Abstract 12624: Understanding the Protective Benefits of Marriage on Survival after Myocardial Infarction
Background: Prior studies have shown that married patients are at less risk for mortality following acute myocardial infarction (AMI) compared to their unmarried counterparts. These studies have had limited capacity to adjust for patient-centered characteristics that might confound this association.
Methods: We prospectively enrolled 6,838 post-AMI patients from 31 US sites between 2003 and 2008. To account for age differences between the married and unmarried, the analysis was restricted to the 4,853 individuals (66.7% male) between 50 and 80 years of age. “Married” included common law marriages. “Non-married” included divorced, widowed, or never married individuals. A proportional hazards regression model was used to evaluate the association between marital status and 2-year mortality. To evaluate if marital status differentially affects men vs women, a marital status-by-gender interaction was tested. To determine what factors may mediate the relationship between marriage and mortality, an additive stepwise approach was taken adjusting sequentially for demographic, socioeconomic, clinical, and psychosocial characteristics.
Results: Overall, 58.6% of the study population was married. Two-year mortality was 8.7% in married and 13.6% in unmarried individuals. There was no interaction between marital status and gender (p= 0.87). Married individuals were at lower risk for mortality compared to unmarried individuals even after adjustment for age (hazard ration [HR] 0.61), gender and race (HR 0.71), and socioeconomic status (HR 0.72). However, after adjusting for clinical (HR 0.83) and psychosocial (HR 0.86) characteristics, the mortality benefit was no longer significant.
Conclusions: The unadjusted survival benefit of marriage is no longer significant after adjusting for clinical and psychosocial characteristics. Future studies should examine whether clinical or psychosocial interventions can improve the outcomes of unmarried patients.
- © 2013 by American Heart Association, Inc.