Single living and/or being unmarried increases the risk of having a heart attack and worsens its prognosis both in men and women regardless of age. Most of the excess mortality appears already before the hospital admission and seems not to be related to differences in treatment of ACS.

ACS incidence and 28-day mortality rate were higher in unmarried men and women in all age groups. The prehospital CF of incident ACS was higher in single living and/or unmarried 35–64-year-old people. The 28-day CF was 26% (95% confidence interval, CI, 24–29%) in married men, 42% (95% CI 37–47%) in men who had previously been married, and 51% (95% CI 46–57%) in never-married men. Among women, the corresponding figures were 20% (95% CI 15–24%), 32% (95% CI 25–39%), and 43% (95% CI 31–56%). Most of these CF differences were apparent already at the prehospital phase. The only difference in treatment was that middle-aged men living alone or unmarried received thrombolysis less often. The disparities in ACS morbidity and mortality by marital status tended to widen during the study period.

The population-based FINAMI myocardial infarction register recorded 15,330 cases of ACS among persons aged 35–99 years in Finland in 1993–2002. Record linkage with the files of Statistics Finland provided information on sociodemographic characteristics (marital status, household size).

Single living has been associated with a worse prognosis of acute coronary syndrome (ACS). We aimed to study the relation of sociodemographic characteristics to the morbidity, mortality, and case fatality (CF) of ACS in a large population-based ACS register.

References

1. Ben-Shlomo, Y, Smith, GD, Shipley, M. Magnitude and causes of mortality differences between married and unmarried men . J Epidemiol Community Health 1993 ; 47: 200 – 205 .

Google Scholar Crossref | Medline | ISI

2. Malyutina, S, Bobak, M, Simonova, G. Education, marital status, and total and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study . Ann Epidemiol 2004 ; 14: 244 – 249 .

Google Scholar Crossref | Medline | ISI

3. Salonen, JT . Socioeconomic status and risk of cancer, cerebral stroke, and death due to coronary heart disease and any disease: a longitudinal study in eastern Finland . J Epidemiol Community Health 1982 ; 36: 294 – 297 .

Google Scholar Crossref | Medline | ISI

4. Empana, JP, Jouven, X, Lemaitre, R. Marital status and risk of out-of-hospital sudden cardiac arrest in the population . Eur J Cardiovasc Prev Rehabil 2008 ; 15: 577 – 582 .

Google Scholar SAGE Journals

5. Nielsen, KM, Larsen, ML, Foldspang, A. Living alone and atypical clinical presentation are associated with higher mortality in patients with all components of the acute coronary syndrome . Eur J Cardiovasc Prev Rehabil 2007 ; 14: 152 – 154 .

Google Scholar SAGE Journals

6. Koskinen, S, Joutsenniemi, K, Martelin, T. Mortality differences according to living arrangements . Int J Epidemiol 2007 ; 36: 1255 – 1264 .

Google Scholar Crossref | Medline | ISI

7. Engström, G, Hedblad, B, Rosvall, M. Occupation, marital status, and low-grade inflammation: mutual confounding or independent cardiovascular risk factors? Arterioscler Thromb Vasc Biol 2006 ; 26: 643 – 648 .

Google Scholar Crossref | Medline | ISI

8. Gerward, S, Tydén, P, Engström, G. Marital status and occupation in relation to short-term case fatality after a first coronary event – a population based cohort . BMC Public Health 2010 10 ; 10: 235 – 242 .

Google Scholar Crossref | Medline | ISI

9. Nilsson, PM, Nilsson, JA, Ostergren, PO. Social mobility, marital status, and mortality risk in an adult life course perspective: the Malmö Preventive Project . Scand J Public Health 2005 ; 33: 412 – 423 .

Google Scholar Crossref | Medline | ISI

10. Venters, M, Jacobs, DR Jr, Pirie, P. Marital status and cardiovascular risk: the Minnesota Heart Survey and the Minnesota Heart Health Program . Prev Med 1986 ; 15: 591 – 605 .

Google Scholar Crossref | Medline | ISI

11. Koskenvuo, M, Kaprio, J, Romo, M. Incidence and prognosis of ischaemic heart disease with respect to marital status and social class. A national record linkage study . J Epidemiol Community Health 1981 ; 35: 192 – 196 .

Google Scholar Crossref | Medline | ISI

12. Nielsen, KM, Faergeman, O, Larsen, ML. Danish singles have a twofold risk of acute coronary syndrome: data from a cohort of 138 290 persons . J Epidemiol Community Health 2006 ; 60: 721 – 728 .

Google Scholar Crossref | Medline | ISI

13. Koskenvuo, M, Kaprio, J, Lönnqvist, J. Social factors and the gender difference in mortality . Soc Sci Med 1986 ; 23: 605 – 609 .

Google Scholar Crossref | Medline | ISI

14. Martikainen, P, Martelin, T, Nihtilä, E. Differences in mortality by marital status in Finland from 1976 to 2000: analyses of changes in marital-status distributions, socio-demographic and household composition, and cause of death . Popul Stud (Camb) 2005 ; 59: 99 – 115 .

Google Scholar Crossref | Medline | ISI

15. Salomaa, V, Ketonen, M, Koukkunen, H. Trends in coronary events in Finland during 1983–1997. The FINAMI study . Eur Heart J 2003 ; 24: 311 – 319 .

Google Scholar Crossref | Medline | ISI

16. Salomaa, V, Niemelä, M, Miettinen, H. Relationship of socioeconomic status to the incidence and prehospital, 28-day, and 1-year mortality rates of acute coronary events in the FINMONICA myocardial infarction register study . Circulation 2000 ; 101: 1913 – 1918 .

Google Scholar Crossref | Medline | ISI

17. Luepker, RV, Apple, FS, Christensen, RH. Case definitions for acute coronary heart disease in epidemiology and clinical research studies . Circulation 2003 ; 108: 2543 – 2549 .

Google Scholar Crossref | Medline | ISI

18. Waterhouse J, Muir C and Correa P. Cancer incidence in five continents, vol III. Lyon, France: International Agency for Research on Cancer, 1976. IARC Scientific Publication no. 15.

Google Scholar

19. Tunstall-Pedoe, H, Kuulasmaa, K, Mähönen, M. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations . Lancet 1999 ; 353: 1547 – 1957 .

Google Scholar Crossref | Medline | ISI

20. Udell, JA, Steg, PG, Scirica, BM. for the REduction of Atherothrombosis for Continued Health (REACH) Registry Investigators . Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis . Arch Intern Med 2012 ; 172: 1086 – 1095 .

Google Scholar Crossref | Medline

21. Nielsen, FE, Mard, S. Single-living is associated with increased risk of long-term mortality among employed patients with acute myocardial infarction . Clin Epidemiol 2010 ; 2: 91 – 98 .

Google Scholar Crossref | Medline

22. Molloy, GJ, Stamatakis, E, Randall, G. Marital status, gender and cardiovascular mortality: behavioural, psychological distress and metabolic explanations . Soc Sci Med 2009 ; 69: 223 – 228 .

Google Scholar Crossref | Medline | ISI

23. Rosengren, A, Wilhelmsen, L, Orth-Gomér, K. Coronary disease in relation to social support and social class in Swedish men. A 15 year follow-up in the study of men born in 1933 . Eur Heart J 2004 ; 25: 56 – 63 .

Google Scholar Crossref | Medline | ISI

24. Horsten, M, Mittleman, MA, Wamala, SP. Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study . Eur Heart J 2000 ; 21: 1072 – 1080 .

Google Scholar Crossref | Medline | ISI

25. Inaba, A, Thoits, PA, Ueno, K. Depression in the United States and Japan: gender, marital status, and SES patterns . Soc Sci Med 2005 ; 61: 2280 – 2292 .

Google Scholar Crossref | Medline | ISI

26. Frasure-Smith, N, Lespérance, F, Talajic, M. Depression and 18-month prognosis after myocardial infarction . Circulation 1995 ; 91: 999 – 1005 .

Google Scholar Crossref | Medline | ISI

27. Frasure-Smith, N, Lespérance, F, Gravel, G. Social support, depression, and mortality during the first year after myocardial infarction . Circulation 2000 ; 101: 1919 – 1924 .

Google Scholar Crossref | Medline | ISI

28. Zimmermann-Viehoff, F, Orth-Gomer, K, Wang, HX. Depressive symptoms and heart rate variability in younger women after an acute coronary event . Eur J Cardiovasc Rehabil 2010 ; 17: 509 – 513 .

Google Scholar SAGE Journals

29. Liao, D, Cai, J, Rosamond, WD. Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study. The ARIC Study. Atherosclerosis Risk in Communities Study . Am J Epidemiol 1997 ; 145: 696 – 706 .

Google Scholar Crossref | Medline | ISI

30. Randall, G, Bhattacharyya, MR, Steptoe, A. Marital status and heart rate variability in patients with suspected coronary artery disease . Ann Behav Med 2009 ; 38: 115 – 123 .

Google Scholar Crossref | Medline | ISI

31. Bouma, J, Broer, J, Bleeker, J. Longer pre-hospital delay in acute myocardial infarction in women because of longer doctor decision time . J Epidemiol Community Health 1999 ; 53: 459 – 464 .

Google Scholar Crossref | Medline | ISI

32. Atzema, CL, Austin, PC, Huynh, T. Effect of marriage on duration of chest pain associated with acute myocardial infarction before seeking care . CMAJ 2011 ; 183: 1482 – 1491 .

Google Scholar Crossref | Medline | ISI

33. Kulkarni, SP, Alexander, KP, Lytle, B. Long-term adherence with cardiovascular drug regimens . Am Heart J 2006 ; 151: 185 – 191 .

Google Scholar Crossref | Medline | ISI

34. Salomaa, V, Koukkunen, H, Ketonen, M. A new definition for myocardial infarction: what difference does it make? Eur Heart J 2005 ; 26: 1719 – 1725 .

Google Scholar Crossref | Medline | ISI