CoChat
Sign Up
Cited by 163Health disparities and outcomesFamily Dynamics and RelationshipsMarriage and Family Dynamics

Associations of marital status with diabetes, hypertension, cardiovascular disease and all-cause mortality: a long term follow-up study

Open access
Ramezankhani, Azra, Azizi, Fereidoun, Hadaegh, Farzad·2019·PLOS ONE
DOI 10.1371/journal.pone.0215593PMC PMC6476533
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: To investigate the associations of marital status with major clinical outcomes including type 2 diabetes (T2D), hypertension, cardiovascular disease (CVD) and all-cause mortality. METHODS: The study cohort (1999-2014) included 9,737 (45% male) Iranian adults with a mean age of 47.6 years. Marital status was defined as married versus never married, divorced and widowed. The relationship between marital status and the four above mentioned outcomes were investigated using Cox regression models adjusted for the main confounders, specific to each outcome. RESULTS: After more than 12 years of follow-up, 1,889 (883 men) individuals developed hypertension, 1,038 (468 men) T2D, 1015 (597 men) CVD and 668 (409 men) all-cause mortality. Compared with married, being never married in men was associated with higher risk of hypertension [hazard ratio (HR): 1.55; 95% confidence interval (CI), 1.11-2.16] and all-cause mortality (2.17; 0.95-5.00; p-value = 0.066) after adjusting for confounders. Among women, compared with married status, widowed status was associated with a lower risk of T2D (0.74; 0.56-0.97) in the confounders adjusted model. Moreover, never married women had a lower risk of hypertension (0.58; 0.37-0.90) compared to married ones in the age adjusted model, a finding that did not achieve significance, after further adjustment for confounders. CONCLUSION: We found that the relationship between marital status and health outcomes varied by gender. Being never married was an important risk factor for hypertension and tended to be a significant risk factor for mortality in men. However, among women, being widowed was associated with a lower risk of T2D.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0215593

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Marital status was included as a proxy for social support, which has been associated with diabetes management and health outcomes.

    “Marital status was included as a proxy for social support, which has been associated with diabetes management and health outcomes [43].”

    From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [43]

    The Methods (Exposure) identify marital status as the study’s exposure, and the Discussion links marriage to health-related behaviors and marital status to type 2 diabetes. The paper does not describe marital status as a proxy for social support or examine diabetes management; its diabetes outcome is occurrence of type 2 diabetes, not management among people with diabetes. Page numbers are not available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 47 · Cited by 163

Research works printed but not linked: 43

  1. [1]Howe TR. Marriages and families in the 21st century: A bioecological approach. John Wiley & Sons; 2011
  2. [2]Kiecolt-Glaser JK, Newton TL. Marriage and health: his and hers. Psychol Bull. 2001; 127(4): 472– 503. 11439708
  3. [3]Gerull S, Denhaerynck K, Chalandon Y, Halter J, Kirsch M, Kiss A et al Lack of association between relationship status and clinical outcome in allogeneic stem cell transplantation-the Swiss Transplant Cohort Study. Bone Marrow Transplant. 2017; 52(12): 1686– 1688. 10.1038/bmt.2017.204 28991251 · DOI
  4. [4]Metsä-Simola N, Martikainen P. The short-term and long-term effects of divorce on mortality risk in a large Finnish cohort, 1990–2003. Popul Stud (Camb). 2013; 67(1): 97– 110. 10.1080/00324728.2012.746386 23237618 · DOI
  5. [5]Manzoli L, Villari P, Pirone GM, Boccia A. Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc Sci Med. 2007 1; 64(1): 77– 94. 10.1016/j.socscimed.2006.08.031 17011690 · DOI
  6. [6]Wong CW, Kwok CS, Narain A, Gulati M, Mihalidou AS, Wu P et al Marital status and risk of cardiovascular diseases: a systematic review and meta-analysis. Heart. 2018 10.1136/heartjnl-2018-313005 29921571 · DOI
  7. [7]Tuoyire DA, Ayetey H. Gender differences in the association between marital status and hypertension in ghana. J Biosoc Sci. 2018: 1– 22. 29781417
  8. [8]Whisman MA, Li A, Sbarra DA, Raison CL. Marital quality and diabetes: Results from the Health and Retirement Study. Health Psychol. 2014; 33(8): 832– 840. 10.1037/hea0000064 25068454 · DOI
  9. [9]Schwandt HM, Coresh J, Hindin MJ. Marital status, hypertension, coronary heart disease, diabetes, and death among African American women and men: incidence and prevalence in the Atherosclerosis Risk in Communities (ARIC) study participants. J Fam Issues. 2010; 31(9): 1211– 1229. 10.1177/0192513X10365487 26752799 PMC4703426 · DOI
  10. [10]Cornelis MC, Chiuve SE, Glymour MM, Chang S-C, Tchetgen EJT, Liang L et al Bachelors, divorcees, and widowers: Does marriage protect men from type 2 diabetes? PLoS One. 2014; 9(9): e106720 10.1371/journal.pone.0106720 25229473 PMC4167705 · DOI
  11. [11]Lundquist JH, Anderton DL, Yaukey D. Demography: the study of human population Waveland Press, 2014.
  12. [12]Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: A meta-analytic review. Psychol Bull. 2014; 140(1): 140– 187. 10.1037/a0031859 23527470 PMC3872512 · DOI
  13. [13]Montazeri S, Gharacheh M, Mohammadi N, Alaghband Rad J, Eftekhar Ardabili H. Determinants of early marriage from married girls’ perspectives in Iranian setting: a qualitative study. J Environ Public Health. 2016; 2016: 8615929 10.1155/2016/8615929 27123012 PMC4829716 · DOI
  14. [14]Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M et al Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials. 2009; 10(1): 5. 19166627 PMC2656492
  15. [15]Chobanian AV. National heart, lung, and blood institute joint national committee on prevention, detection, evaluation, and treatment of high blood pressure; national high blood pressure education program coordinating committee: the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003; 289: 2560– 2572. 10.1001/jama.289.19.2560 12748199 · DOI · Paper page
  16. [17]Ramezankhani A, Azizi F, Hadaegh F, Eskandari F. Sex-specific clustering of metabolic risk factors and their association with incident cardiovascular diseases: a population-based prospective study. Atherosclerosis. 2017; 263: 249– 256. 10.1016/j.atherosclerosis.2017.06.921 28683364 · DOI
  17. [18]Pereira M, Lunet N, Paulo C, Severo M, Azevedo A, Barros H. Incidence of hypertension in a prospective cohort study of adults from Porto, Portugal. BMC Cardiovasc Disord. 2012; 12: 114 10.1186/1471-2261-12-114 23190867 PMC3529102 · DOI
  18. [19]Mc Causland FR, Sacks FM, Forman JP. Marital status, dipping and nocturnal blood pressure: results from the Dietary Approaches to Stop Hypertension trial. J Hypertens. 2014; 32(4): 756– 761. 10.1097/HJH.0000000000000107 24509120 · DOI
  19. [20]Mahdavian M, Zolala F. Determinants of Risky Behaviors in Youth: A Gender-Based Study. Int J High Risk Behav Addict. 2017; 6(1), e23604
  20. [21]Roerecke M, Tobe SW, Kaczorowski J, Bacon SL, Vafaei A, Hasan OSM et al Sex-Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. J Am Heart Assoc. 2018; 27;7(13). PMC6064910 29950485
  21. [22]Diaconu CC, Dediu GN, Iancu MA. Drug-induced arterial hypertension–a frequently ignored cause of secondary hypertension: a review. Acta Cardiol. 2018; 1: 1– 7. 29291681
  22. [23]Sheikhzadeh K, Baneshi MR, Afshari M, Haghdoost AA. Comparing direct, network scale-up, and proxy respondent methods in estimating risky behaviors among collegians. J Subst Use. 2016; 21(1): 9– 13.
  23. [24]Ebrahim S, Wannamethee G, McCallum A, Walker M, Shaper A. Marital status, change in marital status, and mortality in middle-aged British men. Am J Epidemiol. 1995; 142(8): 834– 842. 7572960
  24. [25]Molloy GJ, Stamatakis E, Randall G, Hamer M. Marital status, gender and cardiovascular mortality: behavioural, psychological distress and metabolic explanations. Soc Sci Med. 2009; 69(2): 223– 228. 10.1016/j.socscimed.2009.05.010 19501442 PMC2852675 · DOI
  25. [26]Va P, Yang W-S, Nechuta S, Chow W-H, Cai H, Yang G et al Marital status and mortality among middle age and elderly men and women in urban Shanghai. PLoS One. 2011; 6(11): e26600 10.1371/journal.pone.0026600 22073174 PMC3206811 · DOI
  26. [27]Ikeda A, Iso H, Toyoshima H, Fujino Y, Mizoue T, Yoshimura T et al Marital status and mortality among Japanese men and women: the Japan Collaborative Cohort Study. BMC Public Health. 2007; 7: 73 10.1186/1471-2458-7-73 17484786 PMC1871578 · DOI
  27. [28]Wyke S, Ford G. Competing explanations for associations between marital status and health. Soc Sci Med. 1992; 34(5): 523– 352. 1604359
  28. [29]Jaffe DH, Manor O, Eisenbach Z, Neumark YD. The protective effect of marriage on mortality in a dynamic society. Ann Epidemiol. 2007; 17(7): 540– 547. 10.1016/j.annepidem.2006.12.006 17434751 · DOI
  29. [30]Robards J, Evandrou M, Falkingham J, Vlachantoni A. Marital status, health and mortality. Maturitas. 2012; 73(4): 295– 299. 10.1016/j.maturitas.2012.08.007 23007006 PMC3635122 · DOI
  30. [31]Manfredini R, De Giorgi A, Tiseo R, Boari B, Cappadona R, Salmi R et al Marital status, cardiovascular diseases, and cardiovascular risk factors: A review of the evidence. J Womens Health (Larchmt). 2017; 26(6): 624– 632. 28128671
  31. [32]August KJ, Sorkin DH. Marital status and gender differences in managing a chronic illness: The function of health-related social control. Soc Sci Med. 2010; 71(10): 1831– 1838. 10.1016/j.socscimed.2010.08.022 20889249 PMC2967659 · DOI
  32. [33]Sbarra DA, Law RW, Portley RM. Divorce and death: A meta-analysis and research agenda for clinical, social, and health psychology. Perspect Psychol Sci. 2011; 6(5): 454– 474. 10.1177/1745691611414724 26168197 · DOI
  33. [34]Farahani FKA, Cleland J, Mehryar AH. Associations between family factors and premarital heterosexual relationships among female college students in Tehran. Int Perspect Sex Reprod Health. 2011; 37(1): 30– 39. 10.1363/3703011 21478086 · DOI
  34. [35]Farahani-Khalajabadi F. Methodological considerations in studying sexual behaviors of young people in Iran. J Reprod Infertil. 2014; 15(4): 171– 172. 25469325 PMC4227973
  35. [36]Rahmani A, Merghati-Khoei E, Moghaddam-Banaem L, Zarei F, Montazeri A, Hajizadeh E. Sexuality research in Iran: A focus on methodological and ethical considerations. Iran J Public Health. 2015; 44(7): 979– 986. 26576376 PMC4645769
  36. [37]Sarkisian N, Gerstel N. Does singlehood isolate or integrate? Examining the link between marital status and ties to kin, friends, and neighbors. J Soc Pers Relat. 2016; 33(3): 361– 384.
  37. [38]Azimi-Nezhad M, Ghayour-Mobarhan M, Parizadeh M, Safarian M, Esmaeili H, Parizadeh S et al Prevalence of type 2 diabetes mellitus in Iran and its relationship with gender, urbanisation, education, marital status and occupation. Singapore Med J. 2008; 49(7): 571– 576. 18695867
  38. [39]Hiltunen L. Are there associations between socio-economic status and known diabetes in an elderly Finnish population? Cent Eur J Public Health. 2005; 13(4): 187– 190. 16419383
  39. [40]Trevisan C, Veronese N, Maggi S, Baggio G, De Rui M, Bolzetta F et al Marital status and frailty in older people: gender differences in the Progetto Veneto Anziani Longitudinal Study. J Womens Health (Larchmt). 2016; 25(6): 630– 637. 26845424
  40. [41]Dupre ME, George LK, Liu G, Peterson ED. Association between divorce and risks for acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2015; 8(3): 244– 251. 10.1161/CIRCOUTCOMES.114.001291 25872508 PMC4439317 · DOI
  41. [42]Floud S, Balkwill A, Canoy D, Wright FL, Reeves GK, Green J et al Marital status and ischemic heart disease incidence and mortality in women: a large prospective study. BMC Med. 2014 12; 12: 42 10.1186/1741-7015-12-42 24618083 PMC4103700 · DOI
  42. [43]Sardarinia M, Akbarpour S, Lotfaliany M, Bagherzadeh-Khiabani F, Bozorgmanesh M, Sheikholeslami F et al Risk factors for incidence of cardiovascular diseases and all-cause mortality in a middle eastern population over a decade follow-up: Tehran lipid and glucose study. PLoS One. 2016; 11(12): e0167623 10.1371/journal.pone.0167623 27930696 PMC5145170 · DOI
  43. [45]Tanno K, Ohsawa M, Itai K, Kato K, Turin TC, Onoda T et al Associations of marital status with mortality from all causes and mortality from cardiovascular disease in Japanese haemodialysis patients. Nephrol Dial Transplant. 2013; 28(4): 1013– 1020. 10.1093/ndt/gfs547 23345626 · DOI

Authors
Ramezankhani, A., Azizi, F., & Hadaegh, F.
Affiliations
Research Institute for Endocrine Sciences (IR)
Corresponding author
Hadaegh, Farzad
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2019-04-22
Volume
14
Issue
4
Pages
e0215593
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0215593
PMC
PMC6476533
OpenAlex
W2940484530
Cited by
163
References
47
Citations by year
2026: 15 · 2025: 30 · 2024: 28 · 2023: 25 · 2022: 28 · 2021: 21 · 2020: 14 · 2019: 2
FWCI
15.85
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Demography › Family Dynamics and Relationships
  • Social Sciences › Sociology and Political Science › Marriage and Family Dynamics
Keywords
marital status, never married, widowed, type 2 diabetes, hypertension, cardiovascular disease, all-cause mortality, sex differences, social determinants of health, Iranian adults
MeSH terms
Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Hypertension, Iran, Male, Middle Aged, Risk Factors, Cohort Studies, Marital Status, Risk Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review