Independent associations of inter-spousal gaps in age and education with long-term mortality and cancer survival: The Jerusalem Perinatal Study 1964–2016

Purpose: To identify factors responsible for variation in health among married individuals, we investigated the independent associations of gaps in spousal age and education (or “heterogamy”) with all-cause and cause-specific mortality as well as with survival of cancer patients. Methods: Using over four decades of follow-up data on 36,717 couples from Jerusalem (1964–2016), we compared heterogamous with homogamous couples. Results: Having a less educated spouse was associated with an increased risk for several outcomes in both genders, such as all-cause mortality in males (hazard ratio [HR] = 1.18, 95% confidence interval [CI]: 1.12, 1.25) and in females (HR = 1.11, CI: 1.01, 1.22). Having a more educated spouse was associated with decreased all-cause mortality in males (HR = 0.93, CI: 0.87, 0.99), but not in females. Having an older spouse was detrimental for health of both genders. For example, increased all-cause mortality was seen in men (HR = 1.22, CI: 1.10, 1.34) and in women (HR = 1.10, CI: 1.02, 1.19). A younger spouse was beneficial for some of the outcomes in males, such as decreased cancer-specific mortality (HR = 0.88, CI: 0.78, 0.99), but not in females. Conclusions: Spousal gaps in education and age may be independently associated with health outcomes. The observed relationships may be driven by combined amounts of marital strain as well as shared spousal resources (such as knowledge or income) depending on gender.