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Physical health conditions and subsequent union separation: a couple-level register study on neurological conditions, heart and lung disease, and cancer
  1. Niina Metsä-Simola1,
  2. Elina Einiö1,
  3. Riina Peltonen1,
  4. Pekka Martikainen1,2,3
  1. 1Population Research Unit, University of Helsinki, Helsinki, Finland
  2. 2Laboratory of Population Health, Max-Planck-Institute for Demographic Research, Rostock, Germany
  3. 3Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
  1. Correspondence to Niina Metsä-Simola, Population Research Unit, University of Helsinki, Helsinki, Finland; niina.metsa-simola{at}


Background Studies that assess the role of physical health conditions on separation risk are scarce and mostly lack health information on both partners. It is unclear how the association between physical illness and separation risk varies by type of illness, gender of the ill spouse and age of the couple.

Methods We used Finnish register data on 127 313 couples to examine how neurological conditions, heart and lung disease, and cancer are associated with separation risk. The data included information on medication, hospitalisations, separations and sociodemographic characteristics. Marital and non-marital cohabiting couples aged 40–70 years were followed from 1998 to 2003 for the onset of health conditions and subsequent separation, and Cox regression was used to examine the associations.

Results Compared with healthy couples, the HR of separation was elevated by 43% for couples in which both spouses had a physical health condition, by 22% for couples in which only the male spouse had fallen ill, and by 11% for couples in which only the female had fallen ill. Among older couples, the associations between physical illness and separation risk were even clearer. The association with separation risk was strongest for neurological conditions, and after incidence of these conditions among males, separation risk increased over time. Adjustment for sociodemographic characteristics had little effect.

Conclusions Our findings suggest that poor health may largely strain relationships through disability and associated burden of spousal care, and this should be taken into consideration when planning support services for couples with physical health conditions.

  • cancer
  • heart disease
  • marital status
  • stroke
  • social epidemiology

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  • Contributors This paper and the results have not been published or submitted elsewhere. There is no financial or other conflict of interest that might bias our work. All authors were involved in the design of the study. NM-S wrote the first draft of the manuscript and RP conducted the statistical analyses. All authors critically commented on the manuscript, and have read and approved the final version and believe that it represents honest work. All authors, and no one else, fulfill the criteria for authorship.

  • Funding This work was supported by the Academy of Finland, grant number 308247.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The data underlying this article were provided by Statistics Finland, the National Institute of Health and Welfare, and the Social Insurance Institution by permission. Researcher may apply for permission to use these data from the register holders. Data from Statistics Finland: Data from the National Institute of Health and Welfare and the Social Insurance Institution:

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.