Background: Ischaemic heart disease (IHD) is the leading cause
of mortality worldwide. Although modifiable cardiovascular risk factors, such
as hypertension, diabetes and hyperlipidaemia, account for a large proportion
of IHD the extent to which they are controlled is variable. The reasons for
this undermanagement of risk factors is multifactorial and sociodemographic
factors, such as marital status, could play an important role. This is
especially important in light of recent evidence of higher mortality rates in
single patients following acute coronary syndrome. However, more research is
required into the impact of marital status on mortality in patients with
cardiovascular risk factors.
Objectives: We aimed to investigate the impact of
marital status on mortality of a large database of patients admitted with
hypertension, hyperlipidaemia and type 2 diabetes.
Methods: Anonymous information on patients with
hypertension, hyperlipidaemia and type 2 diabetes was obtained from hospitals
in North England between 1st January 2000 and 31stMarch 2013.
This data was analysed according to the ACALM (Algorithm for
Comorbidities, Associations, Length of stay and Mortality) study
protocol. ICD-10 and OPCS-4 codes were used to trace patients and
demographics including marital status, comorbidities and mortality data.
Mortality of patients of different marital statuses were compared by cox
regression adjusted for age, gender, ethnicity and the top 10 contributors to
mortality in the UK. P values <0.05 were taken as statistically significant.
Results: Amongst 929552 adult patients admitted during
the study period there were 168431 patients with hypertension, 53055 with
hyperlipidaemia and 68098 patients with type 2 diabetes. Crude mortality was
highest among widowed patients in all 3 conditions. Logistic regression
accounting for age, gender, ethnicity and the top contributors to mortality in
the UK showed that married people, as compared to single people, with
hypertension (OR 0.900), hyperlipidaemia (OR 0.836) and type 2 diabetes (OR
0.860) had significantly lower mortality rates. Adjusted mortality rates were
also lower in widowed patients with hypertension (OR 0.973) and in both widowed
and separated patients with type 2 diabetes (OR 0.965 and 0.974, respectively).
Conversely, unmarried patients had significantly raised adjusted mortality
rates in type diabetes (OR 1.046) and in hypertension (1.034).
Conclusion: Single patients with modifiable risk factors
have significantly higher mortality rates compared to married patients which
could help to explain the raised mortality rates documented in single patients
following an acute coronary syndrome. Protective effects of marriage likely
result from increased social support leading to healthier lifestyles and
increased medication compliance. Our findings suggest a need for increased
social support for single patients with modifiable cardiovascular risk factors.