@article {8696, title = {Marital history and survival after a heart attack.}, journal = {Soc Sci Med}, volume = {170}, year = {2016}, month = {2016 12}, pages = {114-123}, abstract = {

Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n~=~2197). We found that adults who were never married (odds ratio [OR]~=~1.73), currently divorced (OR~=~1.70), or widowed (OR~=~1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12\% for every additional marital loss and decreased by 7\% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Divorce, Female, Humans, Male, Marital Status, Myocardial Infarction, Prospective Studies, Retrospective Studies, Single Person, Spouses, Survivors, United States, Widowhood}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.10.013}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616305810}, author = {Matthew E Dupre and Nelson, Alicia} } @article {7779, title = {The cumulative effect of unemployment on risks for acute myocardial infarction.}, journal = {Arch Intern Med}, volume = {172}, year = {2012}, month = {2012 Dec 10}, pages = {1731-7}, publisher = {172}, abstract = {

BACKGROUND: Employment instability is a major source of strain affecting an increasing number of adults in the United States. Little is known about the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI).

METHODS: We investigated the associations between different dimensions of unemployment and the risks for AMI in US adults in a prospective cohort study of adults (N = 13,451) aged 51 to 75 years in the Health and Retirement Study with biennial follow-up interviews from 1992 to 2010. Unadjusted rates of age-specific AMI were used to demonstrate observed differences by employment status, cumulative number of job losses, and cumulative time unemployed. Cox proportional hazards models were used to examine the multivariate effects of cumulative work histories on AMI while adjusting for sociodemographic background and confounding risk factors.

RESULTS: The median age of the study cohort was 62 years, and 1061 AMI events (7.9\%) occurred during the 165,169 person-years of observation. Among the sample, 14.0\% of subjects were unemployed at baseline, 69.7\% had 1 or more cumulative job losses, and 35.1\% had spent time unemployed. Unadjusted plots showed that age-specific rates of AMI differed significantly for each dimension of work history. Multivariate models showed that AMI risks were significantly higher among the unemployed (hazard ratio, 1.35 [95\% CI, 1.10-1.66]) and that risks increased incrementally from 1 job loss (1.22 [1.04-1.42]) to 4 or more cumulative job losses (1.63 [1.29-2.07]) compared with no job loss. Risks for AMI were particularly elevated within the first year of unemployment (hazard ratio, 1.27 [95\% CI, 1.01-1.60]) but not thereafter. Results were robust after adjustments for multiple clinical, socioeconomic, and behavioral risk factors.

CONCLUSIONS: Unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.

}, keywords = {Female, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Stress, Psychological, Survival Rate, Unemployment, United States}, issn = {1538-3679}, doi = {10.1001/2013.jamainternmed.447}, author = {Matthew E Dupre and Linda K George and Liu, Guangya and Eric D Peterson} } @article {7356, title = {Marital trajectories and mortality among US adults.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Sep 01}, pages = {546-55}, publisher = {170}, abstract = {

More than a century of empirical evidence links marital status to mortality. However, the hazards of dying associated with long-term marital trajectories and contributing risk factors are largely unknown. The authors used 1992-2006 prospective data from a cohort of US adults to investigate the impact of current marital status, marriage timing, divorce and widow transitions, and marital durations on mortality. Multivariate hazard ratios were significantly higher for adults currently divorced and widowed, married at young ages (< or =18 years), who accumulated divorce and widow transitions (among women), and who were divorced for 1-4 years. Results also showed significantly lower risks of mortality for men married after age 25 years compared with on time (ages 19-25 years) and among women experiencing > or =10 years of divorce and > or =5 years of widowhood relative to those without exposure to these statuses. For both sexes, accumulation of marriage duration was the most robust predictor of survival. Results from risk-adjusted models indicated that socioeconomic resources, health behaviors, and health status attenuated the associations in different ways for men and women. The study demonstrates that traditional measures oversimplify the relation between marital status and mortality and that sex differences are related to a nexus of marital experiences and associated health risks.

}, keywords = {Age Factors, Cohort Studies, Female, Health Behavior, Humans, Male, Marital Status, Middle Aged, Mortality, Retirement, Retrospective Studies, Risk Factors, Sex Factors, Time Factors, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwp194}, author = {Matthew E Dupre and Audrey N Beck and Sarah O. Meadows} }