Marital Transition and Risk of Stroke

Marital status is viewed as an important determinant of health. Married people have been consistently reported to be healthier than unmarried people, with more profound effects among men. These associations can be attributed to both marital selection (ie, healthier people are more likely to be married) and marital protection (refers to the benefits of marital ties on health). Consistent findings have been reported from research investigating marital transition (ie, a change in marital status during a given time period). Men and women who experience marital transition by death or divorce have prospectively increased risk of associated onset and progression of cardiovascular disease. The hypothesized mechanisms underlying the association between marital transition and cardiovascular risk include preexisting health conditions, change to unhealthy profiles of health behavior, poorer psychological state stemming from the loss of financial stability, and reduced social support and social networks owing to loss of the spouse. However, few studies have been conducted to address stroke risk, particularly stroke subtypes, in this population. In addition, no such studies have been conducted in Asia. Sociocultural differences could be a potential moderator for the health effect of marital transition. A prospective study of middle-aged men and women in Japan showed that marital dissolution significantly increased the risk of cardiovascular mortality among men, but no such impact was identified among women. Another prospective study of Japanese elderly adults showed no evidence of increased all-cause mortality risk among widowed men and women; in fact, decreased mortality risk was found among widowed women. These inconsistent results could be because the social roles of men and women in Japanese society are different, with strong gender role norms (ie, the male breadwinner model). Under such social norms, women are generally more likely to Background and Purpose—There have been consistent findings reported that marital transition (ie, change in marital status during a given time period) is associated with risk of cardiovascular disease; however, few studies have been conducted on stroke risk, particularly stroke subtypes. Moreover, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk. Methods—We examined sex-specific associations between marital transition and stroke risk using data from Japan Public Health Center–based Prospective Study. We included 24 162 men and 25 626 women who were married at prebaseline (5 years before baseline). Marital transition was determined by marital status at baseline. Weighted hazard ratios of stroke risk were estimated by Cox proportional regression analysis with inverse probability of weighting using a propensity score. Results—An increased risk of stroke, particularly hemorrhagic stroke, was observed among men and women with marital transition (ie, married to unmarried); weighted hazard ratios (95% confidence interval [CI]) for men and women were 1.26 (1.13–1.41) and 1.26 (1.09–1.45), respectively. Participants with marital transition and lived with children had increased stroke risk. Living with parents buffered the increased stroke risk owing to marital transition among men; however, no such effect was identified among women. Elevated stroke risk owing to marital transition was magnified among women if they were unemployed; weighted hazard ratio=2.98 (95% CI, 1.66–5.33). Conclusions—Living arrangement and employment status modified the positive associations between marital transition and stroke risk, which differed by sex. (Stroke. 2016;47:991-998. DOI: 10.1161/STROKEAHA.115.011926.)