007 Associations between marital status and survival after a first acute myocardial infarction in Scotland, 1988-2004

Abstract

Background There is evidence that marriage has a beneficial effect on health; unmarried experience higher mortality and incidence of mental and physical disorders. In particular, being unmarried is associated with elevated coronary heart disease mortality. Objectives Investigate the association between marital status and survival after a first acute myocardial infarction (AMI) and any trends and relationships with age, sex and deprivation. Design Linked hospital discharges and death records for all AMI events from 1981 to 2004 for those aged 30+ years. Case-fatality was divided into CF0: death on day of first AMI; CF1: death in 2–28 days following first AMI; and CF2: death in 29–365 days. Area deprivation (DEPCAT) was assessed using Carstairs scores. Marital status was categorised into married, never-married/widowed and other. Setting Scotland, population 5.1 million. Main outcome measures Directly age standardised case-fatality rates were calculated. Odds of case-fatality by marital status, adjusting for age, sex, year, and area deprivation were estimated through multilevel logistic regression. Results Between 1988 and 2004, 178 781 (48%) of the 372 349 patients with a first AMI died on the day of event, 34 198 (18%) of those surviving the day of their first AMI died within 28 days and 17 971 (11%) of those surviving 28 days after their first AMI died within 1 year. Marital status was significantly associated with each case-fatality outcome. The odds of CF0 for never-married/widowed compared to married increased over time and was strongest in 60–74 year-olds living in deprived areas—for example, OR for men aged 60–74 in most deprived areas in 2000–2004 was 2.81 (95% CI 2.65 to to 2.98) and for men 30–59 was 2.43 (95% CI 2.27 to 2.60); the protective effect of marriage appeared stronger for women that is, the respective ORs for women were 3.00 (2.82–3.19) and 3.05 (2.76–3.37). The odds of CF1 by marital status increased and were strongest in younger ages—for example, OR for men aged 30–59 in 2000–04 was 1.54 (1.34–1.77) and for women was 1.45 (1.26–1.67). The odds of CF2 increased over time (OR in 2000–04 was 1.75 (1.61–1.90)) but did not differ by age, sex or deprivation. Conclusions Marriage is beneficial to survival after a first AMI. This relationship differs by socio-economic and demographic circumstances. The benefits of being married may be due to stronger social support—for example, relationship with short-term case-fatality may be explained by married patients taking less time to seek medical attention and may be explained long-term by higher uptake/commitment to secondary prevention programmes.