BACKGROUND

The association between marital status and risk of accidental death among patients with cancer has not been adequately studied. We investigated the association between marital status and accidental mortality using two gender-stratified cohorts of patients with cancers.

METHODS

This study identified and captured data on adult patients diagnosed with 1 of 18 selected cancers from the Surveillance, Epidemiology, and End Results database (2000-2020). All participants were categorized into married (or with a partner) and unmarried (including single, separated, divorced, and widowed) groups. The hazard ratios (HRs) of mortality were estimated using flexible parametric and Cox proportional hazards models.

RESULTS

In the present study, we included 2,104,880 men and 2,153,747 women. Unmarried patients constituted 667,621 (31.7%) and 1,022,592 (47.5%) in the male and female cohorts, respectively. For men, fully adjusted survival model suggested that unmarried status was associated with an increased hazard of accidental death (adjusted HR [aHR], 1.74; 95% CI, 1.681.81). For women, a similar association was observed (aHR, 1.47; 95% CI, 1.411.55). The risk increase was largest in men during the first year of follow-up after a cancer diagnosis (aHR, 1.97; 95% CI, 1.852.11), while in women it peaked at approximately the fifth year of follow-up (aHR, 1.50; 95% CI, 1.391.62).

CONCLUSIONS

Findings highlight that, overall, being unmarried is associated with an increased risk of accidental death in cancer patients and that this association differs between men and women. More attention needs to be given to unmarried cancer survivors in clinical care and social security management.