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36 (95% CI 0.17 to 0.64) unit difference in women's time spent in HPA. The weakest spousal concordance was observed in beta cell function indices. Spousal concordance was strongest in behavioral risk factors. Concordance weakened when moving downstream in the causal cascade leading to type 2 diabetes. Public health prevention strategies to mitigate diabetes risk may benefit from targeting spousal similarities in health-related behaviors and diabetes risk factors to design innovative and potentially more effective couple-based interventi

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