data to assess whether religious affiliation (as measured in UK censuses) attenuated the high levels of Scottish excess mortality. METHODS The study used the Scottish Longitudinal Study (SLS) and the ONS Longitudinal Study of England and Wales. Risk of all-cause mortality (2001-2010) was compared between residents aged 35 and 74 years of Scotland and England and Wales, and between Glasgow and Liverpool/Manchester, using Poisson regression. Models adjusted for age, gender, SES and religious affiliation. Similar country-based analyses were undertaken for suicide. RESULTS After adjustment for age, gender and SES, all-cause mortality was 9% higher in Scotland than in England and Wales, and 27% higher in Glasgow than in Liverpool or Manchester. Religious affiliation was notably lower across Scotland; but, its inclusion in the models did not attenuate the level of Scottish excess all-cause mortality, and only marginally lowered the differences in risk of suicide. CONCLUSIONS Differences in religious affiliation do not explain the higher mortality rates in Scotland compared with the rest of the UK. However, it is possible that other aspects of religion such as religiosity or religious participation which were not assessed here may still be important.
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Affiliation(s)
- Kevin Ralston
- National Centre for Research Methods, University of Edinburgh, Edinburgh, UK
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | - Zhiqiang Feng
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Dermot O'Reilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Daoulah A, Lotfi A, Al-Murayeh M, Al-kaabi S, Al-Faifi SM, Elkhateeb OE, Alama MN, Hersi AS, Dixon CM, Ahmed W, Al-Shehri M, Youssef A, Elimam AM, Abougalambou AS, Murad W, Alsheikh-Ali AA. Polygamy and Risk of Coronary Artery Disease in Men Undergoing Angiography: An Observational Study. Int J Vasc Med 2017; 2017:1925176. [PMID: 28250991 PMCID: PMC5303868 DOI: 10.1155/2017/1925176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 01/05/2017] [Indexed: 12/29/2022] Open
Abstract
Epidemiologic evidence suggests a link between psychosocial risk factors such as marital status and coronary artery disease (CAD). Polygamy (multiple concurrent wives) is a distinct marital status practiced in many countries in Asia and the Middle East, but its association with CAD is not well defined. We conducted a multicenter, observational study of consecutive patients undergoing coronary angiography during the period from April 1, 2013, to March 30, 2014. Of 1,068 enrolled patients, 687 were married men. Polygamy was reported in 32% of married men (1 wife: 68%, 2 wives: 19%, 3 wives: 10%, and 4 wives: 3%). When stratified by number of wives, significant baseline differences were observed in age, type of community (rural versus urban), prior coronary artery bypass grafting (CABG), and household income. After adjusting for baseline differences, there was a significant association between polygamy and CAD (adjusted OR 4.6 [95% CI 2.5, 8.3]), multivessel disease (MVD) (adjusted OR 2.6 [95% CI 1.8, 3.7]), and left main disease (LMD) (adjusted OR 3.5 [95% CI 2.1, 5.9]). Findings were consistent when the number of wives was analyzed as a continuous variable. In conclusion, among married men undergoing coronary angiography for clinical indications, polygamy is associated with the presence of significant CAD, MVD, and LMD.
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Affiliation(s)
- Amin Daoulah
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Mushabab Al-Murayeh
- Cardiovascular Department, Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia
| | - Salem Al-kaabi
- Cardiovascular Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Salem M. Al-Faifi
- Section of Pulmonology, Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Osama E. Elkhateeb
- Cardiac Center, King Abdullah Medical City in Holy Capital, Makkah, Saudi Arabia
| | - Mohamed N. Alama
- Cardiovascular Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ahmad S. Hersi
- Cardiovascular Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ciaran M. Dixon
- Emergency Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Waleed Ahmed
- Section of Infectious Disease, Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Mohamed Al-Shehri
- Cardiovascular Department, Armed Forces Hospital, Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ali Youssef
- Cardiovascular Department, Suez Canal University, Ismailia, Egypt
| | | | | | - Waheed Murad
- Cardiovascular Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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Peltonen R, Ho JY, Elo IT, Martikainen P. Contribution of smoking-attributable mortality to life expectancy differences by marital status among Finnish men and women, 1971-2010. DEMOGRAPHIC RESEARCH 2017; 36:255-280. [PMID: 28127255 PMCID: PMC5260839 DOI: 10.4054/demres.2017.36.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Smoking is known to vary by marital status, but little is known about its contribution to marital status differences in longevity. We examined the changing contribution of smoking to mortality differences between married and never married, divorced or widowed Finnish men and women aged 50 years and above in 1971-2010. DATA AND METHODS The data sets cover all persons permanently living in Finland in the census years 1970, 1975 through 2000 and 2005 with a five-year mortality follow-up. Smoking-attributable mortality was estimated using an indirect method that uses lung cancer mortality as an indicator for the impact of smoking on mortality from all other causes. RESULTS Life expectancy differences between the married and the other marital status groups increased rapidly over the 40-year study period because of the particularly rapid decline in mortality among married individuals. In 1971-1975 37-48% of life expectancy differences between married and divorced or widowed men were attributable to smoking, and this contribution declined to 11-18% by 2006-2010. Among women, in 1971-1975 up to 16% of life expectancy differences by marital status were due to smoking, and the contribution of smoking increased over time to 10-29% in 2006-2010. CONCLUSIONS In recent decades smoking has left large but decreasing imprints on marital status differences in longevity between married and previously married men, and small but increasing imprints on these differences among women. Over time the contribution of other factors, such as increasing material disadvantage or alcohol use, may have increased.
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Affiliation(s)
- Riina Peltonen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Jessica Y Ho
- Sanford School of Public Policy and Population Research Institute, Duke University, Durham, NC, USA
| | - Irma T Elo
- Department of Sociology, Population Aging Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland; Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden; Max Planck Institute for Demographic Research, Rostock, Germany
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Keenan K, Ploubidis GB, Silverwood RJ, Grundy E. Life-course partnership history and midlife health behaviours in a population-based birth cohort. J Epidemiol Community Health 2016; 71:232-238. [PMID: 27655423 PMCID: PMC5318654 DOI: 10.1136/jech-2015-207051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/02/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
Abstract
Background Marital and partnership history is strongly associated with health in midlife and later life. However, the role of health behaviours as an explanatory mechanism remains unclear. The aim of this study was to investigate prospective associations between life-course partnership trajectories (taking into account timing, non-marital cohabitation, remarriage and marital transitions) and health behaviours measured in midlife. Methods We analysed data from the British National Child Development Study, a prospective cohort study that includes all people born in 1 week of March 1958 (N=10 226). This study included men and women with prospective data on partnership history from age 23 to 42–44 and health behaviours collected at ages 42–46 (2000–2004). Latent class analysis was used to derive longitudinal trajectories of partnership history. We used multivariable regression models to estimate the association between midlife health behaviours and partnership trajectory, adjusting for various early and young adult characteristics. Results After adjustment for a range of potential selection factors in childhood and early adulthood, we found that problem drinking, heavy drinking and smoking were more common in men and women who experienced divorce or who had never married or cohabited. Women who married later had a lower prevalence of smoking and were less likely to be overweight than those who married earlier. Overall marriage was associated with a higher body mass index. Individuals who never married or cohabited spent less time exercising. Conclusions Some aspects of partnership history such as remaining unpartnered and experiencing divorce are associated with more smoking and drinking in midlife, whereas marriage is associated with midlife weight gain. Despite these offsetting influences, differences in health behaviours probably account for much of the association between partnership trajectories and health found in previous studies.
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Affiliation(s)
- Katherine Keenan
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - George B Ploubidis
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Richard J Silverwood
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Grundy
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J. Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence 2016; 10:1547-59. [PMID: 27574404 PMCID: PMC4990387 DOI: 10.2147/ppa.s103649] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adhering to weight loss interventions is difficult for many people. The majority of those who are overweight or obese and attempt to lose weight are simply not successful. The objectives of this study were 1) to quantify overall adherence rates for various weight loss interventions and 2) to provide pooled estimates for factors associated with improved adherence to weight loss interventions. METHODS We performed a systematic literature review and meta-analysis of all studies published between January 2004 and August 2015 that reviewed weight loss intervention adherence. RESULTS After applying inclusion and exclusion criteria and checking the methodological quality, 27 studies were included in the meta-analysis. The overall adherence rate was 60.5% (95% confidence interval [CI] 53.6-67.2). The following three main variables were found to impact adherence: 1) supervised attendance programs had higher adherence rates than those with no supervision (rate ratio [RR] 1.65; 95% CI 1.54-1.77); 2) interventions that offered social support had higher adherence than those without social support (RR 1.29; 95% CI 1.24-1.34); and 3) dietary intervention alone had higher adherence than exercise programs alone (RR 1.27; 95% CI 1.19-1.35). CONCLUSION A substantial proportion of people do not adhere to weight loss interventions. Programs supervising attendance, offering social support, and focusing on dietary modification have better adherence than interventions not supervising attendance, not offering social support, and focusing exclusively on exercise.
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Affiliation(s)
| | | | | | - Marla Rogers
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Suicide in married couples in Sweden: Is the risk greater in same-sex couples? Eur J Epidemiol 2016; 31:685-90. [PMID: 27168192 DOI: 10.1007/s10654-016-0154-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on Sweden's extensively linked databases, to investigate whether, among married individuals, same-sex marriage is associated with suicide. Using a population-based register design, we analyzed suicide risk among same-sex married women and men (n = 6456), as compared to different-sex married women and men (n = 1181723) in Sweden. We selected all newly partnered or married individuals in the intervening time between 1/1/1996 and 12/31/2009 and followed them with regard to suicide until 12/31/2011. Multivariate Poisson regression was used to calculate adjusted incidence risk ratios (IRR) with 95 % confidence intervals (CI). The risk of suicide was higher among same-sex married individuals as compared to different-sex married individuals (IRR 2.7, 95 % CI 1.5-4.8), after adjustment for time at risk and socioeconomic confounding. Sex-stratified analyses showed a tentatively elevated risk for same-sex married women (IRR 2.5, 95 % CI 0.8-7.7) as compared to different-sex married women. Among same-sex married men the suicide risk was nearly three-fold greater as compared to different-sex married (IRR 2.895 % CI 1.5-5.5). This holds true also after adjustment for HIV status. Even in a country with a comparatively tolerant climate regarding homosexuality such as Sweden, same-sex married individuals evidence a higher risk for suicide than other married individuals.
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Cervellin G, Rastelli G. The clinics of acute coronary syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:191. [PMID: 27294087 PMCID: PMC4885904 DOI: 10.21037/atm.2016.05.10] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 02/26/2016] [Indexed: 01/24/2023]
Abstract
Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt.
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Living arrangements and marital status: a register-based study of survival of older adults in Belgium at the beginning of the 21st century. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15001002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACTBeing married reduces the mortality risk of older persons. More generally, living arrangements that include co-residence with a source of support and a close care-giver are associated with a lower mortality risk. We build a detailed typology of private and collective living arrangements, including marital status, and check its association with mortality risks, controlling for health status. Using administrative data from the population register, we identify the living arrangement of all individuals aged 65 years and over living in Belgium as at 1 January 2002, and their survival during the year 2002. Data on health status are extracted from the 2001 census. We use binary logistic regression with the probability to die as outcome and living arrangement, health, age and gender as covariates. Our results show that mortality is more closely associated with actual living arrangements than with marital status. This association is age and gender-specific and remains even at very old ages. Living with a spouse is confirmed to be beneficial for survival but in older age living alone becomes more favourable. Of all living arrangements, older persons living in religious communities experience the lowest mortality risk whereas those living in nursing homes experience the highest risk.
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Sbarra DA, Law RW, Portley RM. Divorce and Death: A Meta-Analysis and Research Agenda for Clinical, Social, and Health Psychology. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 6:454-74. [PMID: 26168197 DOI: 10.1177/1745691611414724] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Divorce is a relatively common stressful life event that is purported to increase risk for all-cause mortality. One problem in the literature on divorce and health is that it is fragmented and spread across many disciplines; most prospective studies of mortality are based in epidemiology and sociology, whereas most mechanistic studies are based in psychology. This review integrates research on divorce and death via meta-analysis and outlines a research agenda for better understanding the potential mechanisms linking marital dissolution and risk for all-cause mortality. Random effects meta-analysis with a sample of 32 prospective studies (involving more than 6.5 million people, 160,000 deaths, and over 755,000 divorces in 11 different countries) revealed a significant increase in risk for early death among separated/divorced adults in comparison to their married counterparts. Men and younger adults evidenced significantly greater risk for early death following marital separation/divorce than did women and older adults. Quantification of the overall effect size linking marital separation/divorce to risk for early death reveals a number of important research questions, and this article discusses what remains to be learned about four plausible mechanisms of action: social selection, resource disruptions, changes in health behaviors, and chronic psychological distress.
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Living arrangements as determinants of myocardial infarction incidence and survival: A prospective register study of over 300,000 Finnish men and women. Soc Sci Med 2015; 133:93-100. [DOI: 10.1016/j.socscimed.2015.03.054] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Unraveling the relation between marital status and prognosis among myocardial infarction survivors: Impact of being widowed on mortality. Int J Cardiol 2015; 185:141-3. [DOI: 10.1016/j.ijcard.2015.03.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/07/2015] [Indexed: 12/14/2022]
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Henriksen RE, Torsheim T, Thuen F. Relationship satisfaction reduces the risk of maternal infectious diseases in pregnancy: the Norwegian Mother and Child Cohort Study. PLoS One 2015; 10:e0116796. [PMID: 25608018 PMCID: PMC4301916 DOI: 10.1371/journal.pone.0116796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/16/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aims of this study were to explore the degree to which relationship satisfaction predicts the risk of infectious diseases during pregnancy and to examine whether relationship satisfaction moderates the association between stressful life events and the risk of infections. METHODS This was a prospective study based on data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Pregnant women (n = 67,244) completed questionnaires concerning relationship satisfaction and nine different categories of infectious diseases as well as socioeconomic characteristics and stressful life events. Associations between the predictor variables and the infectious diseases were assessed by logistic regression analyses. A multiple regression analysis was performed to assess a possible interaction of relationship satisfaction with stressful life events on the risk for infectious diseases. RESULTS After controlling for marital status, age, education, income, and stressful life events, high levels of relationship satisfaction at week 15 of gestation were found to predict a significantly lower risk for eight categories of infectious diseases at gestational weeks 17-30. No significant interaction effect was found between relationship satisfaction and stressful life events on the risk for infections.
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Affiliation(s)
| | - Torbjørn Torsheim
- Faculty of Psychology, Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Frode Thuen
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
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Uggla C, Mace R. Someone to live for: effects of partner and dependent children on preventable death in a population wide sample from Northern Ireland. EVOL HUM BEHAV 2015; 36:1-7. [PMID: 25593513 PMCID: PMC4286120 DOI: 10.1016/j.evolhumbehav.2014.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/22/2014] [Indexed: 01/30/2023]
Abstract
How to allocate resources between somatic maintenance and reproduction in a manner that maximizes inclusive fitness is a fundamental challenge for all organisms. Life history theory predicts that effort put into somatic maintenance (health) should vary with sex, mating and parenting status because men and women have different costs of reproduction, and because life transitions such as family formation alter the fitness payoffs from investing in current versus future reproduction. However, few tests of how such life history parameters influence behaviours closely linked to survival exist. Here we examine whether specific forms of preventable death (accidents/suicides, alcohol-related causes, and other preventable diseases) are predicted by marital status and dependent offspring in a modern developed context; that of Northern Ireland. We predict that men, non-partnered individuals and individuals who do not have dependent offspring will be at higher risk of preventable death. Running survival analyses on the entire adult population (aged 16-59, n = 927,134) controlling for socioeconomic position (SEP) and other potential confounds, we find that being single (compared to cohabiting/married) increases risk of accidental/suicide death for men (but not for women), whereas having dependent children is associated with lower risk of preventable mortality for women but less so for men. We also find that the protective effect of partners is larger for men with low SEP than for high SEP men. Findings support life history predictions and suggest that individuals respond to variation in fitness costs linked to their mating and parenting status.
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Affiliation(s)
- Caroline Uggla
- Department of Anthropology, University College London, UK
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45
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Kravdal Ø, Grundy E. Underuse of medication for circulatory disorders among unmarried women and men in Norway? BMC Pharmacol Toxicol 2014; 15:65. [PMID: 25420870 PMCID: PMC4280763 DOI: 10.1186/2050-6511-15-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/24/2014] [Indexed: 01/25/2023] Open
Abstract
Background It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. However, much remains to be known about the underlying mechanisms. Our objective was to examine marital status differences in the purchase of medication for circulatory diseases, and risk factors for them, which may indicate underuse of such medication by some marital status groups. Methods Using data from registers covering the entire Norwegian population, we analysed marital status differences in the purchase of medicine for eight circulatory disorders by people aged 50-79 in 2004-2008. These differences were compared with those in circulatory disease mortality during 2004-2007, considered as indicating probable differences in disease burden. Results The unmarried had 1.4-2.8 times higher mortality from the four types of circulatory diseases considered. However, the never-married in particular purchased less medicine for these diseases, or precursor risk factors of these diseases, primarily because of a low chance of making a first purchase. The picture was more mixed for the divorced and widowed. Both groups purchased less of some of these medicines than the married, but, especially in the case of the widowed, relatively more of other types of medicine. In contrast to the never-married, divorced and widowed people were as least as likely as the married to make a first purchase, but adherence rates thereafter, indicated by continuing purchases, were lower. Conclusion The most plausible interpretation of the findings is that compared with married people, especially the never-married more often have circulatory disorders that are undiagnosed or for which they for other reasons underuse medication. Inadequate use of these potentially very efficient medicines in such a large population group is a serious public health challenge which needs further investigation. It is possible that marital status differences in use of medicines for circulatory disorders combined with an increasing importance of these medicines have contributed to the widening marital status gap in mortality observed in several countries. This also requires further investigation.
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Kriegbaum M, Christensen U, Andersen PK, Osler M, Lund R. Does the association between broken partnership and first time myocardial infarction vary with time after break-up? Int J Epidemiol 2014; 42:1811-9. [PMID: 24415614 DOI: 10.1093/ije/dyt190] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Marriage is associated with lower risk of coronary heart disease, but it is unknown if the association depends on time since break-up with a partner. In this study we included both married and unmarried couples to study if the association between broken partnership (BP) and first time incident myocardial infarction (MI) changes with time since BP. METHODS Register study of the entire Danish population: the population was restricted to those aged 30 to 65 years with follow-up for incident MI between 1985 and 2006 with an annual record on each individual; in total 43 million records. The register data were used to identify MI events. Poisson regression was used to study associations between time since BP and MI adjusted for socio-demographic confounders and hospital admissions. Analyses were stratified by sex. RESULTS Compared with unexposed (no BP), the incidence rate ratio (IRR) of MI in men with BP in the same year was 0.97 [95% confidence interval (CI) 0.90-1.05], year before BP was 1.25 (95% CI 1.17-1.34), 2-3 years after BP was 1.12 (95% CI 1.06-1.18), 4-8 years after BP was 1.09 (95% CI 1.05-1.14) and 9+ years since BP was 1.09 (95% CI 1.05-1.12). In women, the IRR same year as BP was 1.45 (95% CI 1.26-1.66), the year after BP was 1.30 (95% CI 1.14-1.50), 2-3 years after BP was 1.26 (95% CI 1.13-1.39), 4-8 years after BP was 1.17 (95% CI 1.08-1.26) and 9+ years since BP was 1.24 (95% CI 1.17-1.32). CONCLUSIONS We found both a short-term elevated risk of first time MI following BP and a weaker long-term elevated risk, in both men and women.
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Affiliation(s)
- Margit Kriegbaum
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark and Glostrup University Hospital, Copenhagen, Denmark
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Shah NM, Thalib L, Al-Ateeqi A. Mortality differences according to marital status among men and women in Kuwait. ASIAN POPULATION STUDIES 2014. [DOI: 10.1080/17441730.2014.942944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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48
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Lipowicz A. Some evidence for health-related marriage selection. Am J Hum Biol 2014; 26:747-52. [PMID: 25065487 DOI: 10.1002/ajhb.22588] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/25/2014] [Accepted: 07/05/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Married people live longer and are healthier than unmarried people. This can be explained in terms of marriage protection and marriage selection. The aim of the present study was to examine the direct effect of marriage selection on health status. METHODS Data were collected from the archives of the Lower Silesian Medical Center (DOLMED) in Wrocław, Poland. The sample consisted of 2,265 adult (never married or currently married) men. Subjects were assigned to categories for selected variables, including age, level of education, military category upon conscription, height, hearing acuity, and visual acuity. Military category, objective data gathered upon military conscription at age 18, was used to assess initial health status. To identify any relationships between marital status and health status, generalized linear models with binomially distributed dependent variable were used. RESULTS The never-married subjects were more likely to have been assigned to lower military categories, which indicates that their health status at age 18 was inferior to those conscripts who would later marry. Hearing acuity and visual acuity were generally worse in never-married subjects than in married subjects. Never-married subjects were also more likely to be short and less likely to be tall. CONCLUSIONS The results provide evidence for direct health-related marriage selection in men between 25 and 60 years of age. Poor health status reduces the likelihood of marriage.
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Affiliation(s)
- Anna Lipowicz
- Polish Academy of Sciences, Unit of Anthropology, Ul. Podwale 75, 50-449, Wroclaw, Poland
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Does inclusion of education and marital status improve SCORE performance in central and eastern europe and former soviet union? findings from MONICA and HAPIEE cohorts. PLoS One 2014; 9:e94344. [PMID: 24714549 PMCID: PMC3979770 DOI: 10.1371/journal.pone.0094344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/12/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The SCORE scale predicts the 10-year risk of fatal atherosclerotic cardiovascular disease (CVD), based on conventional risk factors. The high-risk version of SCORE is recommended for Central and Eastern Europe and former Soviet Union (CEE/FSU), due to high CVD mortality rates in these countries. Given the pronounced social gradient in cardiovascular mortality in the region, it is important to consider social factors in the CVD risk prediction. We investigated whether adding education and marital status to SCORE benefits its prognostic performance in two sets of population-based CEE/FSU cohorts. METHODS The WHO MONICA (MONItoring of trends and determinants in CArdiovascular disease) cohorts from the Czech Republic, Poland (Warsaw and Tarnobrzeg), Lithuania (Kaunas), and Russia (Novosibirsk) were followed from the mid-1980s (577 atherosclerotic CVD deaths among 14,969 participants with non-missing data). The HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study follows Czech, Polish (Krakow), and Russian (Novosibirsk) cohorts from 2002-05 (395 atherosclerotic CVD deaths in 19,900 individuals with non-missing data). RESULTS In MONICA and HAPIEE, the high-risk SCORE ≥5% at baseline strongly and significantly predicted fatal CVD both before and after adjustment for education and marital status. After controlling for SCORE, lower education and non-married status were significantly associated with CVD mortality in some samples. SCORE extension by these additional risk factors only slightly improved indices of calibration and discrimination (integrated discrimination improvement <5% in men and ≤1% in women). CONCLUSION Extending SCORE by education and marital status failed to substantially improve its prognostic performance in population-based CEE/FSU cohorts.
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50
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Floud S, Balkwill A, Canoy D, Wright FL, Reeves GK, Green J, Beral V, Cairns BJ. Marital status and ischemic heart disease incidence and mortality in women: a large prospective study. BMC Med 2014; 12:42. [PMID: 24618083 PMCID: PMC4103700 DOI: 10.1186/1741-7015-12-42] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Being married has been associated with a lower mortality from ischemic heart disease (IHD) in men, but there is less evidence of an association for women, and it is unclear whether the associations with being married are similar for incident and for fatal IHD. We examined the relation between marital status and IHD incidence and mortality in the Million Women Study. METHODS A total of 734,626 women (mean age 60 years) without previous heart disease, stroke or cancer, were followed prospectively for hospital admissions and deaths. Adjusted relative risks (RRs) for IHD were calculated using Cox regression in women who were married or living with a partner versus women who were not. The role of 14 socio-economic, lifestyle and other potential confounding factors was investigated. RESULTS 81% of women reported being married or living with a partner and they were less likely to live in deprived areas, to smoke or be physically inactive, but had a higher alcohol intake than women who were not married or living with a partner. During 8.8 years of follow-up, 30,747 women had a first IHD event (hospital admission or death) and 2,148 died from IHD. Women who were married or living with a partner had a similar risk of a first IHD event as women who were not (RR = 0.99, 95% confidence interval (CI) 0.96 to 1.02), but a significantly lower risk of IHD mortality (RR = 0.72, 95% CI 0.66 to 0.80, P <0.0001). This lower risk of IHD death was evident both in women with and without a prior IHD hospital admission (respectively: RR = 0.72, 95% CI 0.60 to 0.85, P <0.0001, n = 683; and 0.70, 95% CI 0.62 to 0.78, P <0.0001, n = 1,465). These findings did not vary appreciably between women of different socio-economic groups or by lifestyle and other factors. CONCLUSIONS After adjustment for socioeconomic, lifestyle and other factors, women who were married or living with a partner had a similar risk of developing IHD but a substantially lower IHD mortality compared to women who were not married or living with a partner.
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Affiliation(s)
- Sarah Floud
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Angela Balkwill
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Dexter Canoy
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - F Lucy Wright
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Gillian K Reeves
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Jane Green
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, University of Oxford, Roosevelt Drive, Oxford OX3
7LF, UK
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