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

We conducted five types of prespecified sensitivity analyses. First, we compared the incidence rate ratios obtained from adjusted conditional fixed-effect Poisson regression models (main analysis) with the results from two alternative analyses: unconditional Poisson regression models (further adjusted for sex and age) and Cox proportional hazards regression models stratified on the matched pairs. Second, we assembled a set of controls who were neither married nor recently bereaved. Because single and divorced individuals are too few in these birth cohorts and tend to be highly selected in terms of socioeconomic position and lifestyle, we used a cohort of long-time widows and widowers. Each bereaved case was matched on sex and age to a widowed person who had experienced spousal loss more than 5 years prior to the index date (median 11 years) and who did not remarry afterwards. We hypothesised that if the causal effect of spousal bereavement is mostly acute and weakens as time elapses, then the excess risk of adverse health outcomes should be substantially greater among newly bereaved cases compared to married individuals than compared to long-time widows and widowers.