Marital status and risk of out-of-hospital sudden cardiac arrest in the population

Background We have recently reported on the association between clinical depression and out-of-hospital sudden cardiac arrest (SCA). In this study, we extend our research on the contribution of psychosocial characteristics to SCA, by examining the association between marital status and out-of-hospital SCA. Design A large case-control study of risk factors for incident SCA including 2119 cases and 4042-matched controls. Methods Participants were enrollees of a health maintenance organization (USA). Cases experienced SCA between 1980 and 1994 (mean age of 67 years). Controls were a stratified random sample of enrollees, with the strata defined by age, sex, earlier heart disease, and calendar year. The marital status at the time of the SCA or a comparable index date for controls was assessed using ambulatory care medical records. Conditional logistic regression was used to estimate odds ratio and its 95% confidence interval. Results Cases were more likely to be unmarried than the controls (30.2% vs. 21.0%), defined as being separated or divorced (10.0% vs. 70%), single (5.0% vs. 3.6%) or widowed (15.2% vs. 10.4%). Unmarried participants had a higher risk of SCA (odds ratio: 1.53; 95% confidence interval: 1.33-1.76), after adjustment for SCA risk factors. Consistent findings were observed according to sex, older age (>70 years), earlier coronary heart disease and the presence of clinical depression. Those who were both unmarried and clinically depressed had the highest risk of SCA. Conclusion These data support an association between marital status and SCA. Eur J Cardiovasc Prev Rehabil 15:577-582 (C) 2008 The European Society of Cardiology