Widowhood may be associated with increased sexual risk-taking—and thus an increased risk of STD diagnosis—among men but not among women, according to a study of older married couples in the United States.1 Data for 1993-–2002 show an association between widowhood and diagnosis among older men, which was strongest from one-half to one year since the wife’s death. The association was driven by an elevated risk after the 1998 introduction—and subsequent widespread use—of sildenafil (Viagra) to treat erectile dysfunction.

The researchers used Medicare claims data to construct a random, population-based sample of 420,790 couples who were between the ages of 67 and 99 in 1993. They examined records of inpatient and outpatient provider visits, as well as laboratory tests, to identify men and women who had an STD diagnosed between 1993 and 2002; deaths during the study period were identified from vital records.

Study subjects resided throughout the United States; most were non-Hispanic white (91% of men and 92% of women), and a small proportion (5% of both men and women) had incomes near or below the federal poverty level in 1993. The average age at baseline was 76.6 among men and 74.2 among women. Between 1993 and 2002, 21% of male and 43% of female participants became widowed; 52% and 33%, respectively, died.

Overall, 0.7% of male participants and 1% of female participants had an STD diagnosed in the study period. Among men, the most frequently diagnosed STD was gonorrhea; among women, trichomoniasis was most common.

In a multivariate analysis that adjusted for individual- and aggregate-level factors thought to be associated with STD diagnosis, losing a spouse during the study period was positively associated with the risk of diagnosis among men (hazard ratio, 1.2), but not among women. Overall, the association between widowhood and STD diagnosis was significant for men only from one-half to less than one year after the death of a spouse (1.4). A slightly elevated level of risk was associated with having a wife die after the introduction of sildenafil (1.2). Those whose wives died after the advent of sildenafil were at elevated risk for diagnosis during the postsildenafil period (1.8). In contrast, women who became widowed in the postsildenafil period were at a reduced risk of STD diagnosis between one and two years after the death of their husbands (0.8).

The researchers note that they were unable to control for certain factors that might have contributed to the associations they found. For instance, the postsildenafil increase in older men’s STD diagnosis may have been due to increased awareness—on the part of both patients and physicians—of sexual health among older males. The media attention surrounding sildenafil’s release could have led to greater testing and diagnosis rates among men, and would be consistent with the lack of association between the availability of sildenafil and older women’s diagnoses. Another limitation of the study is that STDs are commonly asymptomatic in women, a fact that may lead to underdiagnosis and could have masked associations between widowhood and STD diagnosis among female participants.

The researchers posit that despite its shortcomings, the study provides needed data on the often overlooked topic of older people’s sexual health. Further, they hypothesize that the lower risk of STD diagnosis among widowed older women than among those still married might be due to greater sexual infidelity among married older men since the advent of sildenafil. According to the researchers, clinicians “need to be more aware of the possibility of [STDs] in older patients and to address sexual health issues with them,… when appropriate. This is particularly the case for older male patients who have lost a spouse, especially if they are taking drugs for [erectile dysfunction].”

H. Ball

REFERENCE

1. Smith KP and Christakis NA, Association between widowhood and risk of diagnosis with a sexually transmitted infection in older adults, American Journal of Public Health, 2009, 99(11):2055–2062.