Marital Dissolution Is Followed by an Increased Incidence of StrokeEngström G.a · Khan F.A.a · Zia E.b · Jerntorp I.a · Pessah-Rasmussen H.b · Norrving B.c · Janzon L.a
Departments of aCommunity Medicine and bNeurology, Malmö University Hospital, Malmö, and cDepartment of Neurology, Lund University Hospital, Lund, Sweden
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Background: Many studies have reported lower mortality in married people. The relation between marital status and incidence of haemorrhagic and ischaemic stroke is unclear. It is largely unknown whether the risk of stroke is increased the first years after divorce or death of spouse. Methods: Incidence of first-ever stroke (n = 6,184) was followed over 10 years in a cohort consisting of all 40- to 89-year-old inhabitants (n = 118,134) in the city of Malmö, Sweden. Marital dissolution (i.e. divorce or death of spouse) prior to the date of stroke was compared in a nested case-control design (3,134 initially married stroke cases, 9,402 initially married controls). Results: As compared to the married groups, the incidence of stroke was increased in divorced men and women (RR = 1.23, CI: 1.10–1.39 and RR = 1.26, CI: 1.12–1.41, respectively) and widowed men and women (RR = 1.13, CI: 0.99–1.28 and RR = 1.13, CI: 1.02–1.24, respectively) after adjustments for age, country of birth and socioeconomic indicators. The risk of stroke was not increased in never married men. Marital dissolution was followed by increased risk of stroke, which was significant for men (adjusted odds ratio: 1.23, CI: 1.03–1.5) and borderline significant for women below 65 years of age (odds ratio: 1.45, CI: 0.99–2.14). Conclusion: The incidence of stroke is increased in divorced and widowed individuals. Never married men do not have an increased incidence. The risk of stroke is elevated during the first years after divorce or death of spouse.
© 2004 S. Karger AG, Basel
- Johnson NJ, Backlund E, Sorlie PD, Loveless CA: Marital status and mortality: The national longitudinal mortality study. Ann Epidemiol 2000;10:224–238.
- Ben-Shlomo Y, Smith GD, Shipley M, Marmot MG: Magnitude and causes of mortality differences between married and unmarried men. J Epidemiol Community Health 1993;47:200–205.
- Ebrahim S, Wannamethee G, McCallum A, Walker M, Shaper AG: Marital status, change in marital status, and mortality in middle-aged British men. Am J Epidemiol 1995;142:834–842.
- Hu YR, Goldman N: Mortality differentials by marital status: An international comparison. Demography 1990;27:233–250.
- Rosengren A, Wedel H, Wilhelmsen L: Marital status and mortality in middle-aged Swedish men. Am J Epidemiol 1989;129:54–64.
- Mendes de Leon CF, Kasl SV, Jacobs S: Widowhood and mortality risk in a community sample of the elderly: A prospective study. J Clin Epidemiol 1993;46:519–527.
- Koskenvuo M, Kaprio J, Romo M, Langinvainio H: Incidence and prognosis of ischaemic heart disease with respect to marital status and social class. A national record linkage study. J Epidemiol Community Health 1981;35:192–196.
- Schaefer C, Quesenberry CP Jr, Wi S: Mortality following conjugal bereavement and the effects of a shared environment. Am J Epidemiol 1995;141:1142–1152.
- Engström G, Tyden P, Berglund G, Hansen O, Hedblad B, Janzon L: Incidence of myocardial infarction in women. A cohort study of risk factors and modifiers of effect. J Epidemiol Community Health 2000;54:104–107.
- Lindegård B, Langman MJ: Marital state, alcohol consumption, and liability to myocardial infarction, stroke, diabetes mellitus, or hypertension in men from Gothenburg. Br Med J 1985;291:1529–1533.
- Simons LA, McCallum J, Friedlander Y, Simons J: Risk factors for ischemic stroke: Dubbo Study of the elderly. Stroke 1998;29:1341–1346.
- Öhgren B, Weinehall L, Stegmayr B, Boman K, Hallmans G, Wall S: What else adds to hypertension in predicting stroke? An incident case-referent study. J Intern Med 2000;248:475–482.
- Boysen G, Nyboe J, Appleyard M, Sorensen PS, Boas J, Somnier F, Jensen G, Schnohr P: Stroke incidence and risk factors for stroke in Copenhagen, Denmark. Stroke 1988;19:1345–1353.
- Thompson SG, Greenberg G, Meade TW: Risk factors for stroke and myocardial infarction in women in the United States as assessed in general practice: A case-control study. Br Heart J 1989;61:403–409.
- Martikainen P, Valkonen T: Mortality after death of spouse in relation to duration of bereavement in Finland. J Epidemiol Community Health 1996;50:264–268.
- Matthews KA, Gump BB: Chronic work stress and marital dissolution increase risk of posttrial mortality in men from the Multiple Risk Factor Intervention Trial. Arch Intern Med 2002;162:309–315.
- Walker M, Shaper AG, Cook DG: Non-participation and mortality in a prospective study of cardiovascular disease. J Epidemiol Community Health 1987;41:295–299.
- Engström G, Jerntorp I, Pessah-Rasmussen H, Hedblad B, Berglund G, Janzon L: Geographic distribution of stroke incidence within an urban population: Relations to socioeconomic circumstances and prevalence of cardiovascular risk factors. Stroke 2001;32:1098–1103.
- Jerntorp P, Berglund G: Stroke registry in Malmö, Sweden. Stroke 1992;23:357–361.
Population and housing census 1990. Stockholm and Örebro, Statistics Sweden. 1992 ISBN 91–618–0406–1.
- Pessah-Rasmussen H, Engström G, Jerntorp I, Janzon L: Increasing stroke incidence and decreasing case fatality 1989–1998. A study from the Stroke Register in Malmö, Sweden. Stroke 2003;34:913–918.
- Koskenvuo M, Kaprio J, Lonnqvist J, Sarna S: Social factors and the gender difference in mortality. Soc Sci Med 1986;23:605–609.
- House A, Dennis M, Mogridge L, Hawton K, Warlow C: Life events and difficulties preceding stroke. J Neurol Neurosurg Psychiatry 1990;53:1024–1028.
- Parkes CM, Benjamin B, Fitzgerald RG: Broken heart: a statistical study of increased mortality among widowers. BMJ 1969;1:740–743.
- Harmsen P, Rosengren A, Tsipogianni A, Wilhelmsen L: Risk factors for stroke in middle-aged men in Göteborg, Sweden. Stroke 1990;21:223–229.
- Truelsen T, Nielsen N, Boysen G, Gronbaek M: Self-reported stress and risk of stroke: The Copenhagen City Heart Study. Stroke 2003;34:856–862.
- Andre-Petersson L, Engström G, Hagberg B, Janzon L, Steen G: Adaptive behavior in stressful situations and stroke incidence in hypertensive men: Results from prospective cohort study ‘Men born in 1914’ in Malmö, Sweden. Stroke 2001;32:1712–1720.
- Rutledge T, Hogan BE: A quantitative review of prospective evidence linking psychological factors with hypertension development. Psychosom Med 2002;64:758–766.
- Appelros P, Hogeras N, Terent A: Case ascertainment in stroke studies: The risk of selection bias. Acta Neurol Scand 2003;107:145–149.
- Stegmayr B, Asplund K: Measuring stroke in the population: Quality of routine statistics in comparison with a population-based stroke registry. Neuroepidemiology 1992;11:204–213.
- Merlo J, Lindblad U, Pessah-Rasmussen H, Hedblad B, Ranstam J, Isacsson SO, Janzon L, Råstam L: Comparison of different procedures to identify probable cases of myocardial infarction and stroke in two Swedish prospective cohort studies using local and national routine registers. Eur J Epidemiol 2000;16:235–243.
- Engström G, Berglund G, Göransson M, Hansen O, Hedblad B, Merlo J, Tyden P, Janzon L: Distribution and determinants of ischaemic heart disease in an urban population. A study from the Myocardial Infarction Register in Malmö, Sweden. J Intern Med 2000;247:588–596.
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