Ben-Shlomo Y, Smith G D, Shipley M, Marmot M G
Department of Epidemiology and Public Health, University College and Middlesex School of Medicine, University College, London.
J Epidemiol Community Health. 1993 Jun;47(3):200-5. doi: 10.1136/jech.47.3.200.
To determine the effect of marital status on mortality for men. In particular, to examine whether subgroups of unmarried men (widowed, single, and divorced/separated men) have a similar mortality to married men.
Cohort study.
Whitehall civil service, London, between 1967 and 1969.
A total of 18,403 men aged 40-64 years with 18 years' follow up.
Cause-specific mortality rates and risk factors at baseline were determined. Overall mortality was greater for all groups of unmarried men. Patterns of mortality were different in the subgroups of unmarried men. Widowed men had a significantly greater risk of dying from ischaemic heart disease (relative risk (RR) 1.46, 95% confidence interval (CI) 1.08, 1.97) which persisted after exclusion of deaths that occurred in the first two years. Divorced men had greater cancer mortality (RR 1.49; 95% CI 1.06, 2.10) that could not be explained simply by their greater consumption of cigarettes. The initial increased mortality for single men was no longer evident after adjustment for other risk factors, suggesting that single status in itself may not increase the risk. The risk for single men may have been underestimated, however, by over adjustment for possible intermediary factors.
Previous studies, which have examined total mortality only or have grouped all unmarried men, have masked interesting differences in the cause of death between subgroups of unmarried men. The extent to which the findings are explicable by psychosocial factors or the role of other environmental factors, which may also differ in relation to marital status, is unclear. Future work should not assume that all unmarried men have similar mortality risks and must examine the life course of each subgroup to advance our understanding of the possible causal role of marital status in disease aetiology.
确定婚姻状况对男性死亡率的影响。特别是，研究未婚男性亚组（丧偶、单身和离异/分居男性）的死亡率是否与已婚男性相似。
队列研究。
1967年至1969年期间伦敦白厅公务员系统。
共有18403名年龄在40 - 64岁之间的男性，随访18年。
确定了基线时的特定病因死亡率和风险因素。所有未婚男性群体的总体死亡率更高。未婚男性亚组的死亡模式有所不同。丧偶男性死于缺血性心脏病的风险显著更高（相对风险（RR）1.46，95%置信区间（CI）1.08，1.97），在排除头两年内发生的死亡后该风险依然存在。离异男性的癌症死亡率更高（RR 1.49；95% CI 1.06，2.10），这不能简单地用他们更多的吸烟量来解释。在对其他风险因素进行调整后，单身男性最初增加的死亡率不再明显，这表明单身状态本身可能不会增加风险。然而，由于对可能的中介因素过度调整，单身男性的风险可能被低估了。
以往仅研究总死亡率或将所有未婚男性归为一组的研究，掩盖了未婚男性亚组之间在死因方面有趣的差异。这些发现多大程度上可由社会心理因素或其他环境因素的作用来解释尚不清楚，而这些因素在婚姻状况方面也可能不同。未来的研究不应假定所有未婚男性都有相似的死亡风险，必须研究每个亚组的生命历程，以增进我们对婚姻状况在疾病病因学中可能的因果作用的理解。
