Marital history, health and mortality among older men and women in England and Wales.
Marital history, health and mortality among older men and women in England and Wales.
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DOI：
10.1186/1471-2458-10-554
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发表时间：
2010-09-15
影响因子：
4.5
通讯作者：
Tomassini C
中科院分区：
文献类型：
--
作者：
Grundy EM;Tomassini C
婚姻对健康的好处早已被认识到并进行了广泛的研究，但之前的研究对老年人，特别是老年妇女的研究结果并不一致。在老年人中，过去的婚姻经历以及当前的婚姻状况积累的好处或坏处可能是相关的，但很少有研究考虑到婚姻历史的影响。也很少考虑到均等可能产生的影响，以及这些影响在多大程度上可能导致婚姻状况在健康方面的差异。我们使用了英国国家统计纵向研究办公室（Office for National Statistics Longitudinal Study）的数据，这是一项针对英格兰和威尔士1%人口的大型记录关联研究，分析了1971-1991年的婚姻史与随后自我报告的限制性长期疾病和死亡率之间的关系，研究对象是1991年年龄在60-79岁之间的约7.5万名男性和女性。我们使用泊松回归分析1991-2001年的死亡率差异，并使用逻辑回归分析1991年和2001年报告限制长期疾病的比例差异，研究了婚姻状况和当前婚姻状态的时间是否影响死亡率或长期疾病的风险。共同变量包括成年后两三个阶段的社会经济地位指标，以及妇女所生子女的数目（胎次）。1991-2001年，与长期第一次婚姻的男性相比，从未结过婚的男性、不同丧偶时间的鳏夫、离婚10至20年的男性以及长期再婚的男性的死亡率有所上升。1991年，长期再婚的男性以及1971年后离婚或丧偶的男性患长期疾病的几率更高；2001年，长期再婚的人是唯一一个长期患病几率显著增加的群体。1991年和2001年，长期再婚的女性报告长期患病的几率也更高，1991年至2001年，再婚和之前离婚的女性长期患病的几率更高，死亡率也更高；后一种效应在包括平价在内的模型中并不显著。1991-2001年期间，所有丧偶妇女的死亡率都有所提高，但一旦社会经济地位得到控制，1991年或2001年期间不同时间的丧偶与长期疾病之间的联系就不明显了。1991-2001年，一些离婚妇女的死亡率更高，1991年长期患病的几率也更高。对未婚妇女的研究结果显示，与死亡率和长期疾病的关系存在差异。在控制社会经济地位的模型中，死亡风险有所提高，但与1991年长期疾病的关系并不显著，2001年从未结婚的妇女报告长期疾病的几率低于长期首次婚姻的妇女。正式考虑进入研究人群前20年的选择性生存率对结果的影响较小。结果与以前的研究一致，即婚姻经历与晚年健康和死亡率之间的关系在很大程度上受到社会经济因素的影响，此外还表明，考虑到妇女平等，进一步缓和了这种关联。考虑婚姻历史而不是简单地考虑当前的婚姻状况提供了一些关于差异的见解，例如，根据以前的婚姻状况和再婚时间再婚的人，但这些群体相对较小，并且在统计能力方面存在一些缺点。考虑过去的历史可能对出生较晚的群体更为重要，因为他们的伴侣关系经历不太稳定，而且更加多样化。
Health benefits of marriage have long been recognised and extensively studied but previous research has yielded inconsistent results for older people, particularly older women. At older ages accumulated benefits or disadvantages of past marital experience, as well as current marital status, may be relevant, but fewer studies have considered effects of marital history. Possible effects of parity, and the extent to which these may contribute to marital status differentials in health, have also been rarely considered. We use data from the Office for National Statistics Longitudinal Study, a large record linkage study of 1% of the population of England & Wales, to analyse associations between marital history 1971-1991 and subsequent self-reported limiting long-term illness and mortality in a cohort of some 75,000 men and women aged 60-79 in 1991. We investigate whether prior marital status and time in current marital status influenced risks of mortality or long term illness using Poisson regression to analyse mortality differentials 1991-2001 and logistic regression to analyse differences in proportions reporting limiting long-term illness in 1991 and 2001. Co-variates included indicators of socio-economic status at two or three points of the adult life course and, for women, number of children borne (parity). Relative to men in long-term first marriages, never-married men, widowers with varying durations of widowerhood, men divorced for between 10 and twenty years, and men in long-term remarriages had raised mortality 1991-2001. Men in long-term remarriages and those divorced or widowed since 1971 had higher odds of long-term illness in 1991; in 2001 the long-term remarried were the only group with significantly raised odds of long-term illness. Among women, the long-term remarried also had higher odds of reporting long-term illness in 1991 and in 2001 and those remarried and previously divorced had raised odds of long-term illness and raised mortality 1991-2001; this latter effect was not significant in models including parity. All widows had raised mortality 1991-2001 but associations between widowhood of varying durations and long-term illness in 1991 or 2001 were not significant once socio-economic status was controlled. Some groups of divorced women had higher mortality risks 1991-2001 and raised odds of long-term illness in 1991. Results for never-married women showed a divergence between associations with mortality and with long-term illness. In models controlling for socio-economic status, mortality risk was raised but the association with 1991 long-term illness was not significant and in 2001 never-married women had lower odds of reporting long-term illness than women in long-term first marriages. Formally taking account of selective survival in the 20 years prior to entry to the study population had minor effects on results. Results were consistent with previous studies in showing that the relationship between marital experience and later life health and mortality is considerably modified by socio-economic factors, and additionally showed that taking women's parity into account further moderated associations. Considering marital history rather than simply current marital status provided some insights into differentials between, for example, remarried people according to prior marital status and time remarried, but these groups were relatively small and there were some disadvantages of the approach in terms of loss of statistical power. Consideration of past histories is likely to be more important for later born cohorts whose partnership experiences have been less stable and more heterogeneous.
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影响因子：
1.7
作者：
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通讯作者：
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