1. Abstract Unmarried Working Men and Unhappily Married at Age 40-65 Carry Excess Risk of 34-year Stroke Mortality Uri Goldbourt, Department of Epidemiology and Preventive Medicine, Sackler Medical Faculty, Tel Aviv University, Israel #####

2. Financial Disclosures No financial disclosure.

3. Background Sparse data exist to permit examination of marital status/satisfaction and the incidence of stroke.

4. Participants 10,059 tenured male civil servants and municipal employees (mean age 49.2 years), who participated in the Israeli Ischemic Heart Disease study in 1963. Of these 86% had migrated from Europe, Asia or Africa.

5. Participants In 1963: Married once - 82.3% Married twice or more-12.8% Never married – 2.3% (n=235) Divorced, separated, widower- 2.6% (n=257). Self-report of marriage In 1965 (n=8945 responders): Successful (43%), quite successful (45%), not so successful (8%), or unsuccessful (3.6%, n=323).

6. Men with different self-reports of marital success Mean( SD) or % for: Success- ful Quite success- ful Not quite Unsucces s-ful Age49.5 (6.9) 48.8 (6.6) 49.1 (6.7) 49.4 (6.8) Systolic BP 135 (21) 135 (20) 134 (20) 134 (21) Ever smoked (%) 68676976 Diabetic (%) 4.94.24.06.2 Mean Socio- economic index (1-5) 2.58 (1.25) 2.62 (1.23) 2.59 (1.15) 2.33 (1.20)

7. Methods Mortality was ascertained by matching with the national death registry using the national ID and verifying names. Underlying cause of death through 1997 was determined from ICD-8, ICD-9 and ICD-10 coding with a re- ascertainment and editing process at the central Bureau of Statistics. Cox proportional hazards using age at death of stroke as time variable. Adjustment for Socio-economic status, body mass index, blood pressure, smoking habits, and baseline prevalence of diabetes and CHD,

8. Results Mortality (1965-1997 ): Unmarried- 343 of 492 (69.7%) Married - 6191 of 9537 (64.9%) Corresponding unadjusted fatal stroke rates were 8.4 and 7.1%, respectively. HR of subsequent fatal stroke for unmarried men in 1963 was 1.64 (95%CI 1.18-2.30).

9. Results Adjusted HR, marriage reportedly: Successful HR= 1.0 “Quite” HR= 1.18 (95% CI 0.98-1.41) “Not Quite” HR= 1.09 (0.79-1.49) “Unsuccessful”, HR= 1.64 (1.11-2.43)

10. Conclusions Hazard ratio associated with being unmarried or reporting failed marriage (HR=1.64 for both) was identical to that associated with baseline diabetes mellitus (HR=1.65, CI 1.30- 2.09). Married men were at a lower risk of long- term fatal stroke, excluding those reporting utter dissatisfaction with their married life.