scholarly journals Long working hours and mortality in Central and Eastern Europe: the HAPIEE study

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H Pikhart ◽  
Q Liu ◽  
A Pajak ◽  
S Malyutina ◽  
R Kubinova ◽  
...  
Keyword(s):  
Eastern Europe ◽  
Cancer Mortality ◽  
Central And Eastern Europe ◽  
Working Hours ◽  
Long Working Hours ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Mortality Analysis ◽  
Cvd Mortality

Abstract Background Long working hours are common in countries of Central and Eastern Europe (CEE). A wide range of epidemiological studies have showed that long working hours had an adverse effect on health but the evidence mostly comes from Western Europe, East Asia and North America. This study aimed to assess the relationship between long working hours and the risk of mortality in employed people in three Eastern European countries. Methods Participants, aged 45-69 years at baseline, were from the Health, Alcohol and Psychosocial Indicators in Eastern Europe (HAPIEE) cohort study conducted in Russia, Poland and the Czech Republic. Baseline survey included a structured questionnaire and examination in the clinic during 2002-2005. Working hours were assessed by a self-reported questionnaire at baseline. Participants have been followed-up for all-cause mortality and cause-specific mortality for an average of 11 years. Impact of long working hours on mortality was analysed by Cox proportional hazards regression. In all-cause mortality analysis, a total of 10878 men and women were included, and 10399 participants were included in cause-specific mortality analysis. Results During the follow-up, there were 1187 deaths from all causes, 288 from CVD, and 251 from cancer. Those who worked 61 hours or more in a week showed higher risk of mortality compared to those working 36-45 hours per week: HR 1.32 (95%CI 1.01 to 1.74) for all-cause mortality and 1.73 (95% CI 1.03-2.93) for CVD mortality. There was no significant increase in risk of cancer mortality associated with working long hours. There was no significant association between working 46-60 hours a week and risk of mortality, including all-cause mortality and cause-specific mortality. Conclusions The risk of all-cause and CVD mortality in three CEE was significantly higher among employees working extensive hours. These findings suggest that more attention should be paid to shortening working hours for those who work extensively. Key messages Long working hours increase risk of all cause and CVD mortality. Cancer mortality is not related to long working hours.

scholarly journals Frailty index as a predictor of all-cause and cause-specific mortality in a Swedish population-based cohort

2017 ◽  
Author(s):  
M Jiang ◽  
AD Foebel ◽  
R Kuja-Halkola ◽  
I Karlsson ◽  
NL Pedersen ◽  
...  
Keyword(s):  
Frailty Index ◽  
Population Based ◽  
Swedish Population ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Younger Men ◽  
Cvd Mortality

AbstractBackgroundFrailty is a complex manifestation of aging and associated with increased risk of mortality and poor health outcomes. Younger individuals (under 65 years) typically have low levels of frailty and are less-studied in this respect. Also, the relationship between the Rockwood frailty index (FI) and cause-specific mortality in community settings is understudied.MethodsWe created and validated a 42-item Rockwood-based FI in The Swedish Adoption/Twin Study of Aging (n=1477; 623 men, 854 women; aged 29-95 years) and analyzed its association with all-cause and cause-specific mortality in up to 30-years of follow-up. Deaths due to cardiovascular disease (CVD), cancer, dementia and other causes were considered as competing risks.ResultsOur FI demonstrated construct validity as its associations with age, sex and mortality were similar to the existing literature. The FI was independently associated with increased risk for all-cause mortality in younger (<65 years; HR per increase in one deficit 1.11, 95%CI 1.07-1.17) and older (≥65 years; HR 1.07, 95%CI 1.04-1.10) women and in younger men (HR 1.05, 95%CI 1.01-1.10). In cause-specific mortality analysis, the FI was strongly predictive of CVD mortality in women (HR per increase in one deficit 1.13, 95%CI 1.09-1.17), whereas in men the risk was restricted to deaths from other causes (HR 1.07, 95%CI 1.01-1.13).ConclusionsThe FI showed good predictive value for all-cause mortality especially in the younger group. The FI predicted CVD mortality risk in women, whereas in men it captured vulnerability to death from various causes.

scholarly journals Association Between Initiation, Intensity, and Cessation of Smoking and Mortality Risk in Patients With Cardiovascular Disease: A Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiang-lin Wang ◽  
Wen-jun Yin ◽  
Ling-yun Zhou ◽  
Ya-feng Wang ◽  
Xiao-cong Zuo
Keyword(s):  
Cardiovascular Disease ◽  
Smoking Cessation ◽  
Cohort Study ◽  
Cancer Mortality ◽  
Smoking Initiation ◽  
Smoking Intensity ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Former Smokers ◽  
Cvd Mortality

Objectives: To examine the effect of smoking status, smoking intensity, duration of smoking cessation and age of smoking initiation on the risk of all-cause and cause-specific mortality among cardiovascular disease (CVD) patients.Design: A population-based prospective cohort study.Setting: The National Health Interview Survey (NHIS) in the U.S. that were linked to the National Death Index (NDI).Participants: 66,190 CVD participants ≥ 18 years of age who were interviewed between 1997 and 2013 in the NHIS linked to the NDI through December 31, 2015.Outcome Measures: The primary outcome was all-cause mortality and the secondary outcome was cause-specific mortality including CVD mortality and cancer mortality.Results: During the mean follow-up of 8.1 years, we documented 22,518 deaths (including 6,473 CVD deaths and 4,050 cancer deaths). In the overall CVD population, former and current smokers had higher risk of all-cause (Former smokers: hazard ratios (HRs), 1.26; 95% confidence interval (CI), 1.21–1.31, P &lt; 0.001; Current smokers: HRs, 1.96; 95%CI, 1.86–2.07, P &lt; 0.001), CVD (Former smokers: HRs, 1.12; 95%CI, 1.05–1.21, P = 0.001; Current smokers: HRs, 1.80; 95%CI, 1.64–1.97, P &lt; 0.001) and cancer mortality (Former smokers: HRs, 1.49; 95%CI, 1.35–1.64, P &lt; 0.001; Current smokers: HRs, 2.78; 95%CI, 2.49–3.09, P &lt; 0.001) than never smokers. Furthermore, similar results were observed when the study subjects were stratified according to the type of CVD. Among current smokers, the risk for cancer mortality increased as the daily number of cigarettes increased, regardless of the specific type of CVD. However, the association of the risk for all-cause and CVD mortality with smoking intensity did not present a dose-response relationship. In participants with angina pectoris or stroke, smoking intensity was inversely associated with deaths from CVD. In addition, the risk for all-cause, CVD and cancer mortality declined as years of smoking cessation increased. Finally, the relative risk of all-cause mortality was not significantly different in individuals with a younger age of smoking initiation.Conclusions: CVD patients who are smokers have an increased risk of all-cause, CVD and cancer mortality, and the risk decreases significantly after quitting smoking. These data further provide strong evidence that supports the recommendation to quit smoking for the prevention of premature deaths among individuals with CVD.

scholarly journals Impact of Combined Lifestyle Factors on All-Cause and Cause-Specific Mortality and Life Expectancy in Chinese: The Singapore Chinese Health Study

2019 ◽  
Vol 75 (11) ◽  
pp. 2193-2199
Author(s):  
Xiong-Fei Pan ◽  
Yanping Li ◽  
Oscar H Franco ◽  
Jian-Min Yuan ◽  
An Pan ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Cancer Mortality ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Health Study ◽  
Chinese Adults ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Singapore Chinese ◽  
Cvd Mortality

Abstract Background To examine the impact of combined lifestyle factors on premature mortality and life expectancy in Chinese adults. Methods A total of 44,052 Chinese adults aged 45–74 years free of cardiovascular disease (CVD), cancer, and diabetes were followed from recruitment (1993–1998) to the end of 2016 in the Singapore Chinese Health Study. A composite score (0–5 scale) was calculated based on five baseline healthy lifestyle factors including healthy diet, nonsmoking status, light to moderate alcohol drinking, being physically active and optimal body mass index. Mortality cases were identified through linkage with the nationwide death registry. Results Adopting five healthy versus none was associated with a lower risk of all-cause and cause-specific mortality, and the hazard ratio (95% confidence interval [CI]) was 0.38 (0.29, 0.51) for all-cause mortality, 0.26 (0.13, 0.52) for CVD mortality, and 0.59 (0.37, 0.92) for cancer mortality. Nonadherence to 4–5 healthy lifestyle factors accounted for 34.9% (95% CI = 29.2, 40.2) in population attributable fraction for all-cause mortality, 35.1% (23.7, 44.9) for CVD mortality, and 18.0% (6.5, 28.0) for cancer mortality. Conversely, adherence to 4–5 healthy lifestyle factors versus none could achieve a gain of 8.1 years in women and 6.6 years in men for the life expectancy at 50 years. Conclusions A healthier lifestyle is associated with a substantially reduced risk of mortality and a longer life expectancy in the Chinese population. Our findings highlight the necessity of coordinated actions targeting combined lifestyle factors in reducing the overall burden of diseases and premature deaths.

scholarly journals Dose–Response Relation between Tea Consumption and Risk of Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis of Population-Based Studies

2020 ◽  
Vol 11 (4) ◽  
pp. 790-814 ◽  
Author(s):  
Mei Chung ◽  
Naisi Zhao ◽  
Deena Wang ◽  
Marissa Shams-White ◽  
Micaela Karlsen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Studies ◽  
Prospective Cohort ◽  
Lower Risk ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Tea Consumption ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cvd Mortality

ABSTRACT Tea flavonoids have been suggested to offer potential benefits to cardiovascular health. This review synthesized the evidence on the relation between tea consumption and risks of cardiovascular disease (CVD) and all-cause mortality among generally healthy adults. PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Food Science and Technology Abstracts, and Ovid CAB Abstract databases were searched to identify English-language publications through 1 November 2019, including randomized trials, prospective cohort studies, and nested case-control (or case-cohort) studies with data on tea consumption and risk of incident cardiovascular events (cardiac or peripheral vascular events), stroke events (including mortality), CVD-specific mortality, or all-cause mortality. Data from 39 prospective cohort publications were synthesized. Linear meta-regression showed that each cup (236.6 mL)  increase in daily tea consumption (estimated 280 mg  and 338 mg  total flavonoids/d for black and green tea, respectively) was associated with an average 4% lower risk of CVD mortality, a 2% lower risk of CVD events, a 4% lower risk of stroke, and a 1.5% lower risk of all-cause mortality. Subgroup meta-analysis results showed that the magnitude of association was larger in elderly individuals for both CVD mortality (n = 4; pooled adjusted RR: 0.89; 95% CI: 0.83, 0.96; P = 0.001), with large heterogeneity (I2 = 72.4%), and all-cause mortality (n = 3; pooled adjusted RR: 0.92; 95% CI: 0.90, 0.94; P &lt; 0.0001; I2 = 0.3%). Generally, studies with higher risk of bias appeared to show larger magnitudes of associations than studies with lower risk of bias. Strength of evidence was rated as low and moderate (depending on study population age group) for CVD-specific mortality outcome and was rated as low for CVD events, stroke, and all-cause mortality outcomes. Daily tea intake as part of a healthy habitual dietary pattern may be associated with lower risks of CVD and all-cause mortality among adults.

Abstract MP35: Physical Activity Before and After Cancer Diagnosis and Total and Cause-Specific Mortality

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Paulette D Chandler ◽  
Deirdre Tobias ◽  
Jule E Buring ◽  
I-Min Lee ◽  
Daniel Chasman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Diagnosis ◽  
Cancer Mortality ◽  
Total Mortality ◽  
Health Study ◽  
Specific Mortality ◽  
Before And After ◽  
After Cancer ◽  
Cvd Mortality

Background: Given the increased prevalence of cancer survivors in the United States, it is imperative to define risk factors for potential reductions in total and cause-specific mortality. Physical activity (PA) represents a promising target for intervention. Design: We prospectively evaluated PA from questionnaires before and after cancer diagnosis with total and cause-specific mortality among 13,297 subjects diagnosed with invasive cancer combined from the Physicians’ Health Study (PHS) (n=6328), Physicians’ Health Study II (PHS II) (n=912), and Women's Health Study (WHS) (n=6057). WHS and PHS participants were free of baseline cancer; PHS II participants reported no active cancer at baseline. We ascertained PA before and after an incident cancer diagnosis based on reports on repeated follow-up questionnaires. Death was ascertained by medical records and death certificates. Cox regression estimated combined hazard ratios (HRs) of mortality by PA adjusted for age, randomized treatments, BMI, and other lifestyle/demographic factors. We evaluated the interaction between PA before and after cancer diagnosis by comparing PA ≤1 versus ≥2 times/wk. Results: The mean follow-up after cancer diagnosis was 8.0, 7.5, and 5.2 y for WHS, PHS, and PHS II, respectively, during which there were 5623 deaths (WHS, 2164; PHS, 3269; PHS II; 190). Higher PA before cancer diagnosis was associated with significantly lower mortality. Compared with PA ≤ once/wk, the HRs (95% CIs) associated with PA 2-4 and >4 times/wk were 0.87 (0.82-0.93) and 0.88 (0.82-0.94) for total mortality; 0.77 (0.63-0.95) and 0.79 (0.62-0.997) for CVD mortality, and 0.90 (0.83-0.98) and 0.90 (0.83-0.98) for cancer mortality. Higher PA after cancer diagnosis was associated with significantly lower total and cancer mortality and non-significantly lower CVD mortality, with HRs (95% CIs) of 0.65 (0.58-0.72) and 0.66 (0.59-0.73) for total mortality; 0.78 (0.59-1.03) and 0.82 (0.61-1.10) for CVD mortality, and 0.66 (0.57-0.77) and 0.64 (0.55-0.74) for cancer mortality. There was a significant interaction of PA before and after cancer diagnosis for total (p int =0.02) and cancer (p int =0.007) mortality, but not CVD mortality (p int =0.38). Conclusions: Greater PA both before and after cancer diagnosis were significantly associated with lower total and cancer mortality. Higher PA before cancer diagnosis was also associated with lower CVD mortality. PA may be an important target for lower mortality after cancer diagnosis.

scholarly journals Estimating Contributions of Social and Behavioral Factors to Cardiovascular Disease, Cancer, COPD, and Unintentional-Injury Mortality Disparities by Psychological Distress in the United States: A Blinder-Oaxaca Decomposition Analysis of the 1997-2014 NHIS-NDI Record Linkage Study

2021 ◽  
Vol 5 (2) ◽  
pp. 259-273
Author(s):  
Hyunjung Lee ◽  
Gopal K. Singh
Keyword(s):  
Psychological Distress ◽  
Cancer Mortality ◽  
Decomposition Analysis ◽  
Unintentional Injury ◽  
Behavioral Characteristics ◽  
Injury Mortality ◽  
Specific Mortality ◽  
Mortality Disparities ◽  
Copd Mortality ◽  
Cvd Mortality

Background: Previous research has shown a significant association between psychological distress (PD) and cause-specific mortality, but contributions of sociodemographic and behavioral characteristics to mortality differences by PD are not fully explored. Methods: The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD), and unintentional-injury mortality disparities between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled 1997-2014 data from the National Health Interview Survey prospectively linked to the National Death Index (N=263,825). Results: Lower levels of education and household income, and higher proportions of current smokers, former drinkers, non-married adults, US-born, and renters contributed to higher mortality for adults with SPD. The relative percentage of mortality explained by sociodemographic and behavioral factors was highest for cancer mortality (71.25%) and lowest for unintentional-injury mortality (20.19%). Enhancing education level among adults with SPD would decrease approximately 30% of cancer or CVD mortality disparity, and around 10% of COPD and unintentional-injury mortality disparities. Half of the cancer mortality disparity (47.4%) could be attributed to a single factor, smoking. Increasing income level will decrease 7 to 13% of the disparity in cause-specific mortality. Higher proportions of renters explained higher CVD and COPD mortality among adults with SPD by 7% and 3%, respectively. Higher proportions of former drinkers explained higher CVD, cancer, and COPD mortality among adults with SPD by 6%, 7%, and 3%, respectively. Younger age, higher proportion of females, and higher BMI among adults with SPD mitigated the mortality disparities. Conclusions and Implications for Translational Research: Improved education and income levels, and reduced smoking among US adults with SPD would eliminate around 90% of the cancer mortality disparity by SPD, and half of the CVD mortality disparity.   Copyright © 2021 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

scholarly journals Association of serum 25-hydroxyvitamin D concentrations with all-cause and cause-specific mortality among individuals with diabetes mellitus

2020 ◽  
Author(s):  
Zhenzhen Wan ◽  
Jingyu Guo ◽  
An Pan ◽  
Chen Chen ◽  
Liegang Liu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vitamin D ◽  
Vitamin D Status ◽  
Hydroxyvitamin D ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
25 Hydroxyvitamin D ◽  
Nationally Representative ◽  
Reduced Risk ◽  
Cvd Mortality

<b>Objective: </b>The evidence regarding vitamin D status and mortality among diabetes is scarce. This study aimed to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with all-cause and cause-specific mortality among adults with <a>diabetes mellitus</a>. <p><b>Research Design and Methods: </b>This study included 6329 adults with diabetes from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001-2014. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence (CIs) for mortality from all causes, cardiovascular disease (CVD), and cancer.</p> <p><b>Results:</b> The weighted mean (95% CI) level of serum 25(OH)D was 57.7 (56.6, 58.8) nmol/L, and 46.6% had deficient vitamin D (<50 nmol/L [20 ng/mL]). <a>Higher </a>serum 25(OH)D levels were significantly associated with lower levels of glucose, insulin, HOMA-IR, HbA1c, blood lipids, and C-reactive protein at baseline (all <i>P</i><sub>trend</sub><0.05). During 55126 person-years of follow-up, 2056 deaths were documented, including 605 CVD deaths and 309 cancer deaths. <a>After multivariate adjustment, higher </a>serum 25(OH)D levels were significantly and linearly associated with lower all-cause and CVD mortality: there was a 31% reduced risk of all-cause mortality and a 38% reduced risk of CVD mortality per one unit increment in natural log-transformed 25(OH)D (both <i>P</i><0.001). Compared with participants with 25(OH)D <25 nmol/L, the multivariate-adjusted HRs and 95% CI for participants with 25(OH)D >75 nmol/L were 0.59 (0.43, 0.83) for all-cause mortality (<i>P</i><sub>trend</sub>=0.003), 0.50 (0.29, 0.86) for CVD mortality (<i>P</i><sub>trend</sub>=0.02), and 0.49 (0.23, 1.04) for cancer mortality (<i>P</i><sub>trend</sub>=0.12). </p> <p><b>Conclusions: </b>In a nationally representative sample of US adults with diabetes, higher serum 25(OH)D levels were significantly associated with lower all-cause and CVD mortality. These findings suggest that maintaining adequate vitamin D status may lower mortality risk in individuals with diabetes.</p>

Sex-specific associations of circulating testosterone levels with all-cause and cause-specific mortality

2021 ◽  
Author(s):  
Jiayu Wang ◽  
Xikang Fan ◽  
Mingjia Yang ◽  
Mingyang Song ◽  
Kai Wang ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Cancer Mortality ◽  
Multiple Testing ◽  
Cox Regression ◽  
Positive Association ◽  
Total Testosterone ◽  
Critical Determinant ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Risk Of Cancer

Objective: Testosterone is a critical determinant of health in both genders. However, the relationship between circulating levels of testosterone and mortality remains undetermined. Methods: We examined the associations of serum total testosterone (TT) and free testosterone (FT) with all-cause and cause-specific mortality in 154,965 men and 93,314 postmenopausal women from UK Biobank. Cox regression models were used to calculate the hazard ratios (HR) and 95% confidence intervals (CI). Given multiple testing, P < 0.005 was considered statistically significant. Results: Over a median follow-up of 8.9 (inter-quartile range, 8.3-9.5) years, we documented 5,754 deaths in men, including 1,243 (21.6%) from CVD and 2,987 (51.9%) from cancer. In postmenopausal women, 2,435 deaths occurred, including 346 (14.2%) from CVD and 1,583 (65.0%) from cancer. TT and FT concentrations were inversely associated with all-cause mortality in men, with the multivariable HR of 0.82 (95% CI: 0.75-0.91) and 0.80 (95% CI: 0.73-0.87) for the highest (Q5) versus the lowest quintile (Q1), respectively. In postmenopausal women, TT concentrations showed a positive association with all-cause mortality (HR for Q5 versus Q1 = 1.20, 95% CI: 1.06-1.37). Furthermore, higher TT and FT concentrations were associated with a lower risk of cancer mortality in men (both P for trend = 0.001), whereas TT concentrations were suggestively associated with a higher risk of cancer mortality in postmenopausal women (P for trend = 0.03). Conclusions: Our findings suggest that high levels of circulating testosterone may be beneficial for all-cause and cancer mortality in men but detrimental in postmenopausal women.

P5495Sex differences in marital status and risk of cardiovascular disease, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Nie ◽  
Y Wang
Keyword(s):  
Cardiovascular Disease ◽  
Sex Differences ◽  
Marital Status ◽  
Cancer Mortality ◽  
Meta Analysis ◽  
Excess Risk ◽  
Stroke Mortality ◽  
Never Married ◽  
All Cause Mortality ◽  
Cvd Mortality

Abstract Background Marital status has been identified as an important social factor associated with mortality. In current epidemiologic research, being unmarried was observed to be a suboptimal health status in the global population. The growing number of unmarried people has health implications, in light of evidence suggesting that it is associated with an increase in the incidence of various diseases and high mortality. Few attempts have been made to produce an overall estimate and sufficiently clarified of the sex difference between unmarried status and mortality risks, this is still a matter of debate. Purpose To ascertain whether sex differences exist in the relationship between marital status and cardiovascular disease (CVD), cancer, all-cause mortality in the general population and to explore the potential effect of age, location, the duration of follow-up and publication years on these outcomes. Methods A systematic search was performed in PubMed and EMBASE from inception through to April 2018 and review of references. We used the sex-specific RRs (relative risk) to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random effects meta-analysis weighted by the inverse of the variances of the log RRRs. Results Twenty-one studies with 7,881,040 individuals were included for meta-analysis. Compared with married individuals, being unmarried was significantly associated with all-cause mortality, cancer mortality, CVD mortality and coronary heart disease (CHD) mortality, especially for singles, for both sexes (Figure 1). However, the association with death from all-cause and CVD was significantly stronger in men. Compared with women who were divorced/separated, divorced/separated men had significantly higher risk of all-cause mortality, cancer mortality and CVD mortality. Moreover, never married men had 31% and 9% higher excess risk of stroke mortality and all-cause mortality, respectively, compared with never married women. No sex differences were observed concerning the impact of any unmarried status on CHD mortality. Conclusions Being unmarried (widowed, divorced/separated or never married) conferred higher excess risk of stroke mortality and all-cause mortality for men than women. Moreover, divorced/separated men had significantly higher risk of cancer mortality and CVD mortality. Further studies are warranted to clarify the biological, behavioral, and/or social mechanisms involved in sex differences driving these associations.

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