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Role of hospitalisation for substance misuse in marital status transitions: a 47-year follow-up of a Swedish birth cohort


Background Substantial research suggests that the risk of substance misuse is higher among individuals who remain unmarried or experience marital dissolution, whereas marriage tends to be protective. However, few studies have considered the role of substance misuse for transitions between discrete marital status categories. The current study aims to estimate associations between substance misuse and marital status transitions from ages 20–66.

Methods Our study population was a national Swedish cohort born in 1953 (n=71 901), followed from 1973 to 2019. Annual marital status and hospitalisation records for substance misuse were derived from the Total Population and National Patient registers, respectively. We used a five-state multistate model to estimate associations between substance misuse and marital status transitions—the state space included never married, married, divorced and widowed with death as the absorbing state. We further used fixed-effect models to estimate the effects of substance misuse on transitions out of marriage.

Results Findings suggested that individuals’ substance misuse was associated with an increased risk of transitioning from married to divorced (HR=3.54, 95% CI 3.40 to 3.69) or widowed (HR=1.71, 95% CI 1.46 to 2.01), and transitioning to death from all states. Substance misuse was also negatively associated with transitioning from never married to married (HR=0.59, 95% CI 0.57 to 0.61), and into remarriage after divorce (HR=0.86, 95% CI 0.80 to 0.92). The fixed-effect results suggested that substance misuse increased the risk of transitioning to divorce and widowhood, net of sociodemographic characteristics.

Conclusion Substance misuse is associated with an increased risk of marital dissolution and death when accounting for nearly 50 years of marital biographies.

  • substance abuse
  • marital status
  • longitudinal studies
  • demography
  • public health

Data availability statement

Data may be obtained from a third party and are not publicly available. Owing to ethical regulations regarding the Stockholm Birth Cohort Multigenerational Study (SBC Multigen), access to the data is restricted. If there is interest in the unpublished data from this research article, readers may contact the Principal Investigator of the SBC Multigen (, who will forward the request to the steering committee.

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