Spouse behavior and coronary heart disease in men: prospective results from the Framingham heart study. I. Concordance of risk factors and the relationship of psychosocial status to coronary incidence.

The relationship of social status and behavior type to the incidence of coronary heart disease was examined among husbands and wives in the Framingham Heart Study. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. Men married to women with 13 or more years of education were 2.6 times more likely to develop coronary disease than men married to women with a grammar school education (95% CI = 1.0-6.9). Incidence rates among husbands married to women employed outside the home were similar to rates among men married to housewives (15.1 vs. 16.1%, respectively). However, men married to women employed in white-collar jobs were over three times more likely to develop heart disease than those married to clerical workers, blue-collar workers, or to housewives (RR = 4.0, 5.4, and 2.9, respectively; p less than or equal to 0.004). The increased risk in husbands married to women educated beyond the high school level was observed only among men married to women employed outside the home. These effects were apparent regardless of the husband's social status or standard coronary risk factors. Further exploration of these associations revealed that higher-educated working wives whose husbands developed coronary heart disease were significantly more likely to have had a nonsupportive boss and fewer job promotions than wives of noncases.