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

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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

linking lives through time www.lscs.ac.uk

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.


Why are married people healthier?

1. SelectionHealthy 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


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?


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.


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


Dependent variables

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

period survived died1971-1980 269,265 19,6741981-1990 276,154 15,8081991-2000 292,293 12,720

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

year good/fair health poor health2001 250,240 26,910


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


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


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


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

1971-1980 1981-1990 1991-2000MEN WOMEN MEN WOMEN MEN WOMENCoef. 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 * 0.009living 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 154556Pseudo R2 0.191 0.139 0.181 0.151 0.165 0.136Source: ONS Longitudinal Study of England and Wales

MEN WOMEN MEN WOMEN MEN WOMENCoef. 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 -0.064living alone 0.027 -0.040 0.242 *** 0.007 0.278 *** 0.004Constant -8.443 *** -8.221 *** -8.421 *** -8.102 *** -7.334 *** -7.332 ***N 142522 146175 140574 144767 150434 154556Pseudo R2 0.209 0.152 0.191 0.161 0.194 0.164

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


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

MEN WOMEN MEN WOMEN MEN WOMENCoef. 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 * 0.009living 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 154556Pseudo R2 0.191 0.139 0.181 0.151 0.165 0.136

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

1971-1980 1981-1990 1991-2000MEN WOMEN MEN WOMEN MEN WOMENCoef. 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 -0.064living alone 0.027 -0.040 0.242 *** 0.007 0.278 *** 0.004Constant -8.443 *** -8.221 *** -8.421 *** -8.102 *** -7.334 *** -7.332 ***N 142522 146175 140574 144767 150434 154556Pseudo R2 0.209 0.152 0.191 0.161 0.194 0.164Source: ONS Longitudinal Study of England and Wales


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, 1991-2000Model with age and living arrangement only

0.100 1.000 10.000

never married, alone

never married, with others

married, alone

married, with others

divorced, alone

divorced, with others

widowed, alone

widowed, with others

MEN

WOMEN

Source: ONS Longitudinal Study of England and Wales


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, 1991-2000Model with control variables

0.100 1.000 10.000

never married, alone

never married, with others

married, alone

married, with others

divorced, alone

divorced, with others

widowed, alone

widowed, with others

MEN

WOMEN



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

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

0.100 1.000 10.000

living alone

living with adults

living with children

living with adults +children

MEN

WOMEN



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

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

0.100 1.000 10.000

living alone

living with adults

living with children

living with adults +children

MEN

WOMEN



H4: Living arrangement in the past influences current health.

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

0.100 1.000 10.000

cont. living alone

cont. living withothers

alone; then withothers

with others; thenalone

alone; with others;alone again

with others; alone;with others again

MEN

WOMEN



H4: Living arrangement in the past influences current health.

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

0.100 1.000 10.000

cont. living alone

cont. living withothers

alone; then withothers

with others; thenalone

alone; with others;alone again

with others; alone;with others again

MEN

WOMEN



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.


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)


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

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