Behind the headlines

Does a stable marriage make you more likely to survive a stroke?

Happy couple sitting beside a lake

According to the Daily Mail, being in a stable marriage means you’re more likely to survive a stroke. Is there truth behind the headlines?

A new study has suggested that people who are divorced, widowed, or never married might be significantly more likely to die following a stroke than those who remained married.

The researchers, from Duke University in North Carolina, looked at the data for 2,351 people who took part in the Health and Retirement Study (HRS) an ongoing study of US adults older than 50. 

For adults who never married, the risks of dying after a stroke were 71 per cent greater than adults who were continuously married. Divorce and widowhood increased the risk of mortality by 23 per cent and 25 per cent respectively, compared to people who had remained married.

The risks were also higher for people who’d gone through multiple divorces (39 per cent higher risk), or deaths of more than one spouse (40 per cent). Marrying again didn’t seem to reduce this risk.

The researchers suggest this is partly because continuous marriages provide stable financial, social, and psychological support that accumulates over time. When people in stable marriages are faced with a stroke, they may be in a stronger position, both mentally and financially, which can help them to better manage the disease and prolong their survival.

They also think that their result could be due to the acute and chronic stress associated with divorce or being widowed. The stress of losing your spouse could be one of the reasons for this increased risk of death after a stroke, they said.

The BHF view

Mike Knapton, BHF Associate Medical Director, says: "This is an interesting study, and confirms the association between marital status and disease recovery, which some studies have also suggested.

"The study is useful as marital status could be taken into account when looking at someone's recovery from stroke. However, there are other factors which should be taken into account, such as the psychological and physical support they receive, and having financial stability, which could in turn reduce their stress levels.

"But we must remember that a stroke could happen to anyone at any time, whether they are married or not. There are simple steps we can take to reduce our risk of stroke, such as eating a balanced diet, taking regular exercise and having regular blood pressure checks."

Limitations

One limitation of this research is that it is based only on stroke patients who survived to discharge, not hose who died in hospital. It was based on self-reported diagnoses of strokes, so there may be somecases of stroke that were not included in the study.

What's more, the researchers could not tell which type of stroke it was, how severe it was, and other medical factors (such as rehabilitation) that are associated with survival.

They also couldn’t tell how long people’s past marriages were, the quality of the marriage, how good their other social support was, and how stressed or anxious someone one after a stroke – which the researchers admit may have contributed to the result of their research.

The people who were analysed were taken from the Health and Retirement Study (HRS) an ongoing study of US adults older than 50. It was taken from interviews between 1992-2010, so the results might be different today, as the treatment for stroke has improved since the 1990s and this is likely to have affected survival rates.

They also recognise that the results do not suggest cause-and-effect and may not be generalisable to other populations. In the UK, there are some differences in medical care, as well as universal healthcare rather than the health insurance system used in the United States.

Media coverage

The Daily Mail headline ‘Why being single really could KILL you: Unmarried adults are 70 per cent more likely to die from a stroke’ is alarming. What it doesn't make clear is that this research looked only at survival past hospital discharge among stroke patients - it didn't look at how your marital status affects your risk of a stroke in the first place, or your risk of immediate death.

The Mail article goes on to say that the researchers think the reason for that is because married people ‘simply have someone to look after them.’ However, the study says that the cause is unclear, and we need further research before claiming to know the cause. They suggest that the accumulated support of a stable marriage could be one factor, but this is connected to a mixture of factors including stress, your medical history, finances, social support more generally, and your medical care.

However, the Mail report does provide some useful context with figures about numbers of strokes in the UK and the US, as well as death rates from stroke.

More useful information