Marital status and health: Descriptive and explanatory studies

DUring the last 30 years social factors have become increasingly important in the evolution of concepts of disease etiology. In the beginning of this century the germ theory and its monocausal orientation, attributing single diseases to single causes (i.e. infectious agents), dominated medical thinking. However, the germ theory failed to explain why only some of those persons exposed to pathogens actually contracted the disease. In addition, the germ theory was less appropriate for the explanation of degenerative causes of death such as cardiovascular diseases and malignant neoplasms, which have replaced Infectious diseases as the main causes of death in this century. The monocausal concept of disease etiology was followed by a multicausal orientation, which emphasized the presence of several interacting causal factors. Multicausal research Initially focused on biological risk factors, such as high serum cholesterol, high blood pressure and cigarette smoking in the development of coronary heart disease. However, this approach also proved to be only partly successful in pinpointing the causes of disease. For instance, only a relatively small proportion of all persons with high serum cholesterol and high blood pressure who smoke cigarettes, develop coronary heart disease and many persons who lack most of these risk factors do develop coronary heart disease. Thus, other factors must be involved in the etiological process. Groups differentiated by social factors have long been found to exhibit characteristic mortality and morbidity patterns. These health differences between social groups (e.g. differences in coronary heart disease) were independent of traditional risk factors (e.g. high serum cholesterol, high blood pressure, cigarette smoking, obesity). The idea that these differences in health must be attributable to specific group characteristics has led to the incorporation of social factors in research of disease etiology. One of the social factors for which intriguing differences in health status have been found is marital status, which is the focus of this thesis.

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