This application proposes an innovative interdisciplinary project that will advance our understanding of how marital factors impact the development and progression of cardiovascular disease (CVD) in U.S. older adults. The research will provide the first comprehensive examination of the associations between the major dimensions of marital trajectories (marital status, timing, sequencing, transitions, and durations) and CVD incidence and mortality using a life course framework that combines conceptual breadth and empirical specificity. The primary aims of this research are threefold: First, to examine the associations between time- varying marital trajectory components and incident cardiovascular events (myocardial infarction [MI] and stroke). Bivariate and multivariate analyses will provide some of the first evidence of whether and to what extent past and present marital experiences precipitate acute MI and stroke in men and women. Second, examine the associations between the marital components and mortality (all-cause and CVD-specific) after MI and stroke. The secondary set of analyses will demonstrate the degree to which marital factors influence survival after a major cardiovascular event. Third, investigate the socioeconomic, psychosocial, behavioral, and physiological mechanisms linking marital trajectories to CVD incidence and mortality. The hypothesized mechanisms will be assessed independently, additively, and multiplicatively as time-varying risks to determine whether they are operating as mediators and/or moderators of marital differences in rates of morbidity and mortality. Drawing from cumulative disadvantage theory, the general hypothesis is that the accumulation of risks and acceleration of cardiovascular aging will be greatest among persons with the least exposure to marriage and most marital instability. The analyses will be based on more than 50 years of prospective and retrospective data from a nationally representative biennial panel (1992-2010) of older adults and will use a variety of age-based methods to elucidate how the multidimensional time-varying effects of marital history impact risks for a major CVD event and subsequent survival. The proposed R03 research will address a significant gap in our understanding of how a major social institution impacts human health and will provide new insights that will advance the interdisciplinary study of CVD. Understanding social disparities in CVD and reducing the excess burden of disease in vulnerable segments of the population are major goals of Healthy People 2020 and the National Institute on Aging. The results of this project will provide new science to identify social groups at high-risk of disease and will provide valuable new knowledge that can translate into innovative yet practical strategies to prevent incident cardiovascular events and prolong survival in adults living with CVD.

Public Health Relevance

Cardiovascular disease (CVD) is a major public health burden in the United States. Understanding how marital trajectories influence myocardial infarction, stroke, and subsequent survival is a critical step toward unraveling the social origins of CVD and providing valuable new knowledge that can translate into innovative yet practical strategies to reduce incident cardiovascular events and prolong survival in vulnerable segments of the population.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Small Research Grants (R03)
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Special Emphasis Panel (SSPB)
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Patmios, Georgeanne E
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Duke University
Other Clinical Sciences
Schools of Medicine
United States
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Dupre, Matthew E; Nelson, Alicia (2016) Marital history and survival after a heart attack. Soc Sci Med 170:114-123
Dupre, Matthew E; Lopes, Renato D (2016) Marital History and Survival After Stroke. J Am Heart Assoc 5:
Dupre, Matthew E (2016) Race, Marital History, and Risks for Stroke in US Older Adults. Soc Forces 95:439-468
Dupre, Matthew E; George, Linda K; Liu, Guangya et al. (2015) Association between divorce and risks for acute myocardial infarction. Circ Cardiovasc Qual Outcomes 8:244-51