Sex differences in health care expenditures and mortality after spousal bereavement: A register-based Danish cohort study.
Level 3 - non-randomized controlled study
Retrospective population-based cohort study
PubMed 36947502 · doi:10.1371/journal.pone.0282892
What was done
Data from a nationwide retrospective cohort study of 924,958 Danish citizens aged over 65 years tracked between 2011 and 2016 were analyzed. The authors evaluated changes in health care expenditures among individuals who experienced spousal bereavement compared with time-matched non-bereaved controls, and estimated post-bereavement mortality hazard ratios using time-to-event analysis stratified by age and sex.
What was found
A total of 77,722 individuals (~8.4%) experienced spousal loss (65.8% female). In the first year post-bereavement, weekly healthcare expenditures were significantly higher than in non-bereaved controls for both males (increase of 42 Euros/week [95% CI, 36 to 48]) and females (increase of 35 Euros/week [95% CI, 30 to 40]). Mortality risk spiked highest in the first year and was most pronounced in younger-old males aged 65-69 (HR 1.70 [95% CI, 1.40 to 2.08]), remaining elevated for 6 years. For females aged 65-69, first-year mortality was also elevated (HR 1.27 [95% CI, 1.07 to 1.52]) but normalized thereafter; mortality hazard elevation was almost absent among the oldest old.
Why it matters
The findings demonstrate substantial sex- and age-specific disparities in health deterioration following spousal bereavement, highlighting younger older males as an especially vulnerable demographic with protracted mortality risk.
Limits
The study is observational and registry-based, meaning unmeasured behavioral, social, or clinical confounders were not accounted for in the abstract. Findings reflect the Danish national healthcare setting and may not generalize to systems with different healthcare access or cost structures.