title: Marital status and mortality among Japanese men and women: the Japan Collaborative Cohort Study.
abstract: BACKGROUND
  Several studies have indicated a significant association between marital status and mortality risks. However, most of these studies have compared married and unmarried people without differentiating among single, divorced and widowed status. Moreover, gender differences in mortality rates associated with marital status have not been sufficiently clarified. With significant increases in the percentages of divorced and widowed people and a corresponding drop in the marriage rate in Japan during the past two or three decades, it can be expected that these changes will have a significant impact on mortality rates.
  
  
  METHODS
  This investigation used a prospective study of a total of 94,062 Japanese men and women aged 40-79 who completed self-administered questionnaires at baseline and during a followed-up of 9.9-years.
  
  
  RESULTS
  Compared with married men, never-married men showed higher risks of mortality from cardiovascular disease [relative risk (RR) = 3.05, 95% confidence interval (CI) 2.03-4.60], respiratory disease (RR = 2.43, 95%CI 1.27-4.63), external causes (RR = 2.18, 95%CI 1.05-4.54) and all causes (RR = 1.91, 95%CI 1.51-2.42) after adjustment for potentially confounding variables. For never-married women, there was a smaller but significantly higher risk of mortality from all causes (RR = 1.46, 95%CI 1.15-1.84). Divorced and widowed men showed moderately higher risks of mortality from cardiovascular disease, external causes and all causes compared with married men, but such a trend was not observed in women.
  
  
  CONCLUSIONS
  Single status was associated with a higher risk of mortality than was married status for both men and women. Divorce and widowhood were associated with elevated risk for men, but not for women. These findings suggest single, divorce and widowhood status constitute potentially adverse health effects.
authors.affiliation: Department of Public Health Medicine, Doctoral Program in Social and Environmental Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennoudai, Tsukuba-shi, Ibaraki, Japan. ai-ikeda@umin.net <ai-ikeda@umin.net>
authors.forename: Ai
authors.initials: A
authors.lastname: Ikeda
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.forename: Hideaki
authors.initials: H
authors.lastname: Toyoshima
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujino
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mizoue
authors.forename: Takesumi
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Inaba
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamakoshi
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012944:Social Support