Does marriage protect against hospitalization with pneumonia? A population-based case-control study

Figures & data

Table 1 Descriptive characteristics of 67,162 cases with a first-time hospitalization for pneumonia and 671,620 matched controls, from 1994–2008 in Northern Denmark, stratified by marital status

Exposure	Total N (%)		Married N (%)		Never married N (%)		Divorced N (%)		Widowed N (%)
	Cases	Controls	Cases	Controls	Cases	Controls	Cases	Controls	Cases	Controls
Total	67,162	671,620	31,746	356,144	8,471	76,102	7,008	49,844	19,758	188,156
Sex
Male (%)	35,718 (53)	357,180 (53)	20,282 (64)	226,462 (64)	5,306 (63)	45,913 (60)	3,568 (51)	25,255 (51)	6,46 (33)	58,82 (31)
Female (%)	31,444 (47)	314,440 (47)	11,464 (36)	129,682 (36)	3,162 (37)	30,189 (40)	3,44 (49)	24,589 (49)	13,298 (67)	129,336 (69)
Age
15–39 years	4,907 (7)	49,291 (7)	1,799 (6)	18,716 (5)	2,769 (33)	28,194 (37)	283 (4)	2,089 (4)	11 (0)	52 (0)
40–64 years	16,716 (25)	167,183 (25)	10,01 (32)	119,910 (34)	2,572 (30)	18,714 (25)	3,174 (45)	2,076 (42)	897 (5)	7,324 (4)
65–79 years	25,044 (37)	250,287 (37)	13,479 (42)	150,743 (42)	1,801 (21)	15,390 (20)	2,597 (37)	18,630 (37)	7,121 (36)	65,043 (35)
80+ years	20,495 (31)	204,859 (31)	6,458 (20)	66,775 (19)	1,329 (16)	13,804 (18)	954 (14)	8,365 (17)	11,729 (59)	115,737 (62)
Comorbidity score
Low (0)	26,411 (39)	444,492 (66)	12,431 (39)	245,218 (69)	4,718 (56)	60,209 (79)	2,504 (36)	32,530 (65)	6,665 (34)	105,496 (56)
Medium (1–2)	27,770 (41)	183,992 (27)	12,926 (41)	90,606 (25)	2,682 (32)	13,254 (17)	2,988 (43)	13,883 (28)	9,114 (46)	65,97 (35)
High (≥3)	12,981 (19)	43,136 (6)	6,389 (20)	20,320 (6)	1,071 (12)	2,639 (3)	1,516 (22)	3,431 (7)	3,979 (20)	16,69 (9)
Selected comorbidities
Cerebrovascular disease	9,881 (15)	57,404 (8)	4,501 (14)	26,202 (7)	766 (9)	3,426 (5)	966 (14)	4,173 (8)	3,634 (18)	23,542 (13)
COPD	13,522 (20)	40,568 (6)	6,46 (20)	20,253 (6)	1,179 (14)	3,272 (4)	1,754 (25)	3,955 (8)	4,113 (21)	13,012 (7)
Diabetes mellitus, uncomplicated	5,265 (8)	25,826 (4)	2,414 (8)	12,197 (3)	587 (7)	2,160(3)	612 (9)	2,182 (4)	1,628 (8)	9,2 (5)
Diabetes mellitus, complicated	2,688 (4)	10,378 (1)	1,253 (4)	4,954 (1)	317 (4)	829 (1)	354 (5)	977 (2)	752 (4)	3,568 (2)
Preexisting heart failure	12,339 (18)	53,989 (80)	5,802 (18)	3,642 (1)	855 (10)	641 (1)	279 (4)	642 (1)	1,194 (6)	4,188 (2)
Living with small children	889 (1)	7,499 (1)	592 (2)	5,180 (1)	233 (3)	1,900 (2)	56 (0)	378 (1)	3 (0)	12 (0)
Alcoholism-related conditions	3,726 (5.5)	11,553 (1.7)	1,038 (3)	3,801 (1)	915 (11)	2,745 (4)	1,296 (18)	3,148 (6)	471 (2)	1,843 (1)
Immunosuppressant use	12,783 (19.0)	45,833 (6.8)	6,583 (20)	23,777 (7)	994 (12)	3,054 (4)	1,349 (19)	3,284 (7)	3,849 (19)	15,642 (8)

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 2 Adjusted odds ratios for pneumonia hospitalization associated with marital status

Exposure	Cases N (%)	Population controls N (%)	Unadjusted OR (95% CI)	Adjusted ORa (95% CI)
Married	31,746 (47.3)	356,144 (53.0)	1.00 (ref)	1.00 (ref)
Never married	8,471 (12.6)	76,102 (11.3)	1.30 (1.26–1.33)	1.33 (1.29–1.37)
Divorced	7,008 (10.4)	49,844 (7.4)	1.59 (1.54–1.63)	1.29 (1.25–1.33)
Widowed	19,758 (29.4)	188,156 (28.0)	1.22 (1.20–1.25)	1.15 (1.12–1.17)
Unknown	179 (0.3)	1,374 (0.2)	1.48 (1.27–1.73)	1.64 (1.39–1.93)

Note:

a Ors adjusted for comorbidities, alcoholism-related conditions, use of immunosuppressant before index hospitalization, household presence of small children, and degree of urbanization.

Abbreviations: CI, confidence interval; OR, odds ratio; ref, reference.

Table 3 Odds ratios for pneumonia hospitalization associated with marital status, adjusted individually for selected important variables

Variables	Married OR (95% CI)	Never married OR (95% CI)	Divorced OR (95% CI)	Widowed OR (95% CI)
Unadjusted Or	1.00 (ref)	1.30 (1.26–1.33)	1.59 (1.54–1.63)	1.22 (1.20–1.25)
OR adjusted for:
Comorbidity index	1.00 (ref)	1.31 (1.27–1.35)	1.40 (1.36–1.44)	1.17 (1.14–1.20)
Alcoholism-related conditions	1.00 (ref)	1.23 (1.19–1.26)	1.43 (1.39–1.47)	1.19 (1.17–1.22)
COPD	1.00 (ref)	1.30 (1.26–1.34)	1.48 (1.44–1.52)	1.19 (1.17–1.22)
Immunosuppressant use	1.00 (ref)	1.36 (1.30–1.37)	1.54 (1.49–1.58)	1.21 (1.18–1.24)

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; OR, odds ratio; ref, reference.

Table 4 Association between marital status and pneumonia hospitalization, stratified by sex, age and comorbidity

	Married	Never married	Divorced	Widowed
	Adjusted ORa (95% CI)	Adjusted ORa (95% CI)	Adjusted ORa (95% CI)	Adjusted ORa (95% CI)
Sex
Male	1.00 (ref)	1.35 (1.30–1.40)	1.58 (1.52–1.64)	1.24 (1.20–1.28)
Female	1.00 (ref)	1.21 (1.16–1.27)	1.59 (1.53–1.66)	1.21 (1.17–1.25)
Age group in years
15–39	1.00 (ref)	1.00 (0.93–1.08)	1.41 (1.23–1.61)	2.20 (1.14–4.24)
40–64	1.00 (ref)	1.67 (1.59–1.75)	1.83 (1.75–1.91)	1.46 (1.36–1.57)
65–79	1.00 (ref)	1.32 (1.25–1.39)	1.57 (1.50–1.64)	1.26 (1.22–1.30)
80+	1.00 (ref)	1.00 (0.94–1.07)	1.18 (1.10–1.27)	1.06 (1.02–1.10)
Comorbidity level
Low	1.00 (ref)	1.34 (1.28–1.40)	1.52 (1.45–1.60)	1.22 (1.17–1.27)
Medium	1.00 (ref)	1.25 (1.18–1.33)	1.35 (1.28–1.42)	1.15 (1.11–1.20)
High	1.00 (ref)	0.94 (0.82–1.09)	1.07 (0.95–1.21)	1.04 (0.96–1.13)
COPD	1.00 (ref)	1.08 (0.93–1.24)	1.25 (1.12–1.40)	1.13 (1.04–1.23)
Alcoholism-related conditions	1.00 (ref)	1.40 (1.09–1.79)	1.40 (1.11–1.77)	1.76 (1.15–2.70)
Immunosuppressant use	1.00 (ref)	1.25 (1.08–1.44)	1.47 (1.30–1.65)	1.20 (1.10–1.30)

Note:

a Ors adjusted for comorbidities, alcoholism-related conditions, use of immunosuppressant before index hospitalization, household presence of small children, and degree of urbanization.

Abbreviations: CI, confidence interval; COPD, chronic obstructive pulmonary disease; OR, odds ratio; ref, reference.