Marital and living status and biological ageing trajectories: a longitudinal cohort study with a 20-year follow-up

Biomarkers of ageing (BA) can predict health risks beyond chronological age, but little is known about how marital/living status affects longitudinal changes in BA. We examined the association between marital/living status and BA over time using the-Swedish-Adoption/Twin-Study-of-Aging (SATSA) cohort. Four BAs were analyzed: telomere length (TL) (638 individuals; 1603 measurements), DNAmAge (535 individuals; 1392 measurements), cognition (823 individuals; 3218 measurements), and frailty index (FI) (1828 individuals; 9502 measurements). Individuals were born between 1900 and 1948, and data on marital/living status, BAs, and covariates were collected through nine waves of questionnaires and in-person testing from 1986 to 2014. Mixed linear regression with random effects at twin-pair and individual levels were used to assess BA changes for constant marital/living status. Conditional generalized estimating equation assessed within-individual BA changes for varying marital/living status. Results showed that individuals who were consistently unmarried/non-cohabiting (β = 0.291, 95%CI = 0.189-0.393) or living alone (β = 0.203, 95%CI = 0.090-0.316) were more frail, and experienced accelerated frailty (p-for-interaction with age < 0.001 for marital status; p-for-interaction = 0.002 for living status) and cognitive decline (p-for-interaction < 0.001), compared to those married/cohabiting or living with someone Among individuals whose marital/living status changed, frailty was higher when living alone (β = 0.089, 95%CI = 0.017-0.162) and frailty accelerated when they became unmarried/non-cohabiting or were living alone (p-for-interaction < 0.001). Cognitive decline also accelerated when living alone (p-for-interaction = 0.020). No associations were observed for TL and DNAmAge. In conclusion, being unmarried/non-cohabiting or living alone from mid-to-old age is linked to accelerated cognitive decline and frailty. These findings highlight the potential importance of social support networks and living arrangements for healthy ageing.