Widowhood and Mortality: A Meta-Analysis

BackgroundWhile the "widowhood effect" is well known, there is substantial heterogeneity in the magnitude of effects reported in different studies. We conducted a meta-analysis of widowhood and mortality, focusing on longitudinal studies with follow-up from the time of bereavement.
Methods and FindingsA random-effects meta-analysis was conducted to calculate the overall relative risk (RR) for subsequent mortality among 2,263,888 subjects from 15 prospective cohort studies. We found a statistically significant positive association between widowhood and mortality, but the widowhood effect was stronger in the period earlier than six months since bereavement (overall RR = 1.41, 95% CI: 1.26, 1.57) compared to the effect after six months (overall RR = 1.14, 95% CI: 1.10, 1.18). Meta-regression showed that the widowhood effect was not different for those aged younger than 65 years compared to those older than 65 (P = 0.25). There was, however, a difference in the magnitude of the widowhood effect by gender; for women the RR was not statistically significantly different from the null (overall RR = 1.04, 95% CI: 1.00, 1.08), while it was for men (overall RR = 1.23, 95% CI: 1.18, 1.28).
ConclusionsThe results suggest that further studies should focus more on the mechanisms that generate this association especially among men.

研究背景 尽管丧偶效应（Widowhood Effect）已为学界广泛熟知，但不同研究报道的效应强度存在显著异质性。本研究针对丧偶与死亡率的关联开展荟萃分析（meta-analysis），重点纳入以丧亲发生时间为随访起点的纵向研究。
研究方法与结果 本研究采用随机效应模型荟萃分析，对来自15项前瞻性队列研究的2263888名研究对象的后续死亡风险计算合并后的相对危险度（Relative Risk, RR）。结果显示，丧偶与死亡率之间存在具有统计学意义的正相关；但丧偶效应在丧亲后6个月内更为显著（合并RR=1.41，95%置信区间CI: 1.26, 1.57），显著高于6个月后的效应（合并RR=1.14，95%CI: 1.10, 1.18）。荟萃回归分析表明，年龄低于65岁与65岁及以上人群的丧偶效应无统计学差异（P=0.25）。不过，不同性别群体的丧偶效应强度存在显著差异：女性群体的RR值与零假设无统计学差异（合并RR=1.04，95%CI: 1.00, 1.08），而男性群体则呈现出显著的丧偶效应（合并RR=1.23，95%CI: 1.18, 1.28）。
研究结论 本研究结果提示，后续研究应更多关注该关联的潜在作用机制，尤其应聚焦男性群体。