Do good health and material circumstances protect older people from the increased risk of death after bereavement?
An increased risk of death in persons who have suffered spousal bereavement has been described in many populations. The impact of modifying factors, such as chronic disease and material circumstances, is less well understood. The authors followed 171,720 [corrected] couples 60 years of age or older in a United Kingdom primary care database between 2005 and 2010 for an average of 4 years. A total of 26,646 (15.5%) couples experienced bereavement, with mean follow up after bereavement of 2 years. In a model adjusted for age, sex, comorbid conditions at baseline, material deprivation based on area of residence, season, and smoking status, the hazard ratio for mortality in the first year after bereavement was 1.25 (95% confidence interval: 1.18, 1.33). Further adjustment for changes in comorbid conditions throughout follow up did not alter the hazard ratio for bereavement (hazard ratio = 1.27, 95% confidence interval: 1.19, 1.35). The association was strongest in individuals with no significant chronic comorbid conditions throughout follow up (hazard ratio = 1.50, 95% confidence interval: 1.28, 1.77) and in more affluent couples (P = 0.035). In the first year after bereavement, the association between bereavement and death is not primarily mediated through worsening or new onset of chronic disease. Good health and material circumstances do not protect individuals from increased mortality rates after bereavement.
Division of Population Health Sciences and Education, St. George's University of London, London, UK. sushah@sgul.ac.uk
Sunil M
SM
Shah
Iain M
IM
Carey
Tess
T
Harris
Stephen
S
DeWilde
Christina R
CR
Victor
Derek G
DG
Cook
D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001601:Bereavement; D002908:Chronic Disease / Q000401:mortality; D015897:Comorbidity; D016001:Confidence Intervals; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006117:Grief; D006304:Health Status; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D012907:Smoking / Q000009:adverse effects; D012923:Social Class; D018454:Spouses / Q000706:statistics & numerical data; D015996:Survival Rate; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology