Scafato Emanuele, Galluzzo Lucia, Gandin Claudia, Ghirini Silvia, Baldereschi Marzia, Capurso Antonio, Maggi Stefania, Farchi Gino
Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Istituto Superiore di Sanità (ISS), Via Giano della Bella 34, 00161 Roma, Italy.
Soc Sci Med. 2008 Nov;67(9):1456-64. doi: 10.1016/j.socscimed.2008.06.026. Epub 2008 Jul 31.
The relationship between mortality and marital status has long been recognized, but only a small number of investigations consider also the association with cohabitation status. Moreover, age and gender differences have not been sufficiently clarified. In addition, little is known on this matter about the Italian elderly population. The aim of this study is to examine differentials in survival with respect to marital status and cohabitation status in order to evaluate their possible predictive value on mortality of an Italian elderly cohort. This paper employs data from the Italian Longitudinal Study on Aging (ILSA), an extensive epidemiologic project on subjects aged 65-84 years. Of the 5376 individuals followed-up from 1992 to 2002, 1977 died, and 1492 were lost during follow-up period. The baseline interview was administered to 84% of the 5376 individuals and 65% of them underwent biological and instrumental examination. Relative risks of mortality for marital (married vs. non-married) and cohabitation (not living alone vs. living alone) categories are estimated through hazard ratios (HR), obtained by means of the Cox proportional hazards regression model, adjusting for age and several other potentially confounding variables. Non-married men (HR=1.25; 95% CI: 1.03-1.52) and those living alone (HR=1.42; 95% CI: 1.05-1.92) show a statistically significant increased mortality risk compared to their married or cohabiting counterparts. After age-adjustment, women's survival is influenced neither by marital status nor by cohabitation status. None of the other covariates significantly alters the observed differences in mortality, in either gender. Neither marital nor cohabitation status are independent predictors of mortality among Italian women 65+, while among men living alone is a predictor of mortality even stronger than not being married. These results suggest that Italian men benefit more than women from the protective effect of living with someone.
死亡率与婚姻状况之间的关系早已为人所知,但只有少数研究同时考虑了与同居状况的关联。此外,年龄和性别差异尚未得到充分阐明。此外,对于意大利老年人口在这方面的情况知之甚少。本研究的目的是考察婚姻状况和同居状况在生存方面的差异,以评估它们对意大利老年队列死亡率的可能预测价值。本文采用了意大利老龄化纵向研究(ILSA)的数据,这是一个针对65 - 84岁人群的广泛流行病学项目。在1992年至2002年随访的5376名个体中,1977人死亡,1492人在随访期间失访。对5376名个体中的84%进行了基线访谈,其中65%接受了生物学和仪器检查。通过Cox比例风险回归模型获得风险比(HR),估计婚姻状况(已婚与未婚)和同居状况(非独居与独居)类别的死亡相对风险,并对年龄和其他几个潜在混杂变量进行了调整。与已婚或同居的男性相比,未婚男性(HR = 1.25;95%置信区间:1.03 - 1.52)和独居男性(HR = 1.42;95%置信区间:1.05 - 1.92)的死亡风险在统计学上显著增加。年龄调整后,女性的生存既不受婚姻状况影响,也不受同居状况影响。在任何一个性别中,其他协变量均未显著改变观察到的死亡率差异。在65岁以上的意大利女性中,婚姻状况和同居状况都不是死亡率的独立预测因素,而在男性中,独居是比未婚更强的死亡率预测因素。这些结果表明,意大利男性比女性从与他人同住的保护作用中受益更多。