title: Marital status and mortality among middle age and elderly men and women in urban Shanghai.
abstract: BACKGROUND
  Previous studies have suggested that marital status is associated with mortality, but few studies have been conducted in China where increasing aging population and divorce rates may have major impact on health and total mortality.
  
  
  METHODS
  We examined the association of marital status with mortality using data from the Shanghai Women's Health Study (1996-2009) and Shanghai Men's Health Study (2002-2009), two population-based cohort studies of 74,942 women aged 40-70 years and 61,500 men aged 40-74 years at the study enrollment. Deaths were identified by biennial home visits and record linkage with the vital statistics registry. Marital status was categorized as married, never married, divorced, widowed, and all unmarried categories combined. Cox regression models were used to derive hazard ratios (HR) and 95% confidence interval (CI).
  
  
  RESULTS
  Unmarried and widowed women had an increased all-cause HR = 1.11, 95% CI: 1.03, 1.21 and HR = 1.10, 95% CI: 1.02, 1.20 respectively) and cancer (HR = 1.17, 95% CI: 1.04, 1.32 and HR = 1.18, 95% CI: 1.04, 1.34 respectively) mortality. Never married women had excess all-cause mortality (HR = 1.46, 95% CI: 1.03, 2.09). Divorce was associated with elevated cardiovascular disease (CVD) mortality in women (HR = 1.47, 95% CI: 1.01, 2.13) and elevated all-cause mortality (HR = 2.45, 95% CI: 1.55, 3.86) in men. Amongst men, not being married was associated with excess all-cause (HR = 1.45, 95% CI: 1.12, 1.88) and CVD (HR = 1.65, 95% CI: 1.07, 2.54) mortality.
  
  
  CONCLUSIONS
  Marriage is associated with decreased all cause mortality and CVD mortality, in particular, among both Chinese men and women.
authors.affiliation: University of New England College of Osteopathic Medicine, Biddeford, Maine, United States of America.
authors.forename: Puthiery
authors.initials: P
authors.lastname: Va
authors.forename: Wan-Shui
authors.initials: WS
authors.lastname: Yang
authors.forename: Sarah
authors.initials: S
authors.lastname: Nechuta
authors.forename: Wong-Ho
authors.initials: WH
authors.lastname: Chow
authors.forename: Hui
authors.initials: H
authors.lastname: Cai
authors.forename: Gong
authors.initials: G
authors.lastname: Yang
authors.forename: Shan
authors.initials: S
authors.lastname: Gao
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Gao
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
authors.forename: Yong-Bing
authors.initials: YB
authors.lastname: Xiang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008393:Marriage; D008875:Middle Aged; D009026:Mortality; D014505:Urban Population
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