The association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: An updated systematic review and meta-analysis

Abstract

Background & aim:Previous studies link marital status to mortality across diverse populations. This study examines how sex influences its association with all-cause, cardiovascular disease (CVD), and cancer mortality.Method:The search was conducted through PubMed, Scopus, and Google Scholar databases and included related articles up to September 16, 2025. The titles, abstracts, and full texts of the included articles were reviewed, and data were extracted and analyzed.Result:Twelve cohort studies (1,785,857 individuals) were analyzed. Unmarried status was significantly associated with an increased risk of all-cause, CVD, and cancer mortality. Specifically, single individuals showed a higher risk of all-cause (hazard ratio HR: 1.55, 95% CI: 1.37-1.74), cancer (HR: 1.14, 95% CI: 1.07-1.22), and CVD mortality (HR: 1.52, 95% CI: 1.28-1.84). Divorced individuals had an increased risk of all-cause (HR: 1.39, 95% CI: 1.12-1.66) and CVD mortality (HR: 1.27, 95% CI: 1.02-1.52). Widowed individuals showed a higher risk of all-cause (HR: 1.43, 95% CI: 1.11-1.74), cancer (HR: 1.13, 95% CI: 1.03-1.23), and CVD mortality (HR: 1.67, 95% CI: 1.23-2.10).Conclusion:Unmarried status is significantly associated with an increased risk of all-cause, cancer, and CVD mortality. The association between marital status and mortality differs by sex and geographic region. For instance, the link between divorced status and all-cause mortality is significantly stronger in men, while the association between single status and cancer mortality is significantly stronger in women. These findings highlight the importance of considering sex and regional differences in public health interventions.