title: Marital Transition and Risk of Stroke: How Living Arrangement and Employment Status Modify Associations.
abstract: OBJECTIVE
  There have been consistent findings reported that marital transition (ie, change in marital status during a given time period) is associated with risk of cardiovascular disease; however, few studies have been conducted on stroke risk, particularly stroke subtypes. Moreover, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk.
  
  
  METHODS
  We examined sex-specific associations between marital transition and stroke risk using data from Japan Public Health Center-based Prospective Study. We included 24 162 men and 25 626 women who were married at prebaseline (5 years before baseline). Marital transition was determined by marital status at baseline. Weighted hazard ratios of stroke risk were estimated by Cox proportional regression analysis with inverse probability of weighting using a propensity score.
  
  
  RESULTS
  An increased risk of stroke, particularly hemorrhagic stroke, was observed among men and women with marital transition (ie, married to unmarried); weighted hazard ratios (95% confidence interval [CI]) for men and women were 1.26 (1.13-1.41) and 1.26 (1.09-1.45), respectively. Participants with marital transition and lived with children had increased stroke risk. Living with parents buffered the increased stroke risk owing to marital transition among men; however, no such effect was identified among women. Elevated stroke risk owing to marital transition was magnified among women if they were unemployed; weighted hazard ratio=2.98 (95% CI, 1.66-5.33).
  
  
  CONCLUSIONS
  Living arrangement and employment status modified the positive associations between marital transition and stroke risk, which differed by sex.
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Department of Public Health, Juntendo University, Faculty of Medicine, Tokyo, Japan (A.I.); Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (M.I.); and Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Kaori
authors.initials: K
authors.lastname: Honjo
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Department of Public Health, Juntendo University, Faculty of Medicine, Tokyo, Japan (A.I.); Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (M.I.); and Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.). iso@pbhel.med.osaka-u.ac.jp.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Department of Public Health, Juntendo University, Faculty of Medicine, Tokyo, Japan (A.I.); Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (M.I.); and Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Ai
authors.initials: A
authors.lastname: Ikeda
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Department of Public Health, Juntendo University, Faculty of Medicine, Tokyo, Japan (A.I.); Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (M.I.); and Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Department of Public Health, Juntendo University, Faculty of Medicine, Tokyo, Japan (A.I.); Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (M.I.); and Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Norie
authors.initials: N
authors.lastname: Sawada
authors.affiliation: From the Global Collaboration Center, Osaka University, Osaka, Japan (K.H.); Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan (H.I.); Department of Public Health, Juntendo University, Faculty of Medicine, Tokyo, Japan (A.I.); Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (M.I.); and Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan (M.I., N.S., S.T.).
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
mesh_terms: D000328:Adult; D000368:Aged; D004651:Employment; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011446:Prospective Studies; D012111:Residence Characteristics; D012306:Risk; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
keywords: Japan; cardiovascular diseases; employment; marital status; stroke