A wide landscape of morbidity and mortality risk associated with marital status in 0.5 million Chinese men and women: a prospective cohort study
Meng Xiao, Aolin Li, Yueqing Wang, Canqing Yu, Yuanjie Pang, Pei Pei, Ling Yang, Yiping Chen, Huaidong Du, Dan Schmidt, Daniel Avery, Qiang Sun, Junshi Chen, Zhengming Chen, Liming Li, Jun Lv, Dianjianyi Sun, Junshi Chen, Zhengming Chen PI, Robert Clarke, Rory Collins, Canqing Yu, Liming Li PI, Jun Lv, Richard Peto, Robin Walters, Daniel Avery, Derrick Bennett, Ruth Boxall, Sue Burgess, Ka Hung Chan, Yu‐Mei Chang, Yiping Chen, Zhengming Chen, Johnathan Clarke, Robert Clarke, Huaidong Du, Ahmed Edris Mohamed, Zammy Fairhurst-Hunter, Hannah Fry, Mike Hill, Michael V. Holmes, Pek Kei Im, Andri Iona, Maria Kakkoura, Christiana Kartsonaki, Rene Kerosi, Kuang Lin, Mohsen Mazidi, Iona Y. Millwood, Sam Morris, Qunhua Nie, Alfred Pozarickij, Paul Ryder, Saredo Said, Dan Schmidt, Paul Sherliker, Becky Stevens, Iain Turnbull, Robin Walters, Lin Wang, Neil Wright, Ling Yang, Xiaoming Yang, Pang Yao, Canqing Yu, Xiao Han, Can Hou, Jun Lv, Pei Pei, Chao Liu, Canqing Yu, Qingmei Xia, Zengchang Pang, Ruqin Gao, Shanpeng Li, Haiping Duan, Shaojie Wang, Yongmei Liu, Huaidong Du, Yajing Zang, Liang Cheng, Xiaocao Tian, Hua Zhang, Yaoming Zhai, Feng Ning, Xiaohui Sun, Feifei Li, Jun Lv, Junzheng Wang, Wei Hou, Wei Sun, Shichun Yan, Xiaoming Cui, Chi Wang, Zhenyuan Wu, Yanjie Li, Quan Kang, Huiming Luo, Tingting Ou
Abstract
Background A comprehensive depiction of long-term health impacts of marital status is lacking. Methods Sex-stratified phenome-wide association analyses (PheWAS) of marital status (living with vs. without a spouse) were performed using baseline (2004–2008) and follow-up information (ICD10-coded events till Dec 31, 2017) from the China Kadoorie Biobank (CKB). We estimated adjusted hazard ratios (aHRs) to evaluate the associations of marital status with morbidity risks of phenome-wide significant diseases or sex-specific top-10 death causes in China documented in 2017. Additionally, the association between marital status and mortality risks among participants with major chronic diseases at baseline was assessed. Findings During up to 11.1 years of the median follow-up period, 1,946,380 incident health events were recorded among 210,202 men and 302,521 women aged 30–79. Marital status was found to have phenome-wide significant associations with thirteen diseases among men ( p < 9.92 × 10 −5 ) and nine diseases among women ( p < 9.33 × 10 −5 ), respectively. After adjusting for all disease-specific covariates in the final model, participants living without a spouse showed increased risks of schizophrenia, schizotypal and delusional disorders (aHR [95% CI]: 2.55, [1.83–3.56] for men; 1.49, [1.13–1.97] for women) compared with their counterparts. Additional higher risks in overall mental and behavioural disorder (1.31, 1.13–1.53), cardiovascular disease (1.07, 1.04–1.10) and cancer (1.06, 1.00–1.12) were only observed among men without a spouse, whereas women living without a spouse were at lower risks of developing genitourinary diseases (0.89, 0.85–0.93) and injury & poisoning (0.93, 0.88–0.97). Among 282,810 participants with major chronic diseases at baseline, 39,166 deaths were recorded. Increased mortality risks for those without a spouse were observed in 12 of 21 diseases among male patients and one of 23 among female patients. For patients with any self-reported disease at baseline, compared with those living with a spouse, the aHRs (95% CIs) of mortality risk were 1.29 (1.24–1.34) and 1.04 (1.00–1.07) among men and women without a spouse ( p interaction <0.0001), respectively. Interpretation Long-term associations of marital status with morbidity and mortality risks are diverse among middle-aged Chinese adults, and the adverse impacts due to living without a spouse are more profound among men. Marital status may be an influential factor for health needs. Funding The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology, and the UK Wellcome Trust.