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Marital Status Health and Mortality The Role of Living Arrangements

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					       Marital Status, Health and Mortality: The
             Role of Living Arrangement

                   Paul Boyle, Peteke Feijten and Gillian Raab

                           University of St Andrews,
                       School of Geography & Geosciences

                      Longitudinal Studies Centre - Scotland


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      Health differences between the
      married and unmarried

         Unmarried people are less healthy and more likely to
          die than their married counterparts.
         This has been found for almost 150 years and in
          many countries:
           • France: Farr, 1858
           • Country-comparison by Hu & Goldman, 1990
           • USA: Gove, 1973; Waite, 1995; Lillard & Panis, 1996;
             Kaplan, 2006
           • UK: Maxwell & Harding, 1998; Breeze et al., 1999; Gardner
             & Oswald, 2004
         ‘Unmarried’ usually meant ‘single’, but nowadays
          many unmarried people are in consensual unions.

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      Why are married people healthier?

 1.    Selection
         Healthy people are more likely to marry and stay married than
         unhealthy people
 2.    Causality
         -Married people have healthier behaviour because they…
             1.   are cared for and corrected by their partner;
             2.   feel the obligation of being a healthy spouse/parent;
             3.   receive support from their partner in dealing with difficult
                  situations
         -Married people have on average better material well-being
         (income, assets and wealth)
         -Married people have a more satisfying sex life


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      Marital status versus living arrangement

         Are the differences found between married and
         unmarried people due to marital status, or merely
         due to the fact that married people have someone to
         live with?


                      Research question:
           How does living arrangement affect health
                        and death risk?




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        Hypotheses

   1.    Those who live alone are more likely to die
         than those who live with others.
   2.    Unmarried adults (never married, divorced or
         widowed) who live with others are no more
         likely to die than married adults who live with
         others.
   3.    Living with other adults is more protective than
         living with children.
   4.    Living arrangement in the past influences
         current health.

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      Data

         Longitudinal Study of England and Wales
         Sample: LS members enumerated in census
          1971, 1981, 1991 and 2001 aged 20-64 in
          the census year (20-74 in 2001), not living in
          communal establishments, who are not lost in
          follow up.
         Type of data used:
           • census data on individual and household
             characteristics
           • death records

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      Dependent variables

   Frequency table of death (dependent variable in Tables 1-6)

   period                           survived          died
   1971-1980                        269,265         19,674
   1981-1990                        276,154         15,808
   1991-2000                        292,293         12,720

   Frequency table of poor health (dependent variable in Tables 7-8)

   year                      good/fair health   poor health
   2001                             250,240         26,910



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      Covariates
                 Gender (separate analyses for men and women)
                 Age
                 Living arrangement
                 Marital status
                 Living arrangement history
                 Social class
                 Economic activity status
                 Highest qualification
                 Tenure
                 Car access
                 Urban/rural indicator of place of residence




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      Definitions
                  Marital status:
                 •      never married
                 •      married (includes re-married and separated)
                 •      divorced
                 •      widowed
                  Living arrangement:
                 •      alone
                 •      with adults
                 •      with children
                 •      with adults and children
                  Living arrangement history:
                 •      continually living with others
                 •      alone; then with others
                 •      with others; then alone
                 •      alone; with others; alone again
                 •      with others; alone; with others again



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      Method

       Hypotheses 1-3:
         Logistic regression of death (0=survived, 1=died) in
           10-year post census period, with individual and
           household characteristics in census year as
           covariates
       Hypothesis 4:
         Logistic regression of poor health in 2001 (0=good/fair
           health, 1=poor health), with individual and
           household characteristics in 2001 and living
           arrangement history as covariates


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                 H1: Those who live alone are more likely to die
                 than those who live with others.


Table 1: Effect of living alone on death risk - controlled for living alone and age only

                       1971-1980                           1981-1990                       1991-2000
                       MEN              WOMEN              MEN             WOMEN           MEN             WOMEN
                       Coef.            Coef.              Coef.           Coef.           Coef.           Coef.
Age                           0.102 ***        0.104   ***       0.080 ***       0.071 ***       0.025 ***       0.028 ***
Age squared                   0.000            0.000             0.000 ***       0.000 ***       0.001 ***       0.001 ***
Living alone status (ref = with others)
unknown                      -0.268           -1.537   ***       0.282 **        0.082           0.157 *         0.009
living alone                  0.162 ***        0.085   **        0.372 ***       0.150 ***       0.579 ***       0.238 ***
Constant                     -7.602 ***       -7.851   ***      -7.409 ***      -7.484 ***      -6.179 ***      -6.480 ***
N                           142522          146175             140574          144767          150434          154556
Pseudo R2                     0.191            0.139             0.181           0.151           0.165           0.136
Source: ONS Longitudinal Study of England and Wales

Table 2: Effect of living alone on death risk - controlled for background characteristics (effects not shown)

                      1971-1980                       1981-1990                       1991-2000
                      MEN             WOMEN           MEN             WOMEN           MEN             WOMEN
                      Coef.           Coef.           Coef.           Coef.           Coef.           Coef.
  linking
Age         lives   through time
                            0.122 ***       0.120 ***       0.104 ***               www.lscs.ac.uk
                                                                            0.112 ***       0.063 ***       0.058 ***
                      Coef.            Coef.                 Coef.               Coef.               Coef.               Coef.
Age                           0.102 ***       0.104    ***           0.080 ***           0.071 ***           0.025 ***           0.028 ***
Age squared                   0.000           0.000                  0.000 ***           0.000 ***           0.001 ***           0.001 ***
Living alone status (ref = with others)
unknown          H1: Those who live***
                             -0.268   alone0.282 ** more likely to0.157 *
                                              are
                                             -1.537    0.082        die                                                       0.009
living alone
Constant         than those who live** with-7.409 ***
                              0.162 ***
                             -7.602 ***
                                    ***     others. -7.484 ***
                                              0.085
                                            0.372
                                                  ***
                                             -7.851
                                                       0.150
                                                             ***
                                                                   0.579 ***
                                                                  -6.179 ***
                                                                                                                              0.238 ***
                                                                                                                             -6.480 ***
N                           142522          146175              140574              144767              150434              154556
Pseudo R2                     0.191           0.139               0.181               0.151              0.165                0.136
Source: ONS Longitudinal Study of England and Wales

Table 2: Effect of living alone on death risk - controlled for background characteristics (effects not shown)

                       1971-1980                           1981-1990                       1991-2000
                       MEN              WOMEN              MEN             WOMEN           MEN             WOMEN
                       Coef.            Coef.              Coef.           Coef.           Coef.           Coef.
Age                           0.122 ***        0.120   ***       0.104 ***       0.112 ***       0.063 ***       0.058 ***
Age squared                   0.000            0.000   ***       0.000           0.000           0.000 ***       0.000 **
Living alone status (ref = with others)
unknown                      -0.448           -1.644   ***        0.308 **            0.115               0.057              -0.064
living alone                  0.027           -0.040              0.242 ***           0.007               0.278 ***           0.004
Constant                     -8.443 ***       -8.221   ***       -8.421 ***          -8.102 ***          -7.334 ***          -7.332 ***
N                           142522          146175              140574              144767              150434              154556
Pseudo R2                     0.209            0.152              0.191               0.161               0.194               0.164
Source: ONS Longitudinal Study of England and Wales




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          H2: Unmarried adults (never married, divorced or
          widowed) who live with others are no more likely to
          die than married adults who live with others.
                                       Odds ratio of death risk, 1991-2000
                                    Model with age and living arrangement only

                                     0.100                1.000                   10.000

                 never married, alone

            never married, with others

                       married, alone

                  married, with others                                                     MEN
                                                                                           WOMEN
                      divorced, alone

                 divorced, with others

                      widowed, alone

                widowed, with others


           Source: ONS Longitudinal Study of England and Wales



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          H2: Unmarried adults (never married, divorced or
          widowed) who live with others are no more likely to
          die than married adults who live with others.
                                         Odds ratio of death risk, 1991-2000
                                           Model with control variables

                                     0.100                  1.000               10.000

                 never married, alone

            never married, with others

                       married, alone

                  married, with others                                                   MEN
                                                                                         WOMEN
                      divorced, alone

                 divorced, with others

                      widowed, alone

                widowed, with others


           Source: ONS Longitudinal Study of England and Wales



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          H3: Living with other adults is more protective than
          living with children.

                                         Odds ratio of death risk, 1991-2000
                                      Model with age and living arrangement only

                              0.100                       1.000                     10.000



                    living alone




              living with adults
                                                                                             MEN
                                                                                             WOMEN
            living with children



            living with adults +
                   children


           Source: ONS Longitudinal Study of England and Wales



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          H3: Living with other adults is more protective than
          living with children.

                                      Odds ratio of death risk, 1991-2000
                                        Model with control variables

                              0.100                   1.000                  10.000



                    living alone




              living with adults
                                                                                      MEN
                                                                                      WOMEN
            living with children



            living with adults +
                   children


           Source: ONS Longitudinal Study of England and Wales



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          H4: Living arrangement in the past influences
          current health.

                                      Odds ratio of poor health risk, 2001
                          Model with age and living arrangement history 1981-2001 only

                              0.100                    1.000                    10.000


              cont. living alone

               cont. living with
                   others

              alone; then with
                   others                                                                MEN
              with others; then                                                          WOMEN
                    alone

            alone; with others;
               alone again

            with others; alone;
            with others again

           Source: ONS Longitudinal Study of England and Wales



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          H4: Living arrangement in the past influences
          current health.

                                      Odds ratio of risk of poor health, 2001
                                         Model with control variables

                              0.100                     1.000                    10.000


              cont. living alone

               cont. living with
                   others

               alone; then with
                    others                                                                MEN
              with others; then                                                           WOMEN
                    alone

            alone; with others;
               alone again

            with others; alone;
            with others again

           Source: ONS Longitudinal Study of England and Wales



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      Summary
   Our findings confirm results from previous marital status
    studies.
   In addition to that:
     • We found that over the whole 1971-2001 period, living with others
       is associated with better health and lower death risk for men and
       women.
     • Yet, living arrangement cannot fully account for the protective
       effect of marriage for men, because married men living with others
       have a lower death risk than unmarried men living with others.
     • When we control for background characteristics (mainly socio-
       economic), effects of living arrangement and marital status
       disappear for women.
     • We found no support for our hypothesis that living arrangement
       history affects current health.



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      Discussion

         The category ‘Unmarried, living with others’
          increasingly consists of unmarried cohabitors.
          Is this similar to being married in the way it
          relates to health?
         What we found are associations. More
          sophisticated modelling could be used to
          distinguish selection from more causal
          mechanisms (e.g., simultaneous equation
          modelling like in Lillard & Panis, 1996)


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        Acknowledgements


   1.    The permission of the Office for National Statistics to use the
         Longitudinal Study is gratefully acknowledged, as is the help
         provided by staff of the Centre for Longitudinal Study
         Information & User Support (CeLSIUS). CeLSIUS is supported
         by the ESRC Census of Population Programme (Award Ref: H
         507 25 5179). The authors alone are responsible for the
         interpretation of the data. The clearance number of this
         presentation is 30056A.
   2.    The presentation of this research was made possible by an
         Overseas Conference Grant of the British Academy, whose
         support is gratefully acknowledged (grant nr OCG-47356).



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