Abstract P213: Marital status and Risk of type 2 Diabetes in the Health Professionals Follow-up Study
Married individuals may enjoy better physical and mental health than their unmarried counterparts. Previous work has suggested that never entering marriage or marital termination by death or divorce increases risk of premature mortality and cardiovascular disease, with more pronounced effects among men. Few studies to date have investigated the role of marital status in the development of type 2 diabetes (T2D). We tested the hypothesis that men who are not married have increased risk of incident T2D in the Health Professionals Follow-up Study, an on-going cohort of men. A total of 41,379 men ages 40 to 75 without diabetes at baseline in 1986 were followed until 2008. T2D, marital status and covariates were assessed by questionnaires biennially. New cases of T2D were confirmed by a supplementary questionnaire validated by medical record review. Cox proportional hazards models estimated the effect of time-dependent measures of marital status on incident T2D. Potential confounders and components of the causal pathway were included as time-dependent covariates. During 22 years of follow-up (801,850 person-years), we documented 2952 incident cases of T2D. Strongest associations were evident for widowed men, while associations among men who were either never married or divorced/separated were less consistent. Compared to married men, RRs (95% CIs) of developing T2D for divorced/separated, widowed and never married men were 1.09 (0.94–1.27), 1.29 (1.06–1.57), and 1.17 (0.91–1.52), respectively, after adjusting for age, family history of diabetes and ethnicity. The RR of T2D associated with widowhood was attenuated after adjusting for lifestyle and dietary factors [RR: 1.21 (1.00–1.48)] and no longer significant when further adjusting for BMI [RR: 1.16 (0.95–1.41)]. The opposite trend was observed for divorced/separated men: when adjusting for lifestyle and dietary factors [RR: 1.12 (0.96–1.30)] as well as BMI [1.14 (0.98–1.32)] the RR of T2D increased slightly. Among men who were never married, diet and lifestyle did not alter RR of T2D [1.17 (0.91–1.52)], however, after further adjusting for BMI there was a notable enhanced RR of T2D [1.23 (0.95–1.60)]. When allowing for a 2-year lag period between marital status and disease, RRs of T2D for widowers were augmented and when further adjusting for BMI remained borderline significant [RR: 1.24 (1.00–1.55)]. In conclusion, being widowed is associated with an increased risk of T2D in men and this may be mediated, in part, through unfavorable changes in lifestyle, diet and adiposity. Together with prior work, our findings suggest that widowhood has important implications for metabolic functioning and greater attention to the cardiometabolic health of this population is warranted.
- © 2012 by American Heart Association, Inc.