Marital Status, Ethnicity, and Cardiovascular Health: A Systematic Literature Review

Objective: The association between marital status and health has long been recognized albeit not without controversy. While substantial empirical research provides evidence that being married confers health benefits, there is evidence that heterogeneity exists in these benefits based on sociodemographic factors, including race/ethnicity, gender, and income. Given continued disparities in a range of health outcomes, there is a need to identify and better understand variations in the health advantage of being married versus unmarried (i.e., never-married, married, widowed, separated, or divorced). In this systematic literature review, we aimed to examine racial/ethnic variations in the purported protective role played by marital status with regard to cardiovascular disease (CVD) risk factors and CVD outcomes. The review focused on studies that included population groups highly vulnerable to poor cardiovascular health. Design: We conducted a search of MEDLINE, PubMed, PsycINFO, and lists of relevant articles published during a five-year period in English. Databases were searched using Medical Subject Headings (MeSH) terms and other appropriate keywords related to marital status, race/ethnicity, and CVD risk factors and outcomes. Four reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: The search yielded 4,577 titles, and 18 studies were included in this review. Studies showed mixed findings on the relationship between marital status, race/ethnicity, and CVD risk factors. With regard to CVD outcomes, most studies reported findings that suggest being married may serve as a protective factor across race/ethnic categories. Conclusion: Some cardiovascular risk factors and disease outcomes vary by the intersection of marital status and race/ethnicity. Differences in the relationship between marital status, race/ethnicity, and cardiovascular health need to be examined further in future research. These differences should be considered in the development of interventions aimed at addressing health disparities.