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Vital statistics data indicate that women live longer than men. One hypothesized explanation is that men are more adversely affected by the absence of a marital relationship. This sex difference may be especially pronounced among those whose health is compromised. The purpose of this study was to examine the joint effects marital status and chronic disease on the sex differential in 30-year all-cause mortality. A retrospective cohort study was conducted among residents of Tecumseh, Michigan. Baseline information was collected in 1959-60, and year-of-death was determined for the 30 years that followed. As predicted, Cox proportional hazards analysis revealed that the male/female mortality differential was largest among unmarried individuals with chronic disease (RR = 2.69; 95% CL = 1.94-3.73). Potential explanatory mechanisms are explored.