title: The health impact of remarriage behavior on chronic obstructive pulmonary disease: findings from the US longitudinal survey.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a major disease among adults, and its deterioration was reported to be associated with psychological imbalance. Meanwhile, bereavement and divorce have proven harmful to the health status of a surviving spouse. But few studies have been conducted to evaluate the remedial effect on survivors' health outcome by remarriage after bereavement. The present study thus examined the associations between remarriage and the onset of COPD.
  
  
  METHODS
  Our cohort was drawn from Health and Retirement Study participants in the United States, and consisted of 2676 subjects who were divorced or bereaved from 1992 to 2002. We then followed them for up to 11 years and assessed the incidence rate of COPD using a Cox proportional hazard model after adjusting for marital status, age, gender, education and the number of cigarettes smoked.
  
  
  RESULTS
  Among all subjects, 224 who remarried after bereavement or divorce tended to be younger and more male dominated. Remarriage after bereavement/divorce was associated with significantly decreased risk of COPD onset for overall subjects [hazard ratio (HR): 0.51, 95% confidence interval (95% CI): 0.28-0.94], female subjects [HR: 0.36, 95% CI: 0.13-0.98], and for those under 70 years old [HR: 0.36, 95% CI: 0.17-0.79].
  
  
  CONCLUSIONS
  This study investigates the impact of remarriage on health outcome based on a large-scale population survey and indicates that remarriage significantly correlates with reduced risk of COPD incidence, even after adjusting smoking habit.
authors.affiliation: Department of Health Care Administration and Management, Kyushu University Graduate School of Medicine, Maidashi 3-1-1, Fukuoka city, Fukuoka, Japan. t-n@umin.ac.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Noda
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ojima
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayasaka
authors.forename: Akihito
authors.initials: A
authors.lastname: Hagihara
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi
authors.forename: Koichi
authors.initials: K
authors.lastname: Nobutomo
mesh_terms: D000368:Aged; D001601:Bereavement; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000453:epidemiology*; D008297:Male; D008393:Marriage; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology