Efficacies of the new Paclitaxel-eluting Coroflex Please™ Stent in percutaneous coronary intervention; comparison of efficacy between Coroflex Please™ and Taxus™ (ECO-PLEASANT) trial: study rationale and design

Background

Almost 50% of Americans have elevated low-density lipoprotein cholesterol (LDL-C). The behaviors required to lower LDL-C levels may be difficult to adhere to if they are inconsistent with spouses' health practices, and, alternatively, may be enhanced by enlisting support from the spouse. This trial extends previous trials by requiring spouse enrollment, teaching spouses how to provide emotional and instrumental support, allowing patients to decide which component of the intervention they would like to receive, and having patients determine their own goals and action plans.

Methods

Veteran outpatients with above-goal LDL-C (N = 250) and their spouses are randomized, as a couple, to receive printed education materials only or the materials plus an 11-month, nurse-delivered, telephone-based intervention. The intervention contains four modules: medication adherence, diet, exercise, and patient-physician communication. Patients decide which modules they complete and in which order; modules may be repeated or omitted. Telephone calls are to patients and spouses separately and occur monthly. During each patient telephone call, patients' progress is reviewed, and patients create goals and action plans for the upcoming month. During spouse telephone calls, which occur within one week of patient calls, spouses are informed of patients' goals and action plans and devise strategies to increase emotional and instrumental support. The primary outcome is patients' LDL-C, measured at baseline, 6 months, and 11 months. Linear mixed models will be used to test the primary hypothesis that an 11-month, telephone-based patient-spouse intervention will result in a greater reduction in LDL-C as compared to printed education materials. Various process measures, including social support, self-efficacy, medication adherence, dietary behavior, and exercise, are also assessed to explain any change, or lack thereof, in LDL-C.

Discussion

Given the social context in which self-management occurs, interventions that teach spouses to provide instrumental and emotional support may help patients initiate and adhere to behaviors that lower their LDL-C levels. Moreover, allowing patients to retain autonomy by deciding which behaviors they would like to change and how may improve adherence and clinical outcomes.

Trial Registration

The ClinicalTrials.gov registration number is NCT00321789.     

Entry Into Romantic Partnership Is Associated With Obesity

BMI is highly correlated between spouses; however, less is understood about the underlying mechanism(s) by which the development of obesity in one individual increases the risk of obesity in his/her spouse. The objective of this study is to investigate whether romantic partnership and duration of cohabitation are related to incident obesity and obesity‐promoting behaviors. We used two data sets from the National Longitudinal Study of Adolescent Health: (i) 6,949 US adolescents (wave II, 1996) followed into adulthood (wave III, 2001–2002) and (ii) 1,293 dating, cohabiting, and married romantic couples from wave III, including measured anthropometry and self‐report behavior data. In the longitudinal cohort, we used sex‐stratified logistic regression models to examine the risk of incident obesity by longitudinal romantic relationship status and duration of time spent living with a romantic partner. In the Couples Sample, we used multinomial logistic regression to predict concordance in outcomes: obesity, moderate‐to‐vigorous physical activity, and screen time by romantic partnership and duration of time living with a romantic partner. Individuals who transitioned from single/dating to cohabiting or married were more likely to become obese than those who were dating at both waves. Partner concordance for negative, obesity‐related behaviors was strongest for married couples and couples who lived together ≥2 years. The shared household environment may increase the likelihood of becoming obese, influence partner concordance, and may be an important target for obesity intervention.     

The Life Cycle, Ecological, and Economic Determinants of Spousal Leisure Sharing: Panel Estimations from Tawahka Amerindians, Honduras

Researchers have used the amount of leisure as a yardstick to proxy for quality of life, but so far they have paid scant attention to the quality of leisure. Here I use spousal leisure sharing to proxy for quality of leisure and, by implication, for quality of life. I draw on life-cycle perspective, price theory, and on human ecology to frame hypotheses about the determinants of spousal leisure sharing. Drawing on longitudinal information collected over 2 years from 32 households in two villages of Tawahka Amerindians, a horticultural and foraging society in the tropical rain forest of eastern Honduras, I estimate the simultaneous effects of age and age squared, cash income, and climatic/seasonal variables on the amount of time spouses spend together in leisure. Analysis using different random and fixed-effect multivariate logit models suggests that (1) life-cycle determinants play a strong role in spousal leisure sharing and (2) neither climate/seasonal variables nor income correlate with spousal leisure sharing. As is true among couples in the United States, among Tawahka couples a change in the income of either spouse has a small effect on the amount of leisure shared by spouses. I find no evidence that economic development erodes spousal leisure sharing or that couples exhibit fissure in their pursuit of a common goal of leisure sharing.     

Association between Spouse/Child Separation and Migration-Related Stress among a Random Sample of Rural-to-Urban Migrants in Wuhan,China

BackgroundMillions of people move from rural areas to urban areas in China to pursue new opportunities while leaving their spouses and children at rural homes. Little is known about the impact of migration-related separation on mental health of these rural migrants in urban China.MethodsSurvey data from a random sample of rural-to-urban migrants (n = 1113, aged 18–45) from Wuhan were analyzed. The Domestic Migration Stress Questionnaire (DMSQ), an instrument with four subconstructs, was used to measure migration-related stress. The relationship between spouse/child separation and stress was assessed using survey estimation methods to account for the multi-level sampling design.Results16.46% of couples were separated from their spouses (spouse-separation only), 25.81% of parents were separated from their children (child separation only). Among the participants who married and had children, 5.97% were separated from both their spouses and children (double separation). Spouse-separation only and double separation did not scored significantly higher on DMSQ than those with no separation. Compared to parents without child separation, parents with child separation scored significantly higher on DMSQ (mean score = 2.88, 95% CI: [2.81, 2.95] vs. 2.60 [2.53, 2.67], p < .05). Stratified analysis by separation type and by gender indicated that the association was stronger for child-separation only and for female participants.ConclusionChild-separation is an important source of migration-related stress, and the effect is particularly strong for migrant women. Public policies and intervention programs should consider these factors to encourage and facilitate the co-migration of parents with their children to mitigate migration-related stress.     

Does Gender Moderate Factors Associated with Whether Spouses Are the Sole Providers of IADL Care to Their Partners?

We explored whether gender moderated the influence of other factors on solo spousal caregiving. The subsample (N = 452) from the AHEAD study included elderly care recipients (CRs) receiving IADL assistance and their spouses. Logistic regression modeled the likelihood of solo spousal IADL care. Gender moderation was tested by product terms between CRs' gender and measures of partners' health, potential helpers, and sociodemographic characteristics. As numbers of CRs' IADLs and couples' proximate daughters increased, wives less often received care solely from their husbands, but husbands' receipt of care from their wives was unaffected. Age differences between spouses and CRs affected solo spousal caregiving to wives and husbands in opposite ways. Regardless of gender, CRs' number of ADL limitations and spouses with IADL or ADL limitations reduced the likelihood of solo spouse care. Identifying circumstances influencing solo spouse caregiving differently among couples with frail wives and husbands facilitates gender sensitive services.     

Changes in cigarette smoking behavior among breast cancer and unaffected women – A prospective study in the MARIE cohort

BackgroundSmoking cessation after a cancer diagnosis can reduce adverse cancer treatment outcomes. Whether a breast cancer diagnosis, a cancer commonly seen as unrelated to smoking cigarettes, motivates changes in smoking behavior is not fully understood. We aimed to compare long-term changes at three follow-up times of cigarette smoking behavior in women with breast cancer and baseline age- and region-matched unaffected women.MethodsWe used longitudinal data from the population-based case-control study MARIE (Mamma Carcinoma Risk Factor Investigation). Women with breast cancer (N = 3813) and unaffected women (N = 7341) aged 50–74 years were recruited from 2002 to 2005. Analyses on changes in smoking were based on data from those who also completed follow-up 1 in 2009–2012, follow-up 2 in 2014–2016 and follow-up 3 in 2020. Multinomial logistic regression for changes (quitting, stable, or start smoking) adjusted for age, study region, education, comorbidities, living situation, and follow-up time, was applied to examine the associations between breast cancer status and changes in smoking behavior.ResultsWomen with breast cancer had significantly higher odds than unaffected women of quitting smoking (OR = 1.38, 95 % CI: 1.01–1.89) and lower odds of returning to smoking (OR = 0.29, 95 % CI: 0.09–0.94) at follow-up 1, but were more likely to start or return to smoking at follow-up 2 (OR = 2.11, 95 % CI 1.08–4.15). No significant group differences were found for changes in smoking behavior at follow-up 3.ConclusionOur findings indicate that short-term changes in smoking behavior can be attributed to a breast cancer diagnosis, but that over time the effect diminishes and changes in smoking no longer differ between breast cancer and breast cancer-free women. To support smoking cessation and to prevent relapse, guidelines to address smoking in cancer care, as well as comprehensive tobacco treatment services, are needed.     

Is Mate Choice in Humans MHC-Dependent?

In several species, including rodents and fish, it has been shown that the Major Histocompatibility Complex (MHC) influences mating preferences and, in some cases, that this may be mediated by preferences based on body odour. In humans, the picture has been less clear. Several studies have reported a tendency for humans to prefer MHC-dissimilar mates, a sexual selection that would favour the production of MHC-heterozygous offspring, who would be more resistant to pathogens, but these results are unsupported by other studies. Here, we report analyses of genome-wide genotype data (from the HapMap II dataset) and HLA types in African and European American couples to test whether humans tend to choose MHC-dissimilar mates. In order to distinguish MHC-specific effects from genome-wide effects, the pattern of similarity in the MHC region is compared to the pattern in the rest of the genome. African spouses show no significant pattern of similarity/dissimilarity across the MHC region (relatedness coefficient, R = 0.015, p = 0.23), whereas across the genome, they are more similar than random pairs of individuals (genome-wide R = 0.00185, p<10(-3)). We discuss several explanations for these observations, including demographic effects. On the other hand, the sampled European American couples are significantly more MHC-dissimilar than random pairs of individuals (R = -0.043, p = 0.015), and this pattern of dissimilarity is extreme when compared to the rest of the genome, both globally (genome-wide R = -0.00016, p = 0.739) and when broken into windows having the same length and recombination rate as the MHC (only nine genomic regions exhibit a higher level of genetic dissimilarity between spouses than does the MHC). This study thus supports the hypothesis that the MHC influences mate choice in some human populations.     

Assortative marriage for specific cognitive abilities in Korea

Abstract

Age‐adjusted spouse correlations for performance on tests of specific cognitive abilities were substantially higher for couples tested in Korea than for Americans of European or Japanese ancestry tested in Hawaii. It was hypothesized that this greater spouse resemblance in Korea may be due to cultural factors such as the Korean practice of arranged marriages.     

Promoting Smoke-Free Homes: A Novel Behavioral Intervention Using Real-Time Audio-Visual Feedback on Airborne Particle Levels

Interventions are needed to protect the health of children who live with smokers. We pilot-tested a real-time intervention for promoting behavior change in homes that reduces second hand tobacco smoke (SHS) levels. The intervention uses a monitor and feedback system to provide immediate auditory and visual signals triggered at defined thresholds of fine particle concentration. Dynamic graphs of real-time particle levels are also shown on a computer screen. We experimentally evaluated the system, field-tested it in homes with smokers, and conducted focus groups to obtain general opinions. Laboratory tests of the monitor demonstrated SHS sensitivity, stability, precision equivalent to at least 1 µg/m³, and low noise. A linear relationship (R² = 0.98) was observed between the monitor and average SHS mass concentrations up to 150 µg/m³. Focus groups and interviews with intervention participants showed in-home use to be acceptable and feasible. The intervention was evaluated in 3 homes with combined baseline and intervention periods lasting 9 to 15 full days. Two families modified their behavior by opening windows or doors, smoking outdoors, or smoking less. We observed evidence of lower SHS levels in these homes. The remaining household voiced reluctance to changing their smoking activity and did not exhibit lower SHS levels in main smoking areas or clear behavior change; however, family members expressed receptivity to smoking outdoors. This study established the feasibility of the real-time intervention, laying the groundwork for controlled trials with larger sample sizes. Visual and auditory cues may prompt family members to take immediate action to reduce SHS levels. Dynamic graphs of SHS levels may help families make decisions about specific mitigation approaches.     

Becoming voluntarily childless: An exploratory study in a Scottish city

Abstract

This paper looks at motives that inform the decision to remain voluntarily childless. It is assumed that voluntary childlessness is not a pathological condition nor is it determined by specific social situations. Situations provide the context within which motives emerge, in the case of voluntary childlessness providing individuals or couples with the opportunity to consider unconventional interpretations of family life that may eventually lead to its rejection. Individuals who become childless prior to finding a “partner” tend to come from families which deviated from the nuclear ideal and to reject parenthood. Those whose decision emerges after a “partnership” has been formed tend to have created alternative life styles and wish to protect the advantages of living without children. It is tentatively concluded that the proportion of couples remaining childless will increase.     

Submitting articles to the BMJ

ObjectiveTo determine whether people whose marital partners have depression, diabetes, hypertension, ischaemic heart disease, stroke, hyperlipidaemia, peptic ulcer disease, or asthma or chronic obstructive pulmonary disease are at increased risk of the same disease.DesignCross sectional study.Setting10 practices from the Trent Focus Collaborative Research Practice Network.Participants8386 married couples (16 772 individuals) from a population of 29 014 participants aged 30-74 years.OutcomesRisk of disease in participants whose marital partner had that disease compared with those whose partner did not.ResultsAfter both partners'' age, smoking, and obesity and which general practice they attend were adjusted for, participants whose marital partner had asthma, depression, hypertension, hyperlipidaemia, and peptic ulcer disease were at increased risk of having the same disease. The adjusted odds ratios were 1.69 (95% confidence interval 1.43 to 2.98) for asthma, 2.08 (1.71 to 2.54) for depression, 1.32 (1.04 to 1.67) for hypertension, 1.44 (1.19 to 1.75) for hyperlipidaemia, and 2.01 (1.48 to 2.73) for peptic ulcer disease.ConclusionPartners of people with specific diseases are at increased risk of the disease themselves—at least 70% increased risk for asthma, depression, and peptic ulcer disease. This implicates shared environmental causes in some diseases in addition to any genetic or distant exposure or shared behaviours with respect to seeking health care.

What is already known on this topic

People whose spouses have hypertension are at increased risk of hypertensionLittle is known about the risks of disease for spouses of patients with diseases other than hypertension

What this study adds

People whose marital partner had asthma, depression, and peptic ulcer disease were at increased risk of having the same diseaseShared environmental factors contribute to the risk of diseasesThe costs and benefits of screening people for diseases of their spouses needs to be considered     

Divorce in the early years of marriage in England and Wales: results from a prospective study using linked records

A representative sample of over 1000 couples who married during 1979 in England and Wales was followed from the date of marriage until mid-1984 to investigate the characteristics of couples who divorce soon after marriage. Results of this 5 year study show that couples who apparently lived together before marriage had a below average chance of early divorce, whereas couples where the addresses of the partners before marriage were very close had a significantly high rate of early breakdown. The chance of early divorce was significantly above average for spouses marrying in their teens and for both husbands and wives who, at their marriage, belonged to social class 5 (work in unskilled manual occupations). Couples who married with a civil ceremony had an above average (and those marrying with a religious ceremony a below average) risk of early divorce, but such differences were found to be negligible on analyzing the results from a matched case-control study in which each "case" marriage (one which did end in early divorce) was matched with a "control" marriage (one which did not end in early divorce). There is substantial evidence that age at marriage and previous marital status of the marriage partners have a decided influence upon the propensity to divorce. 2 conclusions concerning fertility are more likely than the average married couple to have had a pre-maritally conceived child, and 2) that couples who divorce relatively quickly tend on average to have larger family sizes, even if children who were pre-martitally conceived are exluded.     

Nutritional treatment of aged individuals with Alzheimer's disease living at home with their spouses: study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: Nutritional status often deteriorates in Alzheimer's disease (AD). Less is known about whether nutritional care reverses malnutrition and its harmful consequences in AD. The aim of this study is to examine whether individualized nutritional care has an effect on weight, nutrition, health, physical functioning, and quality of life in older individuals with AD and their spouses living at home. METHODS: AD patients and their spouses (aged >65 years) living at home (n = 204, 102 AD patients) were recruited using central AD registers in Finland. The couples were randomized into intervention and control groups. A trained nutritionist visited intervention couples four to eight times at their homes and the couples received tailored nutritional care. When necessary, the couples were given protein and nutrient-enriched complementary drinks. All intervention couples were advised to take vitamin D 20 mug/day. The intervention lasted for 1 year. The couples of the control group received a written guide on nutrition of older people. Participants in the intervention group were assessed every 3 months. The primary outcome measure is weight change. Secondary measures are the intake of energy, protein, and other nutrients, nutritional status, cognition, caregiver's burden, depression, health-related quality of life, and grip strength. DISCUSSION: This study provides data on whether tailored nutritional care is beneficial to home-dwelling AD patients and their spouses. Trial registration ACTRN 12611000018910.     

Impact of future cigarette smoking scenarios on mortality of the adult population in the United States, 2000–2050

Abstract

The prevalence of cigarette smoking in the United States has declined over the past few decades. However, some leveling‐off in prevalence rates has been observed in recent years, and the rate for teenagers and young adults has even turned upward. This paper considers four alternative scenarios of future cigarette smoking patterns in the United States for the population 25 and over and measures the impact these different scenarios would have on excess mortality due to smoking and on the sex and age distributions of deaths. Scenarios reflecting higher levels of smoking prevalence produce considerably more deaths than scenarios tied to lower levels. As many as two and one‐half million excess deaths would take place in the decade of the 2020's if a high prevalence, rather than low prevalence, assumption proves correct. Even when a constant prevalence, assumption proves correct. Even when a constant prevalence assumption is compared with a moderately‐declining prevalence assumption, as many as one million excess deaths would be generated during that decade alone. Lowering smoking prevalence rates would also change the population sex ratio by reducing deaths for males more than deaths for females, and by contributing to the aging of the population. The results are interpreted in terms of the overall impact of smoking on mortality and with regard to public and private policy decisions related to cigarette smoking.     

Circadian preference and relationship satisfaction among three types of couples

ABSTRACT

Mate selection is part of a growing interest in the study of processes by which couples are established, consolidated and/or separated. Similarity in psychological traits has been related to the well-being of couples, but given the possible effect of temporal convergence, it is necessary to control for the relationship length and whether or not both members of the couple live together. The aim of this study was to analyse the association between Morningness/Eveningness (M/E) similarity and relationship satisfaction in young-dating-non-cohabiting, young-married-cohabiting and old-married-cohabiting couples. Participants included 357 heterosexual couples (357 women and 357 men) with a mean age of 38.42 years old (SD = 13.11; age range between 19 and 69) who completed M/E (Composite Scale of Morningness) and relationship satisfaction measures (Comprehensive Marital Satisfaction Scale). Similarity in M/E was positively related to greater relationship satisfaction in both young cohabiting and non-cohabiting couples. In women, their own M/E was related to their own relationship satisfaction, whereas the level of relationship satisfaction in men was related to their partner’s M/E. This relationship was observed in young-married-cohabiting couples. M/E similarity may operate differently as a function of the relationship stage.     

Disagreement in spousal reports of current contraceptive use in sub-Saharan Africa

Contraceptive prevalence is a key variable estimated from Demographic and Health Surveys. But the prevalence estimated from reports of husbands differs widely from that estimated for wives. In this research, using data from six Demographic and Health Surveys of sub-Saharan Africa, reports from spouses in monogamous couples with no other reported sex partners in the recent period are examined. Agreement ranged from 47% to 82%, but among couples in which one or both reported use, the 'both' category represented less than half in all nations except Zimbabwe. Husbands generally had higher reports of condoms, periodic abstinence and pills but fewer reports of the IUD, injections and female sterilization. Either discussion of family planning with the spouse and/or higher socioeconomic status was associated with agreement in most of the surveys. Ambiguities in the survey question regarding current use need to be reduced, perhaps with an added probe question for non-permanent methods.     

A new framework for investigating biotic homogenization and exploring future trajectories: oceanic island plant and bird assemblages as a case study

Studies of biotic homogenization have focused primarily on characterizing changes that have occurred between some past baseline and the present day. In order to understand how homogenization may change in the future, it is important to contextualize the processes driving these changes. Here, we examine empirical patterns of change in taxonomic similarity among oceanic island plant and bird assemblages. We use these empirical cases to unpack dynamic properties of biotic homogenization, thereby elucidating two important factors that have received little attention: 1) initial similarity and 2) the influence of six classes of introduction and extinction events. We use Jaccard's Index to explore the interplay among these factors in determining the changes in similarity that have occurred between human settlement and the present. Specifically, we develop general formulas for changes in similarity resulting from each of the six types of introductions and extinctions, so that the effect of each event type is formulated in terms of initial similarity and species richness. We then apply these insights to project how similarity levels would change in the future if the present patterns of introductions and extinctions continue. We show that the six event types, along with initial similarity, can show dramatically different behavior in different systems, leading to widely variable influences on similarity. Plant and bird biotas have homogenized only slightly to date, but their trajectories of change are highly divergent. Although existing patterns of colonization and extinction might not continue unchanged, if they were to do so then plant assemblages would show little additional change, whereas bird assemblages would become much more strongly homogenized. Our results suggest that moderate changes in similarity observed to date mask the potential for more dramatic changes in the future, and that the interaction among initial similarity and differential introduction and extinction regimes drives these dynamics.     

Characteristics of Malignant Tumors in 230 Husband–Wife Pairs

The aim of this study is to obtain a reference point for early detection of tumors in individuals whose spouses were diagnosed with malignant tumors. Data from 230 husband and wife pairs with malignant tumors were collected and analyzed from the family history records of 15,000 people who came to the Department of Cancer Prevention, Cancer Institute/Hospital, Chinese Academy of Medical Sciences for cancer screening between January 2009 and May 2012. The median diagnosis age was 67 years for husbands and 65 years for wives. A total of 214 cases (46.5 %) had digestive system malignancies. Respiratory system cancers were diagnosed in 64 husbands, of whom 20 (31.3 %) had spouses also with respiratory system cancer. Lung cancer ranked first for the females. The total number of lung cancer and commonly seen female-specific cancers (breast, ovarian, uterine, and cervical) was 127 (55.2 %). The difference in age at diagnosis between spouses was less than 10 years in 134 couples (58.3 %), while 77 (33.5 %) couples had an age difference less than 5 years. A family history of malignant tumors in first-degree relatives was documented in 48.3 % of the husbands and 48.7 % of the wives. The occurrence of cancer in both spouses of the couples studied resulted from an interaction between genetic and environmental factors. Nonhereditary factors such as diet, smoking, passive smoking, and air pollution also contributed to the development of cancers. It is recommended that when husband is diagnosed with cancer, the wife should be screened focusing on lung, breast, and gynecological cancers. If the wife was diagnosed with malignant disease, then screening for lung and digestive system cancers should be emphasized in the husband.     

Environmental tobacco smoke and tobacco related mortality in a prospective study of Californians, 1960-98

Objective To measure the relation between environmental tobacco smoke, as estimated by smoking in spouses, and long term mortality from tobacco related disease.Design Prospective cohort study covering 39 years.Setting Adult population of California, United States.Participants 118 094 adults enrolled in late 1959 in the American Cancer Society cancer prevention study (CPS I), who were followed until 1998. Particular focus is on the 35 561 never smokers who had a spouse in the study with known smoking habits.Main outcome measures Relative risks and 95% confidence intervals for deaths from coronary heart disease, lung cancer, and chronic obstructive pulmonary disease related to smoking in spouses and active cigarette smoking.Results For participants followed from 1960 until 1998 the age adjusted relative risk (95% confidence interval) for never smokers married to ever smokers compared with never smokers married to never smokers was 0.94 (0.85 to 1.05) for coronary heart disease, 0.75 (0.42 to 1.35) for lung cancer, and 1.27 (0.78 to 2.08) for chronic obstructive pulmonary disease among 9619 men, and 1.01 (0.94 to 1.08), 0.99 (0.72 to 1.37), and 1.13 (0.80 to 1.58), respectively, among 25 942 women. No significant associations were found for current or former exposure to environmental tobacco smoke before or after adjusting for seven confounders and before or after excluding participants with pre-existing disease. No significant associations were found during the shorter follow up periods of 1960-5, 1966-72, 1973-85, and 1973-98.Conclusions The results do not support a causal relation between environmental tobacco smoke and tobacco related mortality, although they do not rule out a small effect. The association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed.     

Changes in Health Care Expenditure after the Loss of a Spouse: Data on 6,487 Older Widows and Widowers in the Netherlands

Background

In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care.

Objective

To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affected most.

Design

Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004–2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse.

Results

Mean monthly health care expenditure in married subjects was €502 in the 42 months before the death of the spouse, and expenditure levels rose by €239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (€319; 59%) and the oldest old (€553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together €166).

Conclusions

The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.