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Cited by 501Nursing care and researchPalliative Care and End-of-Life IssuesHealth disparities and outcomes

Mortality after the Hospitalization of a Spouse

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Christakis, Nicholas A., Allison, Paul D.·2006·New England Journal of Medicine
DOI 10.1056/nejmsa050196
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Abstract

BACKGROUND: The illness of a spouse can affect the health of a caregiving partner. We examined the association between the hospitalization of a spouse and a partner's risk of death among elderly people. METHODS: We studied 518,240 couples who were enrolled in Medicare in 1993. We used Cox regression analysis and fixed-effects (case-time-control) methods to assess hospitalizations and deaths during nine years of follow-up. RESULTS: Overall, 383,480 husbands (74 percent) and 347,269 wives (67 percent) were hospitalized at least once, and 252,557 husbands (49 percent) and 156,004 wives (30 percent) died. Mortality after the hospitalization of a spouse varied according to the spouse's diagnosis. Among men, 6.4 percent died within a year after a spouse's hospitalization for colon cancer, 6.9 percent after a spouse's hospitalization for stroke, 7.5 percent after a spouse's hospitalization for psychiatric disease, and 8.6 percent after a spouse's hospitalization for dementia. Among women, 3.0 percent died within a year after a spouse's hospitalization for colon cancer, 3.7 percent after a spouse's hospitalization for stroke, 5.7 percent after a spouse's hospitalization for psychiatric disease, and 5.0 percent after a spouse's hospitalization for dementia. After adjustment for measured covariates, the risk of death for men was not significantly higher after a spouse's hospitalization for colon cancer (hazard ratio, 1.02; 95 percent confidence interval, 0.95 to 1.09) but was higher after hospitalization for stroke (hazard ratio, 1.06; 95 percent confidence interval, 1.03 to 1.09), congestive heart failure (hazard ratio, 1.12; 95 percent confidence interval, 1.07 to 1.16), hip fracture (hazard ratio, 1.15; 95 percent confidence interval, 1.11 to 1.18), psychiatric disease (hazard ratio, 1.19; 95 percent confidence interval, 1.12 to 1.26), or dementia (hazard ratio, 1.22; 95 percent confidence interval, 1.12 to 1.32). For women, the various risks of death after a spouse's hospitalization were similar. Overall, for men, the risk of death associated with a spouse's hospitalization was 22 percent of that associated with a spouse's death (95 percent confidence interval, 17 to 27 percent); for women, the risk was 16 percent of that associated with death (95 percent confidence interval, 8 to 24 percent). CONCLUSIONS: Among elderly people hospitalization of a spouse is associated with an increased risk of death, and the effect of the illness of a spouse varies among diagnoses. Such interpersonal health effects have clinical and policy implications for the care of patients and their families.

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Crossref · 10.1056/nejmsa050196

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  • Spouses of those who were hospitalized and had dementia were more likely to die in the following year than caregivers whose spouses were hospitalized but did not have dementia, after accounting for caregiver age differences.

    “For example, spouses of those who were hospitalized and had dementia were more likely to die in the following year than caregivers whose spouses were hospitalized but did not have dementia (after accounting for differences in caregiver age).530”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [530]

    The Adjusted Analyses (Table 2; page not supplied) report higher partner-mortality hazard ratios after a spouse’s hospitalization for dementia than for the category of all other diagnoses, in models that include both partners’ ages. But those hazard ratios do not directly compare dementia with every non-dementia hospitalization, and the table describes nine years of follow-up rather than deaths specifically in the following year. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Spouses of hospitalized care recipients with dementia were more likely to die in the following year than caregivers whose spouses were hospitalized but did not have dementia (after accounting for differences in caregiver age).

    “For example, spouses of hospitalized care recipients with dementia were more likely to die in the following year than caregivers whose spouses were hospitalized but did not have dementia (after accounting for differences in caregiver age). 578”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [578]

    The Adjusted Analyses table reports higher mortality hazard ratios after a spouse's hospitalization for dementia than for many other diagnoses, for both male and female partners. But the table follows couples over nine years and does not establish the claimed comparison specifically for deaths in the following year; dementia also does not have a higher hazard ratio than every other diagnosis. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Participants were randomly allocated to ERT-C or a waitlist condition.

    “Upon having provided written informed consent, ICs were randomly allocated to either the ERT-C or a waitlist condition as described in the previous publication establishing the efficacy of ERT-C (11).”

    From Moderators and mediators of emotion regulation therapy for psychologically distressed caregivers of cancer patients: secondary analyses from a randomized controlled trial. (2021) · cites this paper as [11]

    The Study Population section describes a random sample of Medicare couples, and Statistical analysis describes observational analyses of spousal hospitalization and mortality. Searches for ERT-C, a waitlist, and random allocation found no passage about the claimed intervention assignment. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Caregiver burden is associated with a range of physical health complications, including sleep difficulties and fatigue, cardiovascular disease, poor immune functioning, and increased mortality.

    “Caregiver burden is also associated with a range of physical health complications, including sleep difficulties and fatigue 10, 11, cardiovascular disease 12, 13, poor immune functioning 14, 15, and increased mortality 16, 17.”

    From Cognitive behavioral therapies for informal caregivers of patients with cancer and cancer survivors: a systematic review and meta-analysis (2017) · cites this paper as [17]

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Research works printed but not linked: 4

  1. [3]3. Dunkin JJ, Anderson-Hanley C. De- mentia caregiver burden: a review of the literature and guidelines for assessment and intervention. Neurology 1998;51: Suppl:S53-S60.
  2. [10]10. www.nejm.org february 16, 2006 Special Article study in schizophrenia vs. physical disor- ders. Soc Sci Med 2005;61:313-22.
  3. [20]20. care data files: their completeness of cov- erage and accuracy. Am J Public Health 1996;86:712-6.
  4. [24]24. Allison PD, Christakis NA. Fixed ef- fects methods for the analysis of non- repeated events. Sociol Methodol (in press).

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Authors
Christakis, N. A., & Allison, P. D.
Affiliations
  • Harvard University (US)
  • University of Pennsylvania (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2006-02-16
Volume
354
Issue
7
Pages
719-730
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmsa050196
OpenAlex
W2031439369
Cited by
501
References
38
Citations by year
2026: 6 · 2025: 10 · 2024: 13 · 2023: 10 · 2022: 11 · 2021: 20 · 2020: 18 · 2019: 14 · 2018: 16 · 2017: 60 · 2016: 25 · 2015: 29 · 2014: 34 · 2013: 35 · 2012: 32
FWCI
93.90
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
National Institute on Aging (R-01AG17548-01, R01AG017548)
Topics
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Social Sciences › Health › Health disparities and outcomes
Keywords
spousal caregiving, older couples, hospitalization, colon cancer, stroke, dementia, mental illness, congestive heart failure, hip fracture, sex differences
MeSH terms
Aged, Bereavement, Female, Follow-Up Studies, Medicare, Hospitalization, Humans, Male, Mortality, Risk, United States, Proportional Hazards Models, Odds Ratio, Case-Control Studies, Caregivers, Spouses

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