TY - JOUR
T1 - Association of Marital Status With Total and Cause-Specific Mortality in Asia
AU - Leung, Chi Yan
AU - Huang, Hsi Lan
AU - Abe, Sarah Krull
AU - Saito, Eiko
AU - Islam, Md Rashedul
AU - Rahman, Md Shafiur
AU - Ikeda, Ai
AU - Sawada, Norie
AU - Tamakoshi, Akiko
AU - Gao, Yu Tang
AU - Koh, Woon Puay
AU - Shu, Xiao Ou
AU - Sakata, Ritsu
AU - Tsuji, Ichiro
AU - Kim, Jeongseon
AU - Park, Sue K.
AU - Nagata, Chisato
AU - You, San Lin
AU - Yuan, Jian Min
AU - Shin, Myung Hee
AU - Pan, Wen Harn
AU - Tsugane, Shoichiro
AU - Kimura, Takashi
AU - Wen, Wanqing
AU - Cai, Hui
AU - Ozasa, Kotaro
AU - Matsuyama, Sanae
AU - Kanemura, Seiki
AU - Sugawara, Yumi
AU - Shin, Aesun
AU - Wada, Keiko
AU - Chen, Chien Jen
AU - Wang, Renwei
AU - Ahn, Yoon Ok
AU - Ahsan, Habibul
AU - Boffetta, Paolo
AU - Chia, Kee Seng
AU - Matsuo, Keitaro
AU - Qiao, You Lin
AU - Rothman, Nathaniel
AU - Zheng, Wei
AU - Kang, Daehee
AU - Inoue, Manami
N1 - Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/5
Y1 - 2022/5
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85131179479
U2 - 10.1001/jamanetworkopen.2022.14181
DO - 10.1001/jamanetworkopen.2022.14181
M3 - Article
C2 - 35639382
AN - SCOPUS:85131179479
SN - 2574-3805
VL - 5
JO - JAMA Network Open
JF - JAMA Network Open
IS - 5
M1 - e2214181
ER -