title: A longitudinal population-based analysis of relationship status and mortality in KwaZulu-Natal, South Africa 2001-2011.
abstract: BACKGROUND
  Mortality risk is lower in married than in unmarried men and women. However, little is known about the association between mortality and relationship status in South Africa where marriage rates are low, migration is common, many couples are not co-resident and HIV prevalence is high.
  
  
  METHODS
  Using demographic surveillance data collected from 2001 to 2011, relationship status was categorised as conjugal (partners belong to the same household), non-conjugal (partners do not belong to the same household) or not partnered. Rates of relationship formation and dissolution were calculated by age and sex. Controlling for antiretroviral treatment (ART) introduction in 2005 as well as education, sex-specific and age-specific Cox proportional hazards models were used to investigate the association between relationship status and (1) all-cause mortality and (2) non-AIDS mortality.
  
  
  RESULTS
  Before 2005, individuals in conjugal relationships had a lower hazard of all-cause mortality in all age groups than not partnered men and women. Non-conjugal relationships lowered the risk of dying compared with not partnered men and women in fewer age groups. After ART introduction, the protective association of conjugal relationships was weaker but remained generally significant for men and women but not in non-conjugal relationships. In the later period, the association is reversed in young men (20-29 years) with mortality higher in conjugal and non-conjugal relationships compared with men not partnered. The analysis of non-AIDS deaths provided similar results.
  
  
  CONCLUSIONS
  The higher degree of social connections within a shared household environment that characterises conjugal relationships affords men and women greater protection against mortality.
authors.affiliation: Oxford Institute of Population Ageing, University of Oxford, Oxford, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Channon
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, Southampton, UK Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hosegood
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa Department of Social Statistics and Demography and Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
authors.forename: Nuala
authors.initials: N
authors.lastname: McGrath
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008393:Marriage; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011157:Population Dynamics; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; MARITAL STATUS; MORTALITY