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Concept: Visual markers of marital status

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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.

Concepts: Marriage, Demography, Cardiovascular disease, Marital status, Visual markers of marital status

189

Being married is associated with healthier lifestyle behaviours and lower mortality and may reduce risk for dementia due to life-course factors. We conducted a systematic review and meta-analysis of studies of the association between marital status and the risk of developing dementia.

Concepts: Marriage, Epidemiology, Observational study, The Association, Visual markers of marital status

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Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort.

Concepts: Health insurance, Marriage, Epidemiology, Socioeconomic status, Sociology, Economics, Marital status, Visual markers of marital status

10

Mortality risk is lower in married than in unmarried men and women. However, little is known about the association between mortality and relationship status in South Africa where marriage rates are low, migration is common, many couples are not co-resident and HIV prevalence is high.

Concepts: Marriage, Sexual intercourse, Africa, South Africa, Wife, Visual markers of marital status, Alimony

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It has been observed that married cancer patients have lower mortality rates than unmarried patients, but data for different racial/ethnic groups are scarce. The authors examined the risk of overall mortality associated with marital status across racial/ethnic groups and sex in data from the California Cancer Registry.

Concepts: Marriage, Mortality rate, Difference, Marital status, Visual markers of marital status

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BACKGROUND: Living arrangements have changed markedly in recent decades, so we wanted to provide an up-to-date assessment of mortality as a function of marital status and cohabitation status in a complete population. METHODS: We studied mortality in a national cohort of 6.5 million Danes followed for 122.5 million person-years during 1982-2011, using continuously updated individual-level information on living arrangements, socio-demographic covariates and causes of deaths. Hazard ratios (HRs) estimated relative mortality in categories of marital status, cohabitation status and combinations thereof. RESULTS: HRs for overall mortality changed markedly over time, most notably for persons in same-sex marriage. In 2000-2011, opposite-sex married persons (reference, HR = 1) had consistently lower mortality than persons in other marital status categories in women (HRs 1.37-1.89) and men (HRs 1.37-1.66). Mortality was particularly high for same-sex married women (HR = 1.89), notably from suicide (HR = 6.40) and cancer (HR = 1.62), whereas rates for same-sex married men (HR = 1.38) were equal to or lower than those for unmarried, divorced and widowed men. Prior marriages (whether opposite-sex or same-sex) were associated with increased mortality in both women and men (HR = 1.16-1.45 per additional prior marriage). CONCLUSION: Our study provides a detailed account of living arrangements and their associations with mortality over three decades, thus yielding accurate and statistically powerful analyses of public health relevance to countries with marriage and cohabitation patterns comparable to Denmark’s. Of note, mortality among same-sex married men has declined markedly since the mid-1990s and is now at or below that of unmarried, divorced and widowed men, whereas same-sex married women emerge as the group of women with highest and, in recent years, even further increasing mortality.

Concepts: Marriage, Epidemiology, Demography, Same-sex marriage, Marital status, Visual markers of marital status, Alimony, Annulment

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This study challenges two well-established associations in medical sociology: the beneficial effect of marriage on health and the predictive power of self-rated health on mortality. Using The National Health Interview Survey 1986-2004 with 1986-2006 mortality follow-up (789,096 respondents with 24,095 deaths) and Cox Proportional Hazards Models, we find the protective effect of marriage against mortality decreases with deteriorating health so that the married and unmarried in poor health are at similar risk for death. We also find the power of self-rated health to predict mortality is higher for the married than for any unmarried group. By using ordered logistic regression models, we find thresholds shift such that, compared to the unmarried, the married may not report poorer health until developing more severe health problems. These findings suggest the married tend to overestimate their health status. These two phenomena (diminishing protection and overestimation) contribute to but do not completely explain each other.

Concepts: Regression analysis, Logistic regression, Marriage, Death, Demography, David Cox, Marital status, Visual markers of marital status

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Based on a large population of 1113 men aged 30-60 at baseline (mean: 44.1 years, standard deviation: 10.5), we investigated whether intra-individual changes in testosterone (T) and related reproductive hormones during a ten year period were dependent of marital status at baseline and follow-up. The studied men were part of a health survey in Denmark, conducted between 1982 and 1984 with a follow-up examination approximately ten years later. Data on reproductive hormones, measured in serum, and lifestyle and marital status were obtained at both time points. As expected, an age-related decline in testosterone was observed. However, independent of age and lifestyle, we observed that men who went from unmarried to married (n=81) during the study period experienced an accelerated age-related decline in testosterone (-6.6nmol/L) whereas men who went from married to unmarried (n=67) experienced an attenuated age-related decline (-2.3nmol/L). Men who were either married or unmarried at both time points (n=167, n=798, respectively) had a testosterone decline in between (-3.7nmol/L and -4.6nmol/L, respectively). Changes in T/LH ratio did not differ according to marital status indicating that the lowered T level is not compensated by increasing LH levels. This could suggest a modification of the gonadostat due to an adaptation to changing life circumstances.

Concepts: Marriage, Luteinizing hormone, Arithmetic mean, Mean, Standard deviation, Puberty, Marital status, Visual markers of marital status

2

Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual’s health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual’s transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual’s life course rather than simply focussing at one stage of the life course.

Concepts: Marriage, Longitudinal study, Epidemiology, Cross-sectional study, Personal life, Cross-sectional data, Marital status, Visual markers of marital status

0

Although social support is used to determine transplant eligibility, the relationship between social support, medication adherence, and survival among transplant recipients remains unclear. We estimated the relationship between social support and post-transplant medication adherence and outcomes using 10 electronic databases from inception to January 2016. Study quality was assessed and all review stages were conducted independently by 2 reviewers. Systematic review and meta-analysis were conducted. Thirty-two studies (9102 participants) met inclusion criteria: 21 assessed medication adherence (5197 participants), and 13 assessed clinical outcomes (3905 participants). Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes. Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post-transplant adherence and outcomes. Larger prospective studies using consistent and validated measures are needed to justify the use of inadequate social support as a contraindication to transplantation.

Concepts: Medicine, Marriage, Systematic review, Organ transplant, Meta-analysis, Marital status, Visual markers of marital status, 2016