In the United States, there is a growing trend among young adults to avoid marriage altogether. Currently, 25% of people aged 40 have never married.[i] The Institute for Family Studies predicts that “one-third of men and women who turn 45 in 2050 (those who are about 18 or 19 today) will not have married”.[ii] There are many implications for the individual and for society of never marrying. Marital status even affects health.
Prior research has shown that being unmarried “is associated with an increase in the incidence of various diseases and high mortality” (p. 2). What is the connection between marital status and disease risk? “Being unmarried has been suggested to contribute to less intimate social networks, loneliness and increased levels of stress hormones, which may increase risk from cardiovascular diseases, cancer, or metabolic syndrome” (p. 2).
The purpose of this study was to explore other purported health risks among the unmarried, including cancer and all-cause mortality, which have received less research attention. Further, the authors wanted to explore connections between health status, biological sex, and sub-groups of unmarried people, including divorced/separated, widowed, and never married. A meta-analysis of relevant studies was performed to identify sex and marital status differences in cardiovascular disease (CVD), coronary heart disease (CHD), cancer, and all-cause mortality. A total of 21 studies of 7,881,040 participants across 15 countries were included.
Results of the meta-analysis found differences by gender, marital status, and type of health outcome. Comparing first all-cause mortality, the relative risk was higher for unmarried than married people. Breaking this down further by gender and type of singlehood, “the risk of all-cause mortality for divorced/separated men was 18% higher than that for divorced/separated women” (p. 4). The risk was also higher for widowed or never-married men compared to women in the same category.
Similar results were obtained for cancer mortality risk for married compared to unmarried women and men. Those in the divorced/separated category had the highest cancer mortality risk compared to other unmarried groups.
Across the board, men fared worse than women in mortality risk among the unmarried. For example, risk of stroke was 31% higher for never-married men compared to never-married women. Unmarried men had a 20% higher risk of death from cardiovascular disease compared to unmarried women. Divorce or separation was a particularly salient status, increasing mortality risk from cancer, CVD, and all-cause mortality for men compared to women.
Explaining these findings, the authors noted: “Marital status appears to be a critical factor of mortality outcomes across different countries and cultures. Compared with married people, unmarried individuals may obtain less emotional, financial and companionship support and can even experience more sub-clinical symptoms of depression and anxiety, and major mental disorder” (p. 9).
Why do unmarried men have a higher likelihood of death from CVD and all-cause mortality compared to unmarried women? “The potential mechanisms for such findings are likely to be biological, psychological and social in nature” (p. 9). For example, estrogen has been found to provide a protective effect against heart disease in women, whereas testosterone “can drive the progression of atherosclerosis and stroke” in men (p. 10). Social support is also vital in helping people deal with stress, and over half of married men report their wives are the primary source of social support. However, for women, low marital quality is linked to heightened disease risk indicators.
Citation: Wang, Y., Jiao, Y., Nie, J., O’Neil, A., Huang, W., Zhang, L., … & Woodward, M. (2020). Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: A systematic review and meta-analysis of 7,881,040 individuals. Global Health Research and Policy, 5, 1-16.
©Jennie Dilworth, Ph.D
[i] https://www.pewresearch.org/short-reads/2023/06/28/a-record-high-share-of-40-year-olds-in-the-us-have-never-been-married/
[ii] https://ifstudies.org/blog/1-in-3-a-record-share-of-young-adults-will-never-marry