Being divorced appears to confer a higher risk for stroke compared with other forms of marital status, such as being married, single (not divorced), or widowed, a new study suggests, with the effect appearing more pronounced in men.

The study, presented at the recent 3rd European Stroke Organisation Conference (ESOC) 2017, showed that living in marriage or living alone as single or widowed did not affect risk for stroke to any clinical significant degree, but stroke rates were higher in divorced men.

"There have been many studies showing marriage is associated with a lower risk of stroke and other medical events, but differences in the various other marital states — single, widowed, or divorced — has not been resolved," coauthor of the study, Tom Skyhøj Olsen, MD, Bispebjerg University Hospital, Copenhagen, Denmark, commented to Medscape Medical News.

"Our data seems to suggest that it doesn't matter if you are married or single — what seems to affect stroke risk is the change in life situation associated with divorce. And this appears to affect men more than women."

He suggested that the results may be explained by divorce having an adverse effect on lifestyle. "Divorce is often associated with an onslaught of problems — housing, financial, emotional stress — and this can be accompanied by an increase in smoking and drinking."

"Married people usually have a healthier lifestyle than nonmarried people," he added. "Many studies have shown this. They generally have lower rates of smoking and alcohol consumption."

On the difference seen between men and women, Dr Olsen said, "Our results may signal a gender difference in the ability to adapt to changes that divorce brings. Women may be better at coping with this than men."

For the study, the researchers analyzed data from the Danish civil registration system on age, sex, marital status (married, single, divorced, or widowed), education level, and disposable income and data from the Danish Stroke Register, which contains information on all patients admitted to a hospital with acute stroke in Denmark.

They investigated marital status in all patients older than age 40 years admitted to a hospital in 2003–2012 in comparison to the general Danish population. Relative risks for stroke in relation to marital status were estimated, with adjustment for age, sex, calendar year, household income, and level of education.

The study included 58,807 patients who had had a stroke, of whom 52% were married, 9% were single, 13% were divorced, and 26% were widowed. 

Results showed that after adjustment for age, sex, calendar year, income, and education when compared to married people, those who were single and not divorced and those who were widowed did not have an increased risk for stroke, but those who were divorced did show a significant increase in the risk for stroke. This increased risk was higher for divorced men (hazard ratio [HR], 1.23) than for divorced women (HR, 1.11).

Table. Stroke Incidence by Marital Status in Men  and Women

Status Relative Risk (95% Confidence Interval)
Men  
  Married 1.00 (reference)
  Single 1.07 (1.03 - 1.11)
  Divorced 1.23 (1.19 - 1.27)
  Widowed 1.02 (0.98 - 1.06)
Women  
  Married 1.00 (reference)
  Single 0.97 (0.97 - 1.03)
  Divorced 1.11 (1.06 - 1.15)
  Widowed 1.00 (0.97 - 1.03)

Dr Olsen concluded: "Our study seems to reflect the benefit of living in harmony — whether that is in a partnership or alone. Perhaps it is not being on your own that increases risk but rather the disharmony of divorce. Most people who have experienced divorce will say this period of their lives was one of disharmony."

"We need to think more about our health during times of disharmony such as divorce, but this is difficult as there are often other, seemingly more urgent, things to attend to at this time — health may not be the first priority."

The study only looked at marital status in the year before the stroke, so the data do not address the length of time an individual has been divorced.

The study was funded by the Jascha Foundation, a private Danish research foundation.

3rd European Stroke Organisation Conference (ESOC) 2017. Session SC16. Presented May 17, 2017.

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