title: The impact of marriage on bladder cancer mortality.
abstract: OBJECTIVE
  Marital status has been found to influence survival in a number of malignancies. We examined data from the Surveillance, Epidemiology, and End Results (SEER) cancer survival database to see if married patients with bladder cancer had a survival advantage vs. nonmarried patients.
  
  
  METHODS
  The SEER database contains data on 127,015 patients diagnosed with bladder cancer between 1973 and 2002. Using multivariate Cox proportional hazard regression analyses, we examined the impact of marital status (single, married, separated, divorced, or widowed) on survival after diagnosis with bladder cancer. Age, race, AJCC stage, radiation and chemotherapy, and cystectomy were other variables analyzed.
  
  
  RESULTS
  Marital status did not appear to have a significant survival effect for women. However, men who were widowed had a risk of death of 1.74 relative to married men (95% CI 1.15, 2.26, P = 0.008). For widowed men over 70, this effect was even more pronounced, with a risk of death of 2.1 (95% CI 1.33, 3.31, P = 0.001).
  
  
  CONCLUSIONS
  While we did not see any definite survival advantage to being married vs. not being married for patients who are diagnosed with bladder cancer, there is a significant risk to widowed men, particularly older widowed men. This risk is independent of age, race, stage, and may reflect the patient's willingness to seek medical treatment in addition to psychoneuroimmune factors.
authors.affiliation: Department of Urology, School of Medicine, University of California-San Francisco, San Francisco, CA 94143, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Nelles
authors.forename: Sue A
authors.initials: SA
authors.lastname: Joseph
authors.forename: Badrinath R
authors.initials: BR
authors.lastname: Konety
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018426:SEER Program / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology