Abstract
BackgroundIt is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. However, much remains to be known about the underlying mechanisms. Our objective was to examine marital status differences in the purchase of medication for circulatory diseases, and risk factors for them, which may indicate underuse of such medication by some marital status groups.MethodsUsing data from registers covering the entire Norwegian population, we analysed marital status differences in the purchase of medicine for eight circulatory disorders by people aged 50-79 in 2004-2008. These differences were compared with those in circulatory disease mortality during 2004-2007, considered as indicating probable differences in disease burden.ResultsThe unmarried had 1.4-2.8 times higher mortality from the four types of circulatory diseases considered. However, the never-married in particular purchased less medicine for these diseases, or precursor risk factors of these diseases, primarily because of a low chance of making a first purchase. The picture was more mixed for the divorced and widowed. Both groups purchased less of some of these medicines than the married, but, especially in the case of the widowed, relatively more of other types of medicine. In contrast to the never-married, divorced and widowed people were as least as likely as the married to make a first purchase, but adherence rates thereafter, indicated by continuing purchases, were lower.ConclusionThe most plausible interpretation of the findings is that compared with married people, especially the never-married more often have circulatory disorders that are undiagnosed or for which they for other reasons underuse medication. Inadequate use of these potentially very efficient medicines in such a large population group is a serious public health challenge which needs further investigation. It is possible that marital status differences in use of medicines for circulatory disorders combined with an increasing importance of these medicines have contributed to the widening marital status gap in mortality observed in several countries. This also requires further investigation.
Highlights
It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing
Associations between marital status and purchase of medication 2004-2008 Never-married men and women were generally less likely than the married to purchase medicine for circulatory disorders (Table 2 and signs shown in Panel A of Table 3)
Our results suggest that there is an underuse of medicine for circulatory disorders among the unmarried, and especially the never-married
Summary
It is well established that unmarried people have higher mortality from circulatory diseases and higher all-cause mortality than the married, and these marital status differences seem to be increasing. Numerous studies from many different countries have shown that married people have lower all-cause mortality than the unmarried and lower mortality from several specific causes and cause groups, including circulatory diseases [1,2,3]. We consider incident and continuing purchase of these medicines. These marital status differences in medication purchase (assumed to be indicative of medication use) are compared with marital status differences in mortality from four specific circulatory causes, used as an indicator of probable differences in disease burden.
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