The Protective Effect of Marriage on Mortality in a Dynamic Society

Purpose We sought to assess whether the protective effect of marriage on overall and cause-specific mortality has changed over time in a dynamic society. Methods Data from the census-based Israel Longitudinal Studies (ILMS) I (1983–1992) and II (1995–2004) were analyzed. Cox proportional hazard modeling adjusting for sociodemographic factors was applied to 152,150 and 209,125 individuals, ages 45–89 years from the ILMS I and II, respectively. During each study period 31,749 (ILMS I) and 37,656 (ILMS II) deaths were reported. Results Mortality inequalities by marital status remained significant and widened over time for middle-aged and elderly men and women. Changes in cause-specific mortality indicated a widening of cardiovascular disease mortality inequalities by marital status. An increasing trend was also noted for deaths from cancer (+25%) and other causes (+38%, p < 0.05) in middle-aged men, but not women (cancer = 0%; other causes = −3%). Conclusions The stronger beneficial effect of marriage over time may reflect societal changes that have differentially affected men and women.