Does widowhood increase mortality risk?: testing for selection effects by comparing causes of spousal death.
BACKGROUND
We consider whether widowhood increases mortality risk. Although commonly observed, this "widowhood effect" could be due to selection effects, as married couples share various characteristics related to the risk of death. We therefore consider the widowhood effect by various causes of spousal death; some causes of death are correlated with shared characteristics in couples, while others are not.


METHODS
Using data from the Scottish Longitudinal Study, we compare outcomes for men and women by the causes of death of their spouse, controlling for a range of individual- and household-level characteristics.


RESULTS
The widowhood effect in these data is greater than has been found in other recent studies, with adjusted hazard ratios of 1.40 (95% confidence interval = 1.33-1.47) for men and 1.36 (1.30-1.44) for women. The risk is highest shortly after widowhood, but remains raised for at least 10 years. There was little evidence that these hazard ratios differed by any classification of the cause of death of the spouse, but interactions were found for those with pre-existing illness or other risk factors. The hazard ratios for widowhood were lower for persons with preexisting risks.


CONCLUSIONS
Our analysis of the widowhood effect uses 3 methods of classifying the causes of spousal death in an attempt to control for potential selection effects. Our results are highly consistent and suggest that this is a causal effect, rather than a result of selection.
Longitudinal Studies Centre-Scotland, University of St Andrews, St Andrews, Scotland, United Kingdom. P.Boyle@st-andrews.ac.uk
Paul J
PJ
Boyle
Zhiqiang
Z
Feng
Gillian M
GM
Raab
D000368:Aged; D000369:Aged, 80 and over; D001601:Bereavement; D002423:Cause of Death; D019352:Censuses; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D018570:Risk Assessment; D012606:Scotland / Q000453:epidemiology; D017805:Widowhood