title: Cause-specific mortality among spouses of Parkinson disease patients.
abstract: BACKGROUND
  Caring for a chronically ill spouse is stressful, but the health effects of caregiving are not fully understood. We studied the effect on mortality of being married to a person with Parkinson disease.
  
  
  METHODS
  All patients in Denmark with a first-time hospitalization for Parkinson disease between 1986 and 2009 were identified, and each case was matched to five population controls. We further identified all spouses of those with Parkinson disease (n = 8,515) and also the spouses of controls (n = 43,432). All spouses were followed in nationwide registries until 2011.
  
  
  RESULTS
  Among men, being married to a Parkinson disease patient was associated with a slightly higher risk of all-cause mortality (hazard ratio = 1.06 [95% confidence interval = 1.00-1.11]). Mortality was particularly high for death due to external causes (1.42 [1.09-1.84]) including suicide (1.89 [1.05-3.42]) and death from undefined symptoms/abnormal findings (1.25 [1.07-1.47]). Censoring at the time of death of the patient attenuated the findings for all-cause mortality in husbands (1.02 [0.95-1.09]), indicating that part of the association is with bereavement. Still, living with a person with Parkinson disease 5 years after first Parkinson hospitalization was associated with higher risk of all-cause mortality for both husbands (1.15 [1.07-1.23]) and wives (1.11 [1.04-1.17]).
  
  
  CONCLUSIONS
  Caring for a spouse with a serious chronic illness is associated with a slight but consistent elevation in mortality risk.
authors.affiliation: From the aDepartment of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; bDanish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark; cSchool of Public Health, UCLA, Los Angeles, CA; dHarvard School of Public Health, Department of Epidemiology, Boston, MA; eDepartment of Neurology, Odense University Hospital, Odense, Denmark; and fThe Copenhagen Stress Research Center, Copenhagen, Denmark.
authors.forename: Malene
authors.initials: M
authors.lastname: Nielsen
authors.forename: Johnni
authors.initials: J
authors.lastname: Hansen
authors.forename: Beate
authors.initials: B
authors.lastname: Ritz
authors.forename: Helene
authors.initials: H
authors.lastname: Nordahl
authors.forename: Eva
authors.initials: E
authors.lastname: Schernhammer
authors.forename: Lene
authors.initials: L
authors.lastname: Wermuth
authors.forename: Naja Hulvej
authors.initials: NH
authors.lastname: Rod
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D002423:Cause of Death; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease; D016016:Proportional Hazards Models; D012042:Registries; D012737:Sex Factors; D018454:Spouses