Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark.
Dept. of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark.
Acta Neurol Scand. 2018 Oct;138(4):377-383. doi: 10.1111/ane.12975. Epub 2018 Jun 19.
Most studies show that marriage conveys a survival advantage. Whether this is valid also for stroke patients is unclear. Results of studies have been inconsistent and conflicting.
MATERIAL & METHODS: We studied 1-week and 1-month stroke case-fatality in relation to marital status (married, unmarried, divorced, and widowed) in all patients admitted to hospital for incident stroke in Denmark during 2003-2012. We used information from Danish registries on stroke merged to information on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, cardiovascular risk profile, and causes of death. We studied deaths due to the index stroke within the first week and month after stroke. Multivariate Cox regression models were applied to estimate cause-specific hazards and relative risks.
We included 60507 patients with an incident stroke of which 51.19% were married, 9.47% were unmarried, 13.29% were divorced, and 26.05% were widowers. Death within the first week and first month was caused by stroke in 2110 (3.5%) and 3423 (5.7%) patients, respectively. Compared to married stroke patients, 1-week/1-month case-fatality (by stroke) was lower for the unmarried (HR (hazard ratio):0.69/0.74), divorced (HR:0.69/0.72), and widowed (HR:0.80/0.74) men and the unmarried (HR:0.84/0.86), divorced (HR:0.82/0.80), and widowed (HR:0.87/0.88) women with stroke.
One-week and one-month case-fatality by stroke was lower among the unmarried, divorced, and widowed than among the married stroke patients. Selection by so-called mortality displacement linked to shorter life expectancy among divorced, widowed, and singles may explain our findings.
大多数研究表明，婚姻具有生存优势。这种优势是否适用于中风患者尚不清楚。研究结果一直存在不一致和矛盾。
我们研究了丹麦 2003 年至 2012 年期间所有因中风入院的患者的 1 周和 1 个月的中风病死率与婚姻状况（已婚、未婚、离婚和丧偶）之间的关系。我们使用了丹麦登记处关于中风的信息，并与年龄、性别、婚姻状况、中风严重程度、中风亚型、社会经济状况、心血管风险概况和死因信息相合并。我们研究了中风发生后 1 周和 1 个月内因指数中风而导致的死亡。应用多变量 Cox 回归模型来估计特定原因的危害比和相对风险。
我们纳入了 60507 例首发中风患者，其中 51.19%为已婚，9.47%为未婚，13.29%为离婚，26.05%为丧偶。第 1 周和第 1 个月内因中风导致的死亡分别为 2110 例（3.5%）和 3423 例（5.7%）。与已婚中风患者相比，未婚（HR：0.69/0.74）、离婚（HR：0.69/0.72）和丧偶（HR：0.80/0.74）男性以及未婚（HR：0.84/0.86）、离婚（HR：0.82/0.80）和丧偶（HR：0.87/0.88）女性的 1 周/1 个月中风病死率更低。
与已婚中风患者相比，未婚、离婚和丧偶的中风患者 1 周和 1 个月的病死率更低。离婚、丧偶和单身者所谓的死亡率转移导致预期寿命缩短，可能解释了我们的发现。
