title: Effect of marriage on duration of chest pain associated with acute myocardial infarction before seeking care.
abstract: BACKGROUND
  Coronary artery disease is the most common cause of death in the Western world, and being married decreases the risk of death from cardiovascular causes. We aimed to determine whether marital status was a predictor of the duration of chest pain endured by patients with acute myocardial infarction before they sought care and whether the patient's sex modified the effect.
  
  
  METHODS
  We conducted a retrospective, population-based cohort analysis of patients with acute myocardial infarction admitted to 96 acute care hospitals in Ontario, Canada, from April 2004 to March 2005. We excluded patients who did not experience chest pain. Using multivariable regression analyses, we assessed marital status in relation to delayed presentation to hospital (more than six hours from onset of pain), both overall and stratified by sex. In patients who reported the exact duration of chest pain, we assessed the effect of marital status on the delay in seeking care.
  
  
  RESULTS
  Among 4403 eligible patients with acute myocardial infarction, the mean age was 67.3 (standard deviation 13.6) years, and 1486 (33.7%) were women. Almost half (2037 or 46.3%) presented to a hospital within two hours, and 3240 (73.6%) presented within six hours. Overall, 75.3% (2317/3079) of married patients, 67.9% (188/277) of single patients, 68.5% (189/276) of divorced patients and 70.8% (546/771) of widowed patients presented within six hours of the onset of chest pain. Being married was associated with lower odds of delayed presentation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.30-0.71, p < 0.001) relative to being single. Among men, the OR was 0.35 (95% CI 0.21-0.59, p < 0.001), whereas among women the effect of marital status was not significant (OR 1.36, 95% CI 0.49-3.73, p = 0.55).
  
  
  CONCLUSIONS
  Among men experiencing acute myocardial infarction with chest pain, being married was associated with significantly earlier presentation for care, a benefit that was not observed for married women. Earlier presentation for medical care appears to be one reason for the observed lower risk of cardiovascular death among married men, relative to their single counterparts.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. clare.atzema@ices.on.ca
authors.forename: Clare L
authors.initials: CL
authors.lastname: Atzema
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.forename: Maria
authors.initials: M
authors.lastname: Chiu
authors.forename: Julie T
authors.initials: JT
authors.lastname: Wang
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008393:Marriage; D009203:Myocardial Infarction / Q000150:complications; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors