Married adults may have lower risk of death following strokes

Married adults had a significantly lower risk of death following a stroke compared with those who were never married, remarried or widowed, according to an analysis of an ongoing observational, prospective cohort study.

Researchers Matthew E. Dupre, PhD, and Renato D. Lopes, MD, PhD, of the Duke Clinical Research Institute, and colleagues published their results online Dec. 14 in the Journal of the American Heart Association.

“Our research is the first to show that current and past marital experiences can have significant consequences for one’s prognosis after a stroke,” Dupre said in a news release. “We hope that a greater recognition and understanding of these associations may enable healthcare providers to better identify and treat patients who may be at a potentially high risk of dying after suffering a stroke.”

They noted that approximately 800,000 adults have strokes each year. Previous research showed that reducing risk factors and adhering to medications helps patients recover from a stroke and may improve survival.

For this analysis, Dupre and Lopes evaluated 2,351 U.S. adults who suffered a stroke and participated in the Health and Retirement Study, an ongoing trial that enrolls adults who are older than 50. The adults were interviewed from 1992 to 2010 and asked about their marital status at each meeting.

The researchers found that adults who died following a stroke were significantly more likely to be older, less educated and have lower levels of income and more likely to have no children, more depressive symptoms, exercise less frequently. They were also less likely to take hypertension medication, have lower body mass index and more activities of daily living limitations.

Adults who never married had a 71 percent greater risk of dying after a stroke compared with those who were continuously married. Meanwhile, divorced patients had a 23 percent greater risk of death and widowed adults had a 25 percent greater risk of death compared with continuously married adults. Further, patients who were divorced more than once had a 39 percent greater risk of death and patients who were widowed more than once had a 40 percent greater risk of death compared with continuously married adults.

“Contrary to expectations and existing literature, we found that factors such as income, health insurance, depressive symptoms, alcohol use, and smoking did not account for the excess risks associated with a history of marital loss,” the researchers wrote. “We suspect that the acute and chronic stress associated with marital loss(es) may have played an important role in our findings—particularly as it related to widowhood in older ages.”

The researchers cited a few limitations of the study, including that the self-diagnoses of strokes were not formally adjudicated. They also mentioned that the study only enrolled adults who survived to hospital discharge, so the findings might be subject to selection bias. In addition, they noted that unmeasured factors could have played a role in the findings.

The researchers did not have information on the severity or type of stroke, the treatment or control of hypertension and diabetes and other clinical factors that have previously been shown to be associated with survival after an acute cerebrovascular event. The observational design of the study was another limitation and meant the results did not indicate causality and might not be generalizable to other groups.

“Although marital events are not amenable to medical intervention or treatment, knowledge about the risks associated with marital life may be useful for personalizing care and improving prognoses for those who experience a stroke,” the researchers wrote. “Greater recognition and understanding of these associations may enable healthcare providers to better identify and treat older adults with illness who are at potentially high risk of dying, as well as provide older adults a greater awareness of the risks associated with their marital status and background. Future studies are needed to further examine the mechanisms contributing to these associations and to assess how such information can be used to aggressively treat vulnerable segments of the population.”