A longitudinal population-based analysis of relationship status and mortality in KwaZulu-Natal, South Africa 2001-2011

Melanie Channon, Victoria Hosegood, Nuala McGrath

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Mortality risk is lower in married than in unmarried men and women. However, little is known about the association between mortality and relationship status in South Africa where marriage rates are low, migration is common, many couples are not co-resident and HIV prevalence is high.

METHOD: Using demographic surveillance data collected from 2001 to 2011, relationship status was categorised as conjugal (partners belong to the same household), non-conjugal (partners do not belong to the same household) or not partnered. Rates of relationship formation and dissolution were calculated by age and sex. Controlling for antiretroviral treatment (ART) introduction in 2005 as well as education, sex-specific and age-specific Cox proportional hazards models were used to investigate the association between relationship status and (1) all-cause mortality and (2) non-AIDS mortality.

RESULTS: Before 2005, individuals in conjugal relationships had a lower hazard of all-cause mortality in all age groups than not partnered men and women. Non-conjugal relationships lowered the risk of dying compared with not partnered men and women in fewer age groups. After ART introduction, the protective association of conjugal relationships was weaker but remained generally significant for men and women but not in non-conjugal relationships. In the later period, the association is reversed in young men (20-29 years) with mortality higher in conjugal and non-conjugal relationships compared with men not partnered. The analysis of non-AIDS deaths provided similar results.

CONCLUSIONS: The higher degree of social connections within a shared household environment that characterises conjugal relationships affords men and women greater protection against mortality.

LanguageEnglish
Pages56-64
Number of pages9
JournalJournal of Epidemiology & Community Health
Volume70
Issue number1
DOIs
StatusPublished - Jan 2016

Fingerprint

South Africa
Mortality
Population
Age Groups
Sex Education
Marriage
Proportional Hazards Models
Demography
HIV
Therapeutics

Keywords

  • Adult
  • Female
  • HIV Infections
  • Humans
  • Longitudinal Studies
  • Male
  • Marriage
  • Middle Aged
  • Mortality
  • Population Dynamics
  • Population Surveillance
  • Proportional Hazards Models
  • Sexual Partners
  • South Africa
  • Young Adult
  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

A longitudinal population-based analysis of relationship status and mortality in KwaZulu-Natal, South Africa 2001-2011. / Channon, Melanie; Hosegood, Victoria; McGrath, Nuala.

In: Journal of Epidemiology & Community Health, Vol. 70, No. 1, 01.2016, p. 56-64.

Research output: Contribution to journalArticle

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AU - Hosegood, Victoria

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N2 - BACKGROUND: Mortality risk is lower in married than in unmarried men and women. However, little is known about the association between mortality and relationship status in South Africa where marriage rates are low, migration is common, many couples are not co-resident and HIV prevalence is high.METHOD: Using demographic surveillance data collected from 2001 to 2011, relationship status was categorised as conjugal (partners belong to the same household), non-conjugal (partners do not belong to the same household) or not partnered. Rates of relationship formation and dissolution were calculated by age and sex. Controlling for antiretroviral treatment (ART) introduction in 2005 as well as education, sex-specific and age-specific Cox proportional hazards models were used to investigate the association between relationship status and (1) all-cause mortality and (2) non-AIDS mortality.RESULTS: Before 2005, individuals in conjugal relationships had a lower hazard of all-cause mortality in all age groups than not partnered men and women. Non-conjugal relationships lowered the risk of dying compared with not partnered men and women in fewer age groups. After ART introduction, the protective association of conjugal relationships was weaker but remained generally significant for men and women but not in non-conjugal relationships. In the later period, the association is reversed in young men (20-29 years) with mortality higher in conjugal and non-conjugal relationships compared with men not partnered. The analysis of non-AIDS deaths provided similar results.CONCLUSIONS: The higher degree of social connections within a shared household environment that characterises conjugal relationships affords men and women greater protection against mortality.

AB - BACKGROUND: Mortality risk is lower in married than in unmarried men and women. However, little is known about the association between mortality and relationship status in South Africa where marriage rates are low, migration is common, many couples are not co-resident and HIV prevalence is high.METHOD: Using demographic surveillance data collected from 2001 to 2011, relationship status was categorised as conjugal (partners belong to the same household), non-conjugal (partners do not belong to the same household) or not partnered. Rates of relationship formation and dissolution were calculated by age and sex. Controlling for antiretroviral treatment (ART) introduction in 2005 as well as education, sex-specific and age-specific Cox proportional hazards models were used to investigate the association between relationship status and (1) all-cause mortality and (2) non-AIDS mortality.RESULTS: Before 2005, individuals in conjugal relationships had a lower hazard of all-cause mortality in all age groups than not partnered men and women. Non-conjugal relationships lowered the risk of dying compared with not partnered men and women in fewer age groups. After ART introduction, the protective association of conjugal relationships was weaker but remained generally significant for men and women but not in non-conjugal relationships. In the later period, the association is reversed in young men (20-29 years) with mortality higher in conjugal and non-conjugal relationships compared with men not partnered. The analysis of non-AIDS deaths provided similar results.CONCLUSIONS: The higher degree of social connections within a shared household environment that characterises conjugal relationships affords men and women greater protection against mortality.

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KW - Proportional Hazards Models

KW - Sexual Partners

KW - South Africa

KW - Young Adult

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KW - Research Support, Non-U.S. Gov't

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