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Cause-Specific Mortality Among Spouses of Parkinson Disease Patients

Nielsen, Malenea; Hansen, Johnnib; Ritz, Beatec; Nordahl, Helenea; Schernhammer, Evad; Wermuth, Lenee; Rod, Naja Hulveja,f

doi: 10.1097/EDE.0000000000000042
Neurologic Disease

Background: Caring for a chronically ill spouse is stressful, but the health effects of caregiving are not fully understood. We studied the effect on mortality of being married to a person with Parkinson disease.

Methods: All patients in Denmark with a first-time hospitalization for Parkinson disease between 1986 and 2009 were identified, and each case was matched to five population controls. We further identified all spouses of those with Parkinson disease (n = 8,515) and also the spouses of controls (n = 43,432). All spouses were followed in nationwide registries until 2011.

Results: Among men, being married to a Parkinson disease patient was associated with a slightly higher risk of all-cause mortality (hazard ratio = 1.06 [95% confidence interval = 1.00–1.11]). Mortality was particularly high for death due to external causes (1.42 [1.09–1.84]) including suicide (1.89 [1.05–3.42]) and death from undefined symptoms/abnormal findings (1.25 [1.07–1.47]). Censoring at the time of death of the patient attenuated the findings for all-cause mortality in husbands (1.02 [0.95–1.09]), indicating that part of the association is with bereavement. Still, living with a person with Parkinson disease 5 years after first Parkinson hospitalization was associated with higher risk of all-cause mortality for both husbands (1.15 [1.07–1.23]) and wives (1.11 [1.04–1.17]).

Conclusions: Caring for a spouse with a serious chronic illness is associated with a slight but consistent elevation in mortality risk.

From the aDepartment of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; bDanish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark; cSchool of Public Health, UCLA, Los Angeles, CA; dHarvard School of Public Health, Department of Epidemiology, Boston, MA; eDepartment of Neurology, Odense University Hospital, Odense, Denmark; and fThe Copenhagen Stress Research Center, Copenhagen, Denmark.

This study was supported by a grant from the National Institutes of Environmental Health Sciences, USA (grant no R01 ES013717). Partial funding was also provided by the National Institutes of Neurologic Diseases and Stroke, USA, for the UCLA Udall Parkinson Disease Center of Excellence (grant no P50 NS038367). M.N was supported by a grant from the Danish Health Insurance Foundation (grant no 2009B126). N.H.R. was supported by a grant from the Danish Research Counsel (grant no 271-06-0687).

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Correspondence: Naja Hulvej Rod, Department of Public Health, University of Copenhagen, PO Box 2099, Øster Farimagsgade 5, Copenhagen K 1014, Denmark. E-mail: nahuro@sund.ku.dk.

© 2014 by Lippincott Williams & Wilkins, Inc