Marital Transition and Risk of Stroke

Abstract

Background and Purpose-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 .).The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

Changes in the living arrangement and risk of stroke in Japan; does it matter who lives in the household? Who among the family matters?

“…The finding that losing companionship was associated with increased risk of stroke in men and women of the current study is consistent with other Japanese and Western studies which showed increased risks of morbidity and mortality after the death of a family member [13–16], divorce [18, 21], separations from a close family member, departure of a household member, movement in of a new household member or a member's relocation of residence [17,18]. …”

“…The indicated increased risk of stroke upon losing family members in our study was associated with the loss of a spouse for both men and women, which was similar to previous studies in Japan [18] and Western countries [21–24]. These findings might be attributed to the psychological stress that follows such major life changing events stemming from the loss of financial stability [22], and reduced social support and social networks [9,23,24].…”

“…Living with other relatives after losing a spouse may cushion the psychosocial stress to some extent in men, but may exacerbate it in women. A recent study showed that living with parent(s) after marital transition exacerbated the stroke risk among women [18]. Although we should expect women to receive similar buffering mechanisms that may cushion their psychosocial stress, like in men, however, this is not the case for the Japanese society.…”

“…Other hypothesized mechanisms underlying the association between losing companionship and stroke risk include adopting unhealthy profiles of health behavior [27–29], and exacerbating of preexisting health conditions [2,3,9,30]; which were evident from the baseline characteristics of our studied participants; more smokers and drinkers, higher prevalence of hypertensions, more mental stress and less life enjoyment in participants who experienced loss of ≥1 family members. Marital dissolution was associated with higher risk of ischemic and hemorrhagic strokes in Japanese and Swedish men, but only with risk of hemorrhagic stroke in Japanese women and ischemic stroke in Swedish women [18, 21]. The exact mechanisms by which changes in the living arrangement were associated with ischemic stroke in Japanese men, while associated with hemorrhagic stroke in women are not clear.…”

“…A recent study has shown that marital transition, defined as a change in marital status during a given time was associated with risk of stroke in Japanese men and women, and the associations were modified by accompanied changes in living arrangement [18]. However, although marital transition has two directions, that study dealt with only marital transition from married to unmarried.…”