Marital history and survival after a heart attack

Abstract

Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n = 2197). We found that adults who were never married (odds ratio [OR] = 1.73), currently divorced (OR = 1.70), or widowed (OR = 1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12% for every additional marital loss and decreased by 7% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.

Keywords: Aging; Heart attack; Marital status; Survival.

Figure 1

Predicted Odds of Mortality after a Heart Attack by Marital History in U.S. Older Adults Note: Predicted odds are based on estimates in Model 2 in Table 2. Non-significant interaction terms were omitted from the equations when illustrating the results in the figure. Marriage duration is illustrated at 33% (short) and 66% (long) as the ratio of longest marriage in years/age.