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

Chi Yan Leung, Hsi Lan Huang, Sarah Krull Abe, Eiko Saito, Md Rashedul Islam, Md Shafiur Rahman, Ai Ikeda, Norie Sawada, Akiko Tamakoshi, Yu Tang Gao, Woon Puay Koh, Xiao Ou Shu, Ritsu Sakata, Ichiro Tsuji, Jeongseon Kim, Sue K. Park, Chisato Nagata, San Lin You, Jian Min Yuan, Myung Hee ShinWen Harn Pan, Shoichiro Tsugane, Takashi Kimura, Wanqing Wen, Hui Cai, Kotaro Ozasa, Sanae Matsuyama, Seiki Kanemura, Yumi Sugawara, Aesun Shin, Keiko Wada, Chien Jen Chen, Renwei Wang, Yoon Ok Ahn, Habibul Ahsan, Paolo Boffetta, Kee Seng Chia, Keitaro Matsuo, You Lin Qiao, Nathaniel Rothman, Wei Zheng, Daehee Kang, Manami Inoue

Research output: Contribution to journalArticlepeer-review

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Abstract

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..

Original languageEnglish
Pages (from-to)E2214181
JournalJAMA network open
DOIs
StateAccepted/In press - 2022
Externally publishedYes

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