Effects of spouses' socioeconomic characteristics on mortality among men and women in a Norwegian longitudinal study

A partner's socioeconomic characteristics can influence one's own health. Nevertheless, little is known about the relative importance of a partner's education, occupation and income in relation to inequalities in mortality. In this study, we consider the relative contribution of these three spouse characteristics to predicting general and cause-specific mortality in men and women. Data on married persons and their spouses were taken from a Norwegian cross-sectional survey of a total county population (the Nord-Trøndelag Health Study, HUNT 1, 1984-1986). A mortality follow-up was maintained until 2003. Associations of mortality with socioeconomic indicators were assessed computing hazard ratios and Relative Index of Inequality in Cox regression. In women, a clear gradient in age-adjusted mortality rates was observed according to all husband's characteristics. In men, wife's education was most consistently associated with their mortality. After mutual adjustment for all own and spouse's socioeconomic characteristics, the effect of husband's education on women's overall mortality diminished (HR 1.07), whereas the effects of husband's occupation and income remained of similarly moderate size (HR 1.12). Wife's education persisted after adjustment as a significant and strong predictor of men's all-cause mortality (HR 1.35). Effects of partner's characteristics were mostly pronounced in cardiovascular mortality and far less in cancer mortality. In men, wife's education was the strongest and only predictor of mortality across all causes of death examined, except stroke. In women, husband's occupation was mainly related to ischemic heart disease and lung cancer mortality, while husband's income influenced mainly stroke mortality. Wife's education and husband's occupation and income were the most important predictors of mortality across partner relationships. It is suggested that men contribute to their wives' health not only by means of financial security, but also through occupational class. Further research should test our hypothesis that the effect of husband's occupation on their spouses works through occupation-related lifestyle and social prestige.

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