Dupre Matthew E, George Linda K, Liu Guangya, Peterson Eric D
From the Duke Clinical Research Institute (M.E.D., E.D.P.), Department of Community and Family Medicine (M.E.D.), Department of Sociology (M.E.D., L.K.G.), Duke Law School (G.L.), and Division of Cardiology, Department of Medicine, Duke University Medical Center (E.D.P.), Duke University, Durham, NC.
Circ Cardiovasc Qual Outcomes. 2015 May;8(3):244-51. doi: 10.1161/CIRCOUTCOMES.114.001291. Epub 2015 Apr 14.
Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in US adults.
We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 years (n=15,827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one third of the cohort had ≥1 divorce in their lifetime. In 200,524 person-years of follow-up, 8% (n=1211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married (P<0.05). Results from competing-risk hazard models showed that AMI risks were significantly higher in women who had 1 divorce (hazard ratio, 1.24; 95% confidence interval, 1.01-1.55), ≥2 divorces (hazard ratio, 1.77; 95% confidence interval, 1.30-2.41), and among the remarried (hazard ratio, 1.35; 95% confidence interval, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of ≥2 divorces (hazard ratio, 1.30; 95% confidence interval, 1.02-1.66) compared with continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant.
Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage.
离婚是一种重大的生活压力源，可能会对经济、情感和身体健康产生影响。然而，离婚与急性心肌梗死（AMI）风险之间的累积关联尚不清楚。本研究调查了美国成年人一生中经历离婚与AMI发病率之间的关联。
我们使用了来自一个前瞻性队列的具有全国代表性的数据，该队列由年龄在45至80岁之间的曾经结婚的成年人组成（n = 15,827），从1992年至2010年每两年进行一次随访。基线时，约14%的男性和19%的女性离婚，超过三分之一的队列成员一生中经历过≥1次离婚。在200,524人年的随访中，8%（n = 1211）的队列成员发生了AMI，与持续婚姻者相比，离婚者的年龄特异性AMI发病率始终较高（P < 0.05）。竞争风险危害模型的结果显示，在调整了多个风险因素后，经历过1次离婚的女性（危害比，1.24；95%置信区间，1.01 - 1.55）、≥2次离婚的女性（危害比，1.77；95%置信区间，1.30 - 2.41）以及再婚女性（危害比，1.35；95%置信区间，1.07 - 1.70）发生AMI的风险显著高于持续婚姻的女性。与持续婚姻的男性相比，只有有≥2次离婚史的男性经多变量调整后的风险升高（危害比，1.30；95%置信区间，1.02 - 1.66）。再婚男性发生AMI的风险无显著升高。性别交互项无统计学意义。
离婚是AMI的一个重要风险因素。多次离婚相关的风险在女性中尤其高，且不会因再婚而降低。
