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. 2016 May 15;122(10):1570-8.
doi: 10.1002/cncr.29886. Epub 2016 Apr 11.

Differences in marital status and mortality by race/ethnicity and nativity among California cancer patients

María Elena Martínez  1   2 , Kristin Anderson  1 , James D Murphy  1 , Susan Hurley  3 , Alison J Canchola  3 , Theresa H M Keegan  4 , Iona Cheng  3   5 , Christina A Clarke  3   6   5 , Sally L Glaser  3   6   5 , Scarlett L Gomez  3   6   5
Affiliations

Differences in marital status and mortality by race/ethnicity and nativity among California cancer patients

María Elena Martínez et al. Cancer. .

Abstract

Background: It has been observed that married cancer patients have lower mortality rates than unmarried patients, but data for different racial/ethnic groups are scarce. The authors examined the risk of overall mortality associated with marital status across racial/ethnic groups and sex in data from the California Cancer Registry.

Methods: California Cancer Registry data for all first primary invasive cancers diagnosed from 2000 through 2009 for the 10 most common sites of cancer-related death for non-Hispanic whites (NHWs), blacks, Asians/Pacific Islanders (APIs), and Hispanics were used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for marital status in relation to overall mortality by race/ethnicity and sex. The study cohort included 393,470 male and 389,697 female cancer patients and 204,007 and 182,600 deaths from all causes, respectively, through December 31, 2012.

Results: All-cause mortality was higher in unmarried patients than in married patients, but there was significant variation by race/ethnicity. Adjusted HRs (95% CIs) ranged from 1.24 (95% CI, 1.23-1.26) in NHWs to 1.11 (95% CI, 1.07-1.15) in APIs among males and from 1.17 (95% CI, 1.15-1.18) in NHWs to 1.07 (95% CI, 1.04-1.11) in APIs among females. All-cause mortality associated with unmarried status compared with married status was higher in US-born API and Hispanic men and women relative to their foreign-born counterparts.

Conclusions: For patients who have the cancers that contribute most to mortality, being unmarried is associated with worse overall survival compared with being married, with up to 24% higher mortality among NHW males but only 6% higher mortality among foreign-born Hispanic and API females. Future research should pursue the identification of factors underlying these associations to inform targeted interventions for unmarried cancer patients. Cancer 2016;122:1570-8. © 2016 American Cancer Society.

Keywords: marriage; mortality; nativity; neighborhood socioeconomic status; race/ethnicity.

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Conflict of interest statement

Conflict of Interest Disclosures: Christina A. Clarke reports grants from Genentech outside the submitted work.

Comment in

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