Spousal bereavement, mortality and risk of negative health outcomes among older adults: a population-based study

Lucas Morin; Jonas W Wastesson; Stefan Fors; Neda Agahi; Kristina Johnell

As previous reports suggested that spousal loss may have more detrimental effects on health among men than among women 3 , all analyses were stratified by sex. To overcome some of the caveats of relative summary metrics of between-group survival differences, 39 we compared the adjusted restricted mean survival time of bereaved and married individuals. 40 In addition, we assessed the time-dependent effect of spousal loss on mortality by computing piecewise Poisson regression models and by fitting flexible parametric survival models with restricted cubic splines to plot a smooth curve of the hazard ratio as a function of time since bereavement. 41 We also investigated variations in the hazard ratio for mortality throughout the age span and across percentiles of income by constructing restricted cubic splines for these two continuous variables.