Marital Transition and Risk of Stroke: How Living Arrangement and Employment Status Modify Associations

Stroke. 2016 Apr;47(4):991-8. doi: 10.1161/STROKEAHA.115.011926. Epub 2016 Mar 1.


Background and purpose: There have been consistent findings reported that marital transition (ie, change in marital status during a given time period) is associated with risk of cardiovascular disease; however, few studies have been conducted on stroke risk, particularly stroke subtypes. Moreover, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk.

Methods: We examined sex-specific associations between marital transition and stroke risk using data from Japan Public Health Center-based Prospective Study. We included 24 162 men and 25 626 women who were married at prebaseline (5 years before baseline). Marital transition was determined by marital status at baseline. Weighted hazard ratios of stroke risk were estimated by Cox proportional regression analysis with inverse probability of weighting using a propensity score.

Results: An increased risk of stroke, particularly hemorrhagic stroke, was observed among men and women with marital transition (ie, married to unmarried); weighted hazard ratios (95% confidence interval [CI]) for men and women were 1.26 (1.13-1.41) and 1.26 (1.09-1.45), respectively. Participants with marital transition and lived with children had increased stroke risk. Living with parents buffered the increased stroke risk owing to marital transition among men; however, no such effect was identified among women. Elevated stroke risk owing to marital transition was magnified among women if they were unemployed; weighted hazard ratio=2.98 (95% CI, 1.66-5.33).

Conclusions: Living arrangement and employment status modified the positive associations between marital transition and stroke risk, which differed by sex.

Keywords: Japan; cardiovascular diseases; employment; marital status; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Employment*
  • Female
  • Humans
  • Incidence
  • Japan / epidemiology
  • Life Style*
  • Male
  • Marital Status*
  • Middle Aged
  • Prospective Studies
  • Residence Characteristics
  • Risk
  • Stroke / epidemiology*
  • Stroke / etiology