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

Adjusted restricted mean survival time analyses showed that bereaved cases survived on average 4.2 days shorter than married controls when they were followed for 1 year, and 20.5 days shorter when follow-up was extended to 3 years (Supplementary table S8) . We also observed an increased risk of acute cardiovascular events (IRR 1.34, 95% CI 1.24-1.44), hip fracture (IRR 1.48, 95% CI 1.30-1.68), pneumonia (1.14, 95% CI 1.04-1.25), and self-harm (IRR 3.49, 95% CI 2.11-5.76) among bereaved cases compared with their married counterparts. Although effect estimates decreased for all outcomes when we considered the entire available follow-up time, the association with spousal loss remained (IRR for all-cause mortality 1.36, 95% CI 1.29-1.43). The excess risk of mortality was highest during the first 3 months after spousal loss, and gradually decreased throughout the remaining follow-up (Supplementary Figure S2 and Table S9) . We observed a similar pattern for the time-varying association of spousal loss with adverse health events (Supplementary Figure S3) . As shown in Table 3 , bereaved older adults also had higher incidence rates of non-elective hospitalisations (IRR 1.17, 95% CI 1.14-1.21) and nursing home admissions (IRR 3.10, 95% CI 2.81-3.45).