Marriage: It’s good for a man’s colon!

Her: "You're totally getting a colonoscopy 25 years from now!" Him: "What?"

Her: “You’re totally getting a colonoscopy 25 years from now!”
Him: “What?!”

Did you know that married men have a lower colorectal cancer mortality when compared to unmarried men? What about the fact that married men have higher rates of colorectal cancer screening? Interesting, right? In fact, studies showing the association between marriage and favorable behavior regarding colon cancer screening have been published as early as 2010.

More recently, a study published in the journal Preventive Medicine found that married men are 9% more likely overall to get a colonoscopy than unmarried men. What is more interesting is that specific characteristics of the marriage predicted which men were more likely to adhere to the screening guidelines and actually get a colonoscopy.

Both married men and married women were more likely to have a colonoscopy if their spouse had one in the last 5 years, or even if the spouse had ever had a colonoscopy in his or her lifetime. Couples with higher net worth were also more likely to have a colonoscopy. This is where the similarities between men and women end however.

Interestingly, married men were more likely to have a colonoscopy if their spouse was college-educated, but the husband’s level of education did not affect his wife’s decision to have a colonoscopy. In fact, a woman’s colonoscopy rate in general is not influenced by much her husband does, or even if she has a husband (about 60% of women choose to get a colonoscopy, married or unmarried)!

Married men were more likely to have a colonoscopy if their spouse was “happy” with the marriage (65% colonoscopy rate) compared to men in marriages where their wives were “not happy” (51% colonoscopy rate). Also, a man who perceives a low level of support from his wife is less likely to have a colonoscopy. So basically, a man is more likely to take care of himself if his wife is happy, and if he feels supported.

Interpreted in a more Darwinian way, maybe this happens because a woman in a happy marriage wants her husband to stick around longer, therefore she encourages positive health behaviors (like getting a colonoscopy). Perhaps men in happy marriages are willing to take advice from their wives more readily, so that the harmony of the relationship is not disturbed?

In keeping with the theme of women being smarter than men, the authors found no association between the happiness of the marriage or the degree of support from their husbands for women who chose to get a colonoscopy. Basically, women are just better at taking care of themselves independently without the need for their husbands approval, input, or coercion.

OK, so these are all interesting little factoids from this one study, but how does this affect the practicing gastroenterologist? Well, we all know that colorectal screening rates in general are woefully low. And as the authors suggest, it seems that many women are “gate-keepers” to their husband’s use of health care resources. Therefore, it would stand to reason that discussing colonoscopy and colon cancer screening recommendations when a man comes to your office with his wife would be an excellent use of your time as a gastroenterologist! If the man is in a happy marriage, chances are that he will book a colonoscopy soon, or risk hearing about it from his wife for the rest of his life!

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Kotwal AA, Lauderdale DS, Waite LJ et al. Differences between husbands and wives in colonoscopy use: results from a national sample of married couples. Prev Med 2016;88:46-52.

Image via Kovacs