The effect of widowhood on mortality by the causes of death of both spouses

Abstract

Objectives: We investigated the effect of spousal bereavement on mortality to document cause-specific bereavement effects by the causes of death of both the predecedent spouse and the bereaved partner.

Methods: We obtained data from a nationally representative cohort of 373 189 elderly married couples in the United States who were followed from 1993 to 2002. We used competing risk and Cox models in our analyses.

Results: For both men and women, the death of a predecedent spouse from almost all causes, including various cancers, infections, and cardiovascular diseases, increased the all-cause mortality of the bereaved partner to varying degrees. Moreover, the death of a predecedent spouse from any cause increased the survivor's cause-specific mortality for almost all causes, including cancers, infections, and cardiovascular diseases, to varying degrees.

Conclusions: The effect of widowhood on mortality varies substantially by the causes of death of both spouses, suggesting that the widowhood effect is not restricted to one aspect of human biology. Future research should examine the specific mechanisms of the widowhood effect and identify opportunities for health interventions.

FIGURE 1

Hazard ratios (HRs) and 95% confidence intervals (CIs) for the effect of widowhood (from any cause) on cause-specific mortality among bereaved men (a) and women (b): Medicare-based cohort of Black and White married couples, aged 67 to 98 years at baseline (n = 373 189), United States, 1993–2002. Note. CVA = cerebral vascular accident; COPD = chronic obstructive pulmonary disease. Estimates from Cox models were adjusted for all baseline covariates. There are separate models for husbands and wives. ^aCancers of the head, neck, upper gastrointestinal tract, liver, central nervous system, or pancreas and melanoma, lymphoma, and leukemia.

FIGURE 2

Hazard ratios (HRs) and 95% confidence intervals (CIs) for the effect of widowhood on all-cause mortality, by the cause of death of the predecedent spouse, among bereaved men (a) and women (b): Medicare-based cohort of Black and White married couples, aged 67 to 98 years at baseline (n = 373 189), United States, 1993–2002. Note. CVA = cerebral vascular accident; COPD = chronic obstructive pulmonary disease. Estimates from competing risk models were adjusted for all baseline covariates. There are separate models for husbands and wives. ^aCancers of the head, neck, upper gastrointestinal tract, liver, central nervous system, or pancreas and melanoma, lymphoma, and leukemia.