摘要：Objectives. We sought to determine whether unexpected bereavement has a greater impact on mortality in the surviving partner than death of a partner with preexisting chronic disease or disability. Methods. In a UK primary care database (The Health Improvement Network), we identified 171 720 couples aged 60 years and older. We compared the rise in mortality in the first year after bereavement in those whose partner died without recorded chronic disease (unexpected bereavement) to those whose deceased partner had a diagnosis of chronic disease (known morbidity). Results. For unexpected bereavement (13.4% of all bereavements), the adjusted hazard ratio for death in the first year after bereavement was 1.61 (95% confidence interval [CI] = 1.39, 1.86) compared with 1.21 (95% CI = 1.14, 1.30) where the partner had known morbidity. Differences between bereaved groups were significant ( P = .001) and present for both men and women. Conclusions. Unexpected bereavement has a greater relative mortality impact than bereavement preceded by chronic disease. Our findings highlight the potential value of preparing individuals for the death of a spouse with known morbidity and providing extra support after bereavement for those experiencing sudden unexpected bereavement. Death of a spouse is a major life event that is more common in older people. A rise in mortality after bereavement, most markedly in the first year, has been described in many populations, but individual risk factors for poor physical health after bereavement are not well understood. 1,2 This paucity of evidence limits the potential for clinical, social, and public health intervention to improve the well-being of older people after bereavement. Preparedness for death of a partner is known to be protective against the adverse psychological effects of bereavement 3,4 and some studies have suggested that sudden, in particular traumatic, bereavement may increase vulnerability to poor mental health outcomes. 5,6 Few studies have examined how the expectation of bereavement influences subsequent physical health. A large US study investigated the relationship between cause of death and subsequent mortality in the surviving spouse. 7 The findings suggested that when the spouse died from a long-term disabling condition, such as dementia, the rise in mortality after bereavement was attenuated but results for other conditions, such as cancers, were less clear. Another US study has suggested that access to palliative care may be protective, in terms of mortality in the surviving spouse. 8 This finding suggests that preparedness and support before bereavement are determinants of physical health and amenable to intervention. We tested the hypothesis that unexpected death has a greater impact on the surviving partner’s risk of death than bereavement when the deceased partner has recognized preexisting morbidity. This is the first large study to examine this important question for medical care and services caring for families that experience unexpected bereavement.
