Biological Sciences Division
Published May 31, 2022 | Version v1
Journal article Open

Association of Marital Status With Total and Cause-Specific Mortality in Asia

Creators

  • 1. National Cancer Institute for Cancer Control
  • 2. National Center for Global Health and Medicine
  • 3. University of Tokyo
  • 4. Hamamatsu University
  • 5. Juntendo University
  • 6. Hokkaido University
  • 7. Shanghai Cancer Institute
  • 8. National University of Singapore
  • 9. Vanderbilt University Medical Center
  • 10. Radiation Effects Research Foundation
  • 11. Tohoku University
  • 12. National Cancer Center
  • 13. Seoul National University
  • 14. Gifu University
  • 15. Fu Jen Catholic University
  • 16. University of Pittsburgh
  • 17. Sungkyunkwan University
  • 18. Academia Sinica
  • 19. University of Chicago

Description

Importance: Marital status has been shown to be associated with mortality, but evidence in Asian populations is limited.

Objective: To examine the association of marital status with total and cause-specific mortality.

Design, Setting, and Participants: This cohort study included individual participant data from 16 prospective studies in the Asia Cohort Consortium conducted between 1963 and 2015. Asian participants with complete information on marital and vital status were included. Study-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards model and then pooled using a random-effects meta-analysis. The analysis began in February 2021 and ended in August 2021. Exposures: Marital status.

Main Outcomes and Measures: All-cause and cause-specific mortality.

Results: Of 623140 participants (326397 women [52.4%] and 296743 men [47.6%]; mean [SD] age, 53.7 [10.2] years; mean [SD] follow-up time, 15.5 [6.1] years), 123264 deaths were ascertained. Compared with married individuals, those who were unmarried had pooled HRs of 1.15 (95% CI, 1.07-1.24) for total mortality, 1.12 (95% CI, 1.03-1.22) for cerebrovascular disease mortality, 1.20 (95% CI, 1.09-1.31) for coronary heart disease mortality, 1.17 (95% CI, 1.07-1.28) for circulatory system diseases mortality, 1.06 (95% CI, 1.01-1.11) for cancer mortality, 1.14 (95% CI, 1.05-1.23) for respiratory diseases mortality, and 1.19 (95% CI, 1.05-1.34) for external causes of death. Positive associations with total mortality were also observed for those who were single (HR, 1.62; 95% CI, 1.41-1.86), separated (HR, 1.35; 95% CI, 1.13-1.61), divorced (HR, 1.38; 95% CI, 1.13-1.69), and widowed (HR, 1.09; 95% CI, 1.04-1.13). In subgroup analyses, the positive association persisted across baseline health conditions, and the risk of death was more pronounced among men or people younger than 65 years.

Conclusions and Relevance: This large pooled cohort study of individual participant data provides strong evidence that being unmarried, as well as belonging to the unmarried subcategories, was positively associated with total and cause-specific mortality. Investment of targeted social support services might need to be considered in light of the mortality differences between married and unmarried individuals.

Notes

Due to the large number of authors, only the first 20 and the University of Chicago authors are included on the above author list. Please download the article for the complete list of authors.

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Additional details

Identifiers

DOI
10.1001/jamanetworkopen.2022.14181
Other
oai:uchicago.tind.io:11206

Funding

National Institutes of Health
R01CA0403092
National Institutes of Health
R01CA144034
National Institutes of Health
UM1CA182876
National Cancer Institute
UM1 CA173640
National Cancer Institute
R37 CA070867
National Cancer Institute
UM1 CA182910
National Cancer Center
Research and Development Fund
National Cancer Center
Research and Development Fund
National Cancer Center
Research and Development Fund
Ministry of Health Labour and Welfare
Grant-in-Aid for Cancer Research
Ministry of Education, Culture, Sports, Science and Technology
United States Department of Energy
Ministry of Science and ICT
2016R1A2B4014552
National Cancer Center
1510040
National Cancer Center
1810090
National Cancer Center
1910330
Ministry of Health and Welfare
0520160-1
Unknown funder
Singapore Chinese Health Study
National Cancer Institute
R01CA144034
National Cancer Institute
UM1CA182876
Ministry of Health and Welfare
Department of Health
DOH80-27
Department of Health
DOH81-021
Department of Health
DOH8202-1027
Department of Health
H83-TD-01
Department of Health
DOH84-TD-006

UChicago Information

Division(s)
Biological Sciences Division
Department(s)
Public Health Sciences