Mental Health and Addictions Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Mental Health and Addictions Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Lancet Public Health. 2018 Mar;3(3):e115-e123. doi: 10.1016/S2468-2667(18)30003-3. Epub 2018 Feb 15.
Single parent families, including families headed by single fathers, are becoming increasingly common around the world. Previous evidence suggests that single parenthood is associated with adverse health outcomes and increased mortality; however, most studies have focused on single mothers, with little known about the health of single fathers. This study aimed to examine mortality in a large population-based sample of Canadian single fathers compared with single mothers and partnered fathers and mothers.
We used a representative sample of 871 single fathers, 4590 single mothers, 16 341 partnered fathers, and 18 688 partnered mothers from the Canadian Community Health Survey (cycles 2001-12; earliest survey date: Sept 5, 2000; latest survey date: Dec 24, 2012). We anonymously linked survey participants to health administrative database records to ascertain health status at baseline and mortality from survey date up to Oct 28, 2016. We included individuals who were aged 15 years or older, living in a household with one or more biological or adopted child younger than 25 years, and living in Ontario, and we excluded those who left Ontario during the study period or had data discrepancies. Single parents were defined as those who were divorced, separated, widowed, or single, never-married, and non-cohabitating, and partnered parents were defined as those who were married or common-law partners. We investigated differences in mortality using Cox proportional hazards models with adjustment for sociodemographic, lifestyle, and clinical factors.
Median follow-up was 11·10 years (IQR 7·36-13·54). Mortality in single fathers (5·8 per 1000 person-years) was three-times higher than rates in single mothers (1·74 per 1000 person-years) and partnered fathers (1·94 per 1000 person-years). Single fathers had a significantly higher adjusted risk of dying than both single mothers (hazard ratio [HR] 2·49, 95% CI 1·20-5·15; p=0·01) and partnered fathers (2·06, 1·11-3·83; p=0·02).
In this first head-to-head comparison of mortality across single and partnered parent groups, we found that single fathers had the least favourable risk factor profile and greatest risk of mortality. Social histories might help physicians identify these high-risk patients. Further work is needed to understand the causes of this high mortality risk and how clinical and public health interventions can improve lifestyle and behavioural risk factors.
Ontario Ministry of Health and Long-Term Care.
单亲家庭，包括由单身父亲组成的家庭，在全球范围内变得越来越普遍。先前的证据表明，单亲家庭与不良健康结果和死亡率增加有关；然而，大多数研究都集中在单身母亲身上，对于单身父亲的健康状况知之甚少。本研究旨在检查加拿大一个大型基于人群的单身父亲样本的死亡率，与单身母亲和有伴侣的父亲和母亲进行比较。
我们使用了加拿大社区健康调查（2001-12 年周期；最早的调查日期：2000 年 9 月 5 日；最晚的调查日期：2012 年 12 月 24 日）的代表性样本，包括 871 名单身父亲、4590 名单身母亲、16341 名有伴侣的父亲和 18688 名有伴侣的母亲。我们将调查参与者匿名链接到健康管理数据库记录，以确定基线时的健康状况和截至 2016 年 10 月 28 日的死亡率。我们纳入了年龄在 15 岁或以上、与 25 岁以下的一个或多个亲生或领养的孩子一起生活在家庭中的个人，以及居住在安大略省的个人，并排除了在研究期间离开安大略省或数据有差异的个人。单身父母被定义为离婚、分居、丧偶或单身、未婚且未同居的父母，而有伴侣的父母被定义为已婚或事实伴侣的父母。我们使用 Cox 比例风险模型调查了死亡率差异，并对社会人口统计学、生活方式和临床因素进行了调整。
中位随访时间为 11.10 年（IQR 7.36-13.54）。单身父亲（5.8/1000 人年）的死亡率是单身母亲（1.74/1000 人年）和有伴侣父亲（1.94/1000 人年）的三倍。与单身母亲（危险比[HR]2.49，95%CI 1.20-5.15；p=0.01）和有伴侣的父亲（2.06，1.11-3.83；p=0.02）相比，单身父亲的死亡调整风险显著更高。
在首次对单身和有伴侣父母群体的死亡率进行直接比较中，我们发现单身父亲的风险因素状况最差，死亡率最高。社会史可能有助于医生识别这些高风险患者。需要进一步研究以了解这种高死亡率风险的原因，以及临床和公共卫生干预措施如何改善生活方式和行为风险因素。
安大略省卫生和长期护理部。
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