Widowhood and mortality: a meta-analysis and meta-regression

Abstract

The study of spousal bereavement and mortality has long been a major topic of interest for social scientists, but much remains unknown with respect to important moderating factors, such as age, follow-up duration, and geographic region. The present study examines these factors using meta-analysis. Keyword searches were conducted in multiple electronic databases, supplemented by extensive iterative hand searches. We extracted 1,377 mortality risk estimates from 123 publications, providing data on more than 500 million persons. Compared with married people, widowers had a mean hazard ratio (HR) of 1.23 (95% confidence interval (CI), 1.19-1.28) among HRs adjusted for age and additional covariates and a high subjective quality score. The mean HR was higher for men (HR, 1.27; 95% CI, 1.19-1.35) than for women (HR, 1.15; 95% CI, 1.08-1.22). A significant interaction effect was found between gender and mean age, with HRs decreasing more rapidly for men than for women as age increased. Other significant predictors of HR magnitude included sample size, geographic region, level of statistical adjustment, and study quality.

Figures

Figure 1

Flow chart of publications reviewed for study eligibility

Figure 2

Mean hazard ratio by mean age and gender, based on Model 3 of Table 6

Figure 3

Funnel plot of hazard ratios (logged) versus sample size: hazard ratios statistically adjusted for age and additional covariates Vertical line denotes the mean hazard ratio (logged) of 0.1866. Y-axis scale changes at 1,000,000 to provide better resolution for smaller sample sizes.