Abstract
PurposeTo ascertain whether sex differences exist in the relationship between marital status and cardiovascular diseases (CVD), coronary heart disease (CHD), cancer and all-cause mortality in the general population and to explore the potential effect of age, location, the duration of follow-up and publication years on these outcomes.MethodsA systematic search was performed in PubMed and EMBASE from inception through to April 2018 and review of references to obtain sex-specific relative risks and their 95% confidence intervals. These were used to derive the women-to-men ratio of RRs (RRR) and 95% CI for each study. RRs and RRRs for each outcome were then pooled using random effects inverse-variance weighted meta-analysis.ResultsTwenty-one studies with 7,891,623 individuals and 1,888,752 deaths were included in the meta-analysis. Compared with married individuals, being unmarried was significantly associated with all-cause, cancer, CVD and coronary heart disease mortalities for both sexes. However, the association with CVD and all-cause mortality was stronger in men. Being divorced/separated was associated with a higher risk of all-cause mortality in men and a stronger risk of cancer and CVD mortality. The pooled ratio for women versus men showed 31 and 9% greater risk of stroke mortality and all-cause mortality associated with never married in men than in women.ConclusionsBeing unmarried conferred higher risk of stroke and all-cause mortality for men than women. Moreover, divorced/separated men had higher risk of cancer mortality and CVD mortality. Further studies are warranted to clarify the biological, behavioral, and/or social mechanisms involved in sex differences by these associations.
Highlights
Marital status has been identified as an important social factor associated with mortality
Marriage offers a direct form of social support [5, 6] and it can reduce the risk of unhealthy behaviors such as poor diet or alcohol use [5–7]
Being unmarried has been suggested to contribute to less intimate social networks, loneliness and increased levels of stress hormones [8], which may increase risk from cardiovascular diseases (CVD) [9, 10], cancer [11, 12] or metabolic syndrome [13, 14]
Summary
Marital status has been identified as an important social factor associated with mortality. In current epidemiologic research, being unmarried was observed to be a suboptimal health status in the global population [1]. The growing number of unmarried people has health implications, in light of evidence suggesting that it is associated with an increase in the incidence of various diseases and high mortality. Being unmarried has been suggested to contribute to less intimate social networks, loneliness and increased levels of stress hormones [8], which may increase risk from cardiovascular diseases (CVD) [9, 10], cancer [11, 12] or metabolic syndrome [13, 14]. While the links between marital status and CVD mortality risk have been widely reported [15–19], comparatively less has been observed regarding other conditions including cancer mortality and all-causes more broadly
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