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- Title
Association of Marital Status With Total and Cause-Specific Mortality in Asia.
- Authors
Leung, Chi Yan; Huang, Hsi-Lan; Abe, Sarah Krull; Saito, Eiko; Islam, Md. Rashedul; Rahman, Md. Shafiur; Ikeda, Ai; Sawada, Norie; Tamakoshi, Akiko; Gao, Yu-Tang; Koh, Woon-Puay; Shu, Xiao-Ou; Sakata, Ritsu; Tsuji, Ichiro; Kim, Jeongseon; Park, Sue K.; Nagata, Chisato; You, San-Lin; Yuan, Jian-Min; Shin, Myung-Hee
- Abstract
Key Points: Question: What is the association between marital status and mortality outcomes in Asian populations? Findings: In this cohort study of 623 140 individuals from 16 prospective cohorts participating in the Asia Cohort Consortium, a pooled analysis found that being unmarried was associated with a higher risk of all-cause and cause-specific mortality, compared with being married. The excess risks of death persisted across health conditions and were particularly pronounced among men and people younger than 65 years. Meaning: These findings highlight that being unmarried substantially increases the risk of death among Asian individuals. This cohort study examines the association of marital status with total and cause-specific mortality in Asian populations. 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 623 140 participants (326 397 women [52.4%] and 296 743 men [47.6%]; mean [SD] age, 53.7 [10.2] years; mean [SD] follow-up time, 15.5 [6.1] years), 123 264 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.
- Subjects
ASIA; CAUSES of death; CONFIDENCE intervals; DESCRIPTIVE statistics; MARITAL status; LONGITUDINAL method; PROPORTIONAL hazards models; EPIDEMIOLOGICAL research
- Publication
JAMA Network Open, 2022, Vol 5, Issue 6, pe2214181
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.14181