Marital status and occupation in relation to short-term case fatality after a first coronary event--a population based cohort.
BACKGROUND
Although marital status and low occupation level has been associated with mortality, the relationship with case fatality rates (CFR) after a coronary event (CE) is unclear. This study explored whether incidence of CE and short-term CFR differ between groups defined in terms of marital status and occupation, and if this could be explained by biological and life-style risk factors.


METHODS
Population-based cohort study of 33,224 subjects (67% men), aged 27 to 61 years, without history of myocardial infarction, who were enrolled between 1974 and 1992. Incidence of CE, and CFR (death during the first day or within 28 days after CE, including out-of-hospital deaths) was examined over a mean follow-up of 21 years.


RESULTS
A total of 3,035 men (6.0 per 1000 person-years) and 507 women (2.4 per 1000) suffered a first CE during follow-up. CFR (during the 1st day) was 29% in men and 23% in women. After risk factor adjustments, unmarried status in men, but not in women, was significantly associated with increased risk of suffering a CE [hazard ratios (HR) 1.10, 95% CI: 0.97-1.24; 1.42: 1.27-1.58 and 1.77: 1.31-2.40 for never married, divorced and widowed, respectively, compared to married]. Unmarried status, in both gender, was also related with an increased CFR (1st day), taking potential confounders into account (odds ratio (OR) 2.14, 95% CI: 1.63-2.81; 1.91: 1.50-2.43 and 1.49: 0.77-2.89 for never married, divorced and widowed, respectively, compared to married men. Corresponding figures for women was 2.32: 0.93-5.81; 1.87: 1.04-3.36 and 2.74: 1.03-7.28. No differences in CFR (1st day) were observed between occupational groups in neither gender.


CONCLUSIONS
In this population-based Swedish cohort, short-term CFR was significantly related to unmarried status in men and women. This relationship was not explained by biological-, life-style factors or occupational level.
Gerward
Sofia
S
Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Skåne University Hospital, Malmö, Sweden. sofia.gerward@med.lu.se
Tydén
Patrik
P
Engström
Gunnar
G
Hedblad
Bo
B
D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality*; D009790:Occupations / Q000706:statistics & numerical data; D011159:Population Surveillance; D012307:Risk Factors; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology
J Intern Med. 2000 Jan;247(1):19-29
10672127
Eur J Public Health. 2008 Oct;18(5):533-8
18621776
Am J Cardiol. 1993 May 1;71(12):1031-5
8475864
BMC Public Health. 2008 Feb 01;8:44
18241335
J Intern Med. 2001 Sep;250(3):201-7
11555123
Eur J Cardiovasc Prev Rehabil. 2008 Oct;15(5):577-82
18756177
Scand J Public Health. 2005;33(3):175-82
16040457
Am J Epidemiol. 1995 Oct 15;142(8):834-42
7572960
Neuropsychiatr Dis Treat. 2008 Apr;4(2):425-32
18728739
J Intern Med. 2000 May;247(5):588-96
10809998
Circulation. 1997 Dec 2;96(11):3849-59
9403607
Am J Epidemiol. 2000 Feb 1;151(3):283-92
10670553
Int J Epidemiol. 2003 Oct;32(5):830-7
14559760
Circulation. 1993 Oct;88(4 Pt 1):1973-98
8403348
N Engl J Med. 1999 Oct 28;341(18):1359-67
10536129
J Intern Med. 2002 Dec;252(6):542-50
12472916
J Intern Med. 1996 Jun;239(6):489-97
8656142
Med J Aust. 1989 Aug 21;151(4):185-8
2629720
N Engl J Med. 1984 Nov 1;311(18):1144-7
6482932
Am J Epidemiol. 1989 Jan;129(1):54-64
2910072
Int J Behav Med. 2006;13(4):340-7
17228992
Scand J Public Health. 2005;33(6):412-23
16332606
J Intern Med. 2006 Feb;259(2):164-72
16420545
Scand J Prim Health Care. 2005 Jun;23(2):75-81
16036545
Arch Intern Med. 2004 Jul 26;164(14):1514-8
15277281
Heart. 2001 Apr;85(4):390-4
11250961
Circulation. 2006 Jul 11;114(2):168-82
16801458
Arterioscler Thromb Vasc Biol. 2006 Mar;26(3):643-8
16357315