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We estimated the average effect of bereavement on cause-specific mortality. Furthermore, we developed and evaluated the performance of prediction models estimating individualized mortality risks. This matched cohort study leveraged nationwide registry data on 223,500 married Danish individuals aged\u2009\u2265\u200965 years. Individuals were followed from bereavement date until death, emigration, or 3-year end of follow-up. G-estimation was used to estimate the average effect of bereavement on cause-specific mortality. Risk prediction models were developed and internally validated using logistic regression and Extreme Gradient Boosting utilizing information on sociodemographic factors and healthcare expenditures prior to bereavement. Among males, bereavement was associated with increased 3-year mortality from cardiovascular disease (CVD) (Risk Difference: 8 deaths\/1000 individuals [95% confidence intervals (CI) 3;13]), digestive diseases (3 [95% CI 1;5]), psychiatric diseases\/suicide (3 [95% CI 1;5]), and respiratory diseases (4 [95% CI 1;8]) and decreased 3-year mortality for dying from dementia\/Parkinson\u2019s disease (-4 [95% CI -6;-2]). Among females, bereavement was only associated with increased 3-year mortality from CVD (5 [95% CI 3;7\u00a0]) and from psychiatric diseases\/suicide (1 [95% CI 1;2]). The prediction models developed using sociodemographic information and healthcare expenditures showed limited accuracy in identifying cause-specific mortality risk. On average, spousal bereavement slightly elevated the risk for most causes of death for males and less so for females. Despite incorporating comprehensive healthcare and sociodemographic data, accurately predicting individual cause-specific mortality remains challenging.<\/jats:p>","DOI":"10.1038\/s41598-025-90657-1","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T12:20:46Z","timestamp":1740054046000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Cause-specific mortality after spousal bereavement in a Danish register-based cohort"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2261-8779","authenticated-orcid":false,"given":"Mathilde Marie Br\u00fcnnich","family":"Sloth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Hruza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6399-495X","authenticated-orcid":false,"given":"Laust Hvas","family":"Mortensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0891-4611","authenticated-orcid":false,"given":"Samir","family":"Bhatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0957-9835","authenticated-orcid":false,"given":"Alexandros","family":"Katsiferis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"90657_CR1","unstructured":"Statistics Denmark. Life expectancy, (2022). https:\/\/www.dst.dk\/en\/Statistik\/emner\/borgere\/befolkning\/middellevetid. Accessed 20 November 2023."},{"key":"90657_CR2","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1007\/s10522-010-9287-2","volume":"11","author":"T Fulop","year":"2010","unstructured":"Fulop, T. et al. Aging, frailty and age-related diseases. Biogerontology 11, 547\u2013563 (2010).","journal-title":"Biogerontology"},{"key":"90657_CR3","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1007\/s10865-013-9524-7","volume":"37","author":"ST Stahl","year":"2014","unstructured":"Stahl, S. T. & Schulz, R. Changes in Routine Health behaviors following late-life bereavement: a systematic review. J. Behav. Med. 37, 736\u2013755 (2014).","journal-title":"J. Behav. Med."},{"key":"90657_CR4","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1007\/s00127-019-01680-3","volume":"54","author":"CB Kristiansen","year":"2019","unstructured":"Kristiansen, C. B. et al. The association of time since spousal loss and depression in widowhood: a systematic review and meta-analysis. Soc. Psychiatry Psychiatr Epidemiol. 54, 781\u2013792 (2019).","journal-title":"Soc. Psychiatry Psychiatr Epidemiol."},{"key":"90657_CR5","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.socscimed.2006.08.031","volume":"64","author":"L Manzoli","year":"2007","unstructured":"Manzoli, L., Villari, P. & Pirone, M. Marital status and mortality in the elderly: a systematic review and meta-analysis. Soc. Sci. Med. 64, 77\u201394 (2007).","journal-title":"Soc. Sci. Med."},{"key":"90657_CR6","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1093\/gerona\/glr144","volume":"66","author":"BR Williams","year":"2011","unstructured":"Williams, B. R. et al. Intrinsic association of widowhood with mortality in community-dwelling older women and men: findings from a prospective propensity-matched population study. J. Gerontol. Biol. Sci. Med. 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Danish legislation allows for register-based research of this type to be conducted without the consent of participants and without ethical committee approval\n                      37\n                      . The study was conducted according to the rules of the Danish Data Protection Agency. All data was held at Statistics Denmark, which is the Danish national statistical institution.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Declaration"}}],"article-number":"6240"}}