Association between marital status and mortality risk in cardiac disease: a cardiopulmonary exercise testing cohort study.

IF 2.9 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Environmental Health and Preventive Medicine Pub Date : 2026-01-01 DOI:10.1265/ehpm.25-00433

Shinya Takahashi, Atsuko Nakayama, Mamoru Nanasato, Mitsuaki Isobe

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引用次数: 0

Abstract

Background: Although marital status is a key social determinant of health, its prognostic relevance in cardiopulmonary exercise testing (CPX) cohorts remains unclear. We aimed to evaluate the association between marital status and mortality risk in patients with cardiac disease (CD) who underwent CPX.

Methods: This retrospective, single-center observational study involved consecutive patients with CD who underwent post-discharge CPX between 2008 and 2020. Participants (mean age: 69 years; 73% male) were categorized as either unmarried (never married, divorced, or widowed) or married. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. We used Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Model 1 was adjusted for age and sex to estimate the overall association between marital status and outcomes. Model 2 was adjusted for Model 1 covariates and peak VO₂ to account for objectively measured exercise capacity.

Results: Of 4,681 patients analyzed, 1,117 were unmarried and 3,564 were married. In Model 1, being married was associated with a lower risk of all-cause mortality (aHR: 0.75, 95% CI: 0.62-0.91, P < 0.001). This association persisted after adjusting for peak VO₂ in Model 2 (aHR: 0.79, 95% CI: 0.65-0.96, P = 0.002). For cardiovascular mortality, the estimates were consistent in direction (Model 1; aHR: 0.64, 95% CI: 0.44-0.93, P = 0.019, Model 2; aHR: 0.69, 95% CI: 0.47-1.02, P = 0.061).

Conclusions: In a large CPX cohort of patients with CD, married status was associated with a lower risk of all-cause mortality. The association was attenuated but remained after adjustment for peak VO₂, suggesting that differences in exercise capacity may contribute but do not fully account for the observed association. Marital status should be interpreted as a social marker rather than a causal or interventional exposure, and future studies should clarify modifiable factors related to prognosis.

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婚姻状况与心脏病死亡风险的关系：一项心肺运动试验队列研究

背景：虽然婚姻状况是健康的关键社会决定因素，但其在心肺运动试验（CPX）队列中的预后相关性尚不清楚。我们的目的是评估婚姻状况与接受CPX的心脏病（CD）患者死亡风险之间的关系。方法：这项回顾性、单中心观察性研究纳入了2008年至2020年间连续接受出院后CPX治疗的CD患者。参与者（平均年龄：69岁；73%为男性）分为未婚（从未结婚、离婚或丧偶）或已婚。主要结局是全因死亡率，次要结局是心血管死亡率。我们使用Cox比例风险模型来估计校正风险比（aHRs）和95%置信区间（ci）。模型1对年龄和性别进行了调整，以估计婚姻状况与结果之间的总体关联。模型2对模型1协变量和峰值VO2进行了调整，以考虑客观测量的运动能力。结果：4681例患者中，1117例未婚，3564例已婚。在模型1中，结婚与全因死亡风险降低相关（aHR: 0.75, 95% CI: 0.62-0.91, P < 0.001）。在模型2中调整峰值VO2后，这种关联仍然存在（aHR: 0.79, 95% CI: 0.65-0.96, P = 0.002）。对于心血管死亡率，估计方向一致（模型1；aHR: 0.64, 95% CI: 0.44-0.93, P = 0.019，模型2；aHR: 0.69, 95% CI: 0.47-1.02, P = 0.061）。结论：在一项大型CPX患者队列中，已婚状态与全因死亡风险较低相关。这种关联减弱，但在调整峰值VO2后仍然存在，这表明运动能力的差异可能有所贡献，但不能完全解释所观察到的关联。婚姻状况应被解释为一种社会标志，而不是因果或干预性暴露，未来的研究应阐明与预后相关的可改变因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Environmental Health and Preventive Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -

CiteScore

7.90

自引率

2.10%

发文量

审稿时长

10 weeks

期刊介绍： The official journal of the Japanese Society for Hygiene, Environmental Health and Preventive Medicine (EHPM) brings a comprehensive approach to prevention and environmental health related to medical, biological, molecular biological, genetic, physical, psychosocial, chemical, and other environmental factors. Environmental Health and Preventive Medicine features definitive studies on human health sciences and provides comprehensive and unique information to a worldwide readership.