Does Widowhood Increase Mortality Risk? Testing for Selection Effects by Comparing Causes of Spousal Death
Does Widowhood Increase Mortality Risk? Testing for Selection Effects by Comparing Causes of Spousal Death
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DOI：
10.1097/ede.0b013e3181fdcc0b
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发表时间：
2011-01-01
期刊：
影响因子：
5.4
通讯作者：
Raab, Gillian M.
中科院分区：
文献类型：
--
作者：
Boyle, Paul J.;Feng, Zhiqiang;Raab, Gillian M.
背景：我们考虑丧偶是否会增加死亡风险。虽然普遍观察到，这种“寡妇效应”可能是由于选择效应，因为已婚夫妇具有与死亡风险相关的各种特征。因此，我们考虑了配偶死亡的各种原因对丧偶的影响；一些死因与夫妻共有的特征相关，而另一些则不相关。方法：使用苏格兰纵向研究的数据，我们比较了男性和女性的结果，根据配偶的死亡原因，控制了一系列个人和家庭层面的特征。结果：这些数据中的丧偶效应比最近的其他研究发现的更大，调整后的危险比男性为1.40(95%可信区间=1.33-1.47)，女性为1.36(1.30-1.44)。这种风险在丧偶后不久最高，但至少会在10年内保持上升。几乎没有证据表明，这些风险比率与配偶死亡原因的任何分类不同，但发现有既往疾病或其他风险因素的人存在交互作用。结论：我们对丧偶效应的分析使用了3种对配偶死亡原因进行分类的方法，试图控制潜在的选择效应。我们的结果高度一致，表明这是一种因果关系，而不是选择的结果。
Background: We consider whether widowhood increases mortality risk. Although commonly observed, this "widowhood effect" could be due to selection effects, as married couples share various characteristics related to the risk of death. We therefore consider the widowhood effect by various causes of spousal death; some causes of death are correlated with shared characteristics in couples, while others are not.Methods: Using data from the Scottish Longitudinal Study, we compare outcomes for men and women by the causes of death of their spouse, controlling for a range of individual- and household-level characteristics.Results: The widowhood effect in these data is greater than has been found in other recent studies, with adjusted hazard ratios of 1.40 (95% confidence interval = 1.33-1.47) for men and 1.36 (1.30-1.44) for women. The risk is highest shortly after widowhood, but remains raised for at least 10 years. There was little evidence that these hazard ratios differed by any classification of the cause of death of the spouse, but interactions were found for those with pre-existing illness or other risk factors. The hazard ratios for widowhood were lower for persons with preexisting risks.Conclusions: Our analysis of the widowhood effect uses 3 methods of classifying the causes of spousal death in an attempt to control for potential selection effects. Our results are highly consistent and suggest that this is a causal effect, rather than a result of selection.