Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 32161813 · doi:10.1186/s41256-020-00133-8
What was done
Researchers performed a systematic review and meta-analysis by searching PubMed and EMBASE from inception through April 2018. They extracted sex-specific relative risks (RRs) to compute the women-to-men ratio of RRs (RRR) and 95% confidence intervals, pooling outcomes across studies using random-effects inverse-variance weighting to assess cardiovascular disease, coronary heart disease, cancer, and all-cause mortality.
What was found
Twenty-one studies encompassing 7,891,623 individuals and 1,888,752 deaths were included. Being unmarried was associated with higher all-cause, cancer, CVD, and CHD mortality in both sexes, but the adverse associations for CVD and all-cause mortality were stronger in men. Divorced/separated status was linked to a higher risk of all-cause, cancer, and CVD mortality in men. Never-married men had a 31% greater risk of stroke mortality and a 9% greater risk of all-cause mortality compared with never-married women. Specific numerical point estimates and 95% CIs for individual RRs were not reported in the abstract.
Why it matters
This large meta-analysis demonstrates that the mortality penalties associated with unmarried or divorced status are disproportionately higher in men than women, pointing to sex-specific behavioral or social support dynamics in health outcomes.
Limits
Findings rely on observational cohort studies prone to residual confounding (such as baseline lifestyle factors, socioeconomics, and pre-existing illness). Specific effect sizes, confidence intervals, and statistical heterogeneity metrics were omitted from the abstract.
Cited by
- supports The mortality risk associated with divorce is significantly higher for men than for women.