title: Intrinsic association of widowhood with mortality in community-dwelling older women and men: findings from a prospective propensity-matched population study.
abstract: OBJECTIVE
  Widowhood is associated with increased mortality. However, to what extent this association is independent of other risk factors remains unclear. In the current study, we used propensity score matching to design a study to examine the independent association of widowhood with outcomes in a balanced cohort of older adults in the United States.
  
  
  METHODS
  We used public-use copies of the Cardiovascular Health Study data obtained from the National Heart, Lung, and Blood Institute. Of the 5,795 community-dwelling older men and women aged 65 years and older in Cardiovascular Health Study, 3,820 were married and 1,436 were widows or widowers. Propensity scores for widowhood, estimated for each of the 5,256 participants, were used to assemble a cohort of 819 pairs of widowed and married participants who were balanced on 74 baseline characteristics. The 1,638 matched participants had a mean (± standard deviation) age of 75 (± 6) years, 78% were women, and 16% African American.
  
  
  RESULTS
  All-cause mortality occurred in 46% (374/819) and 51% (415/819) of matched married and widowed participants, respectively, during more than 11 years of median follow-up (hazard ratio associated with widowhood, 1.18; 95% confidence interval, 1.03-1.36; p = .018). Hazard ratios (95% confidence intervals) for cardiovascular and noncardiovascular mortalities were 1.07 (0.87-1.32; p = .517) and 1.28 (1.06-1.55; p = .011), respectively. Widowhood had no independent association with all-cause or heart failure hospitalization or incident cardiovascular events.
  
  
  CONCLUSIONS
  Among community-dwelling older adults, widowhood was associated with increased mortality, which was independent of confounding by baseline characteristics and largely driven by an increased noncardiovascular mortality. Widowhood had no independent association with hospitalizations or incident cardiovascular events.
authors: Section of Geriatrics, VA Medical Center, Birmingham, Alabama, USA.
authors: Beverly R
authors: BR
authors: Williams
authors: Yan
authors: Y
authors: Zhang
authors: Patricia
authors: P
authors: Sawyer
authors: Marjan
authors: M
authors: Mujib
authors: Linda G
authors: LG
authors: Jones
authors: Margaret A
authors: MA
authors: Feller
authors: O James
authors: OJ
authors: Ekundayo
authors: Inmaculada B
authors: IB
authors: Aban
authors: Thomas E
authors: TE
authors: Love
authors: Amy
authors: A
authors: Lott
authors: Ali
authors: A
authors: Ahmed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D009026:Mortality; D011446:Prospective Studies; D011634:Public Health; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D017805:Widowhood / Q000706:statistics & numerical data