在过去的几十年里，全球结婚率显著下降，关于婚姻状况与死亡率之间的关系，人们已经形成广泛的共识。最近的一项荟萃分析显示，未婚的人比已婚的人有更高的全因死亡和特定原因死亡的风险。

研究共纳入623140名患者，与已婚个体相比，未婚个体的总死亡率hr 1.15 (95% CI, 1.07-1.24)，脑血管疾病死亡率hr 1.12 (95% CI, 1.03-1.22)，冠心病死亡率为1.20 (95% CI, 1.09-1.31)，循环系统疾病死亡率hr1.17 (95% CI, 1.07-1.28)，癌症死亡率hr1.06 (95% CI, 1.01-1.11)，呼吸系统疾病死亡率hr1.14 (95% CI, 1.05-1.23)，外因死亡hr1.19 (95% CI, 1.05-1.34)。

这项针对个体参与者数据的大型集合队列研究提供了强有力的证据，表明未婚以及属于未婚亚类别与总死亡率和病因特异性死亡率呈正相关。可能需要根据已婚和未婚个人之间的死亡率差异来考虑有针对性的社会支助服务的投资。

Abstract

Importance: Marital status has been shown to be associated with mortality, but evidence in Asian populations is limited.

Objective: To examine the association of marital status with total and cause-specific mortality.

Design, setting, and participants: This cohort study included individual participant data from 16 prospective studies in the Asia Cohort Consortium conducted between 1963 and 2015. Asian participants with complete information on marital and vital status were included. Study-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards model and then pooled using a random-effects meta-analysis. The analysis began in February 2021 and ended in August 2021.

Exposures: Marital status.

Main outcomes and measures: All-cause and cause-specific mortality.

Results: Of 623 140 participants (326 397 women [52.4%] and 296 743 men [47.6%]; mean [SD] age, 53.7 [10.2] years; mean [SD] follow-up time, 15.5 [6.1] years), 123 264 deaths were ascertained. Compared with married individuals, those who were unmarried had pooled HRs of 1.15 (95% CI, 1.07-1.24) for total mortality, 1.12 (95% CI, 1.03-1.22) for cerebrovascular disease mortality, 1.20 (95% CI, 1.09-1.31) for coronary heart disease mortality, 1.17 (95% CI, 1.07-1.28) for circulatory system diseases mortality, 1.06 (95% CI, 1.01-1.11) for cancer mortality, 1.14 (95% CI, 1.05-1.23) for respiratory diseases mortality, and 1.19 (95% CI, 1.05-1.34) for external causes of death. Positive associations with total mortality were also observed for those who were single (HR, 1.62; 95% CI, 1.41-1.86), separated (HR, 1.35; 95% CI, 1.13-1.61), divorced (HR, 1.38; 95% CI, 1.13-1.69), and widowed (HR, 1.09; 95% CI, 1.04-1.13). In subgroup analyses, the positive association persisted across baseline health conditions, and the risk of death was more pronounced among men or people younger than 65 years.

Conclusions and relevance: This large pooled cohort study of individual participant data provides strong evidence that being unmarried, as well as belonging to the unmarried subcategories, was positively associated with total and cause-specific mortality. Investment of targeted social support services might need to be considered in light of the mortality differences between married and unmarried individuals.

文章连接：

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792821

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