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The Times They Are a Changin': Marital Status and Health Differentials from 1972 to 2003

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Although the meanings and rates of being married, divorced, separated, never-married, and widowed have changed significantly over the past several decades, we know very little about historical trends in the relationship between marital status and health. Our analysis of pooled data from the National Health Interview Survey from 1972 to 2003 shows that the self-rated health of the never-married has improved over the past three decades. Moreover, the gap between the married and the never married has steadily converged over time for men but not for women. In contrast, the self-rated health of the widowed, divorced, and separated worsened over time relative to the married, and the adverse effects of marital dissolution have increased more for women than for men. Our findings highlight the importance of social change in shaping the impact of marital status on self-reported health and challenge long-held assumptions about gender, marital status, and health.
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The Times They Are a Changin’:
Marital Status and Health Differentials
from 1972 to 2003*
HUI LIU
Michigan State University
DEBRA J. UMBERSON
The University of Texas at Austin
Journal of Health and Social Behavior 2008, Vol 49 (September): 239–253
Although the meanings and rates of being married, divorced, separated, never-
married, and widowed have changed significantly over the past several decades,
we know very little about historical trends in the relationship between marital
status and health. Our analysis of pooled data from the National Health
Interview Survey from 1972 to 2003 shows that the self-rated health of the nev-
er-married has improved over the past three decades. Moreover, the gap be-
tween the married and the never married has steadily converged over time for
men but not for women. In contrast, the self-rated health of the widowed, di-
vorced, and separated worsened over time relative to the married, and the ad-
verse effects of marital dissolution have increased more for women than for men.
Our findings highlight the importance of social change in shaping the impact of
marital status on self-reported health and challenge long-held assumptions
about gender, marital status, and health.
239
Politicians and scholars emphasize that mar-
riage benefits health and empirical evidence
supports the view that the married are healthi-
er than the unmarried (Waite and Gallagher
2000). While a significant body of work estab-
lishes the link between marital status and
health, previous studies do not consider histor-
ical trends in this association. Moreover, past
studies often combine the divorced, separated,
widowed, and never-married into one “unmar-
ried” category, and there are both empirical and
theoretical reasons to make distinctions among
these unmarried groups.
Several factors may contribute to changing
patterns in the link between marital status and
health. The sociodemographic composition of
marital status groups (e.g., socioeconomic sta-
tus, gender, and race) has changed over time,
and these variables are also associated with
health. Moreover, the past several decades have
witnessed rapid change in the predominant
family structures and norms in the United
States, and these changes may alter the link be-
tween marital status and health. The main ob-
jective of the present study is to describe
whether and how the association between mar-
ital status and health has changed over the past
three decades. Documenting these historical
trends is an essential first step toward under-
standing change in the relationship between
marital status and health over time. Given long-
standing observations about gender and race
* We thank Robert A. Hummer, R. Kelly Raley,
Catherine E. Ross, and John Mirowsky for their
helpful comments and advice. We are grateful for
suggestions from Peggy Thoits, Eliza Pavalko, and
the anonymous reviewers of this manuscript. This re-
search was supported by grant RO1AG026613
(Principal Investigator, Debra Umberson) from the
National Institute on Aging. An earlier version of
this paper was presented at the annual meeting of the
Population Association of America, 2006. Address
correspondence to Hui Liu, Department of
Sociology, 316 Berkey Hall, Michigan State
University, East Lansing, MI 48824-1111 (e-mail:
huiliu@prc.utexas.edu).
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differences in family and health processes, our
second objective is to consider gender and race
variation in marital status/health trends. Third,
we consider whether health trends by marital
status can be attributed to change in family in-
come, often viewed as an explanatory mecha-
nism linking marital status to health.
This study is particularly important for po-
litical and scholarly debates about marriage.
While some scholars argue that marriage
should be encouraged because it is beneficial
to health and well-being (Waite and Gallagher
2000), other scholars argue that marriage is not
as strongly linked to individual well-being as it
was in the past and that alternatives to marriage
(e.g., cohabitation, same-sex unions) provide
individuals with the same benefits that are pro-
vided by marriage (Musick and Bumpass
2006). An analysis of trends in marital status
and health over time can shed light on the na-
ture of marital status and health linkages and
has important implications for public policy
and population health.
BACKGROUND
Most of the recent research on historical
trends in health differences by marital status is
based on European mortality data (e.g.,
Martikainen et al. 2005; Van Poppel and Joung
2001), with one study including U.S. data (Hu
and Goldman 1990). These studies generally
conclude that the excess mortality of the un-
married (never-married, widowed, and di-
vorced) relative to the married has increased
over time and that this occurs primarily be-
cause of a more pronounced improvement
among the married, rather than a worsening sit-
uation for the unmarried (Van Poppel and
Joung 2001). Mortality improvement among
the married may result from cumulative bene-
fits associated with longer marital durations
than in the past or stronger selection processes
associated with the transition to marriage (Van
Poppel and Joung 2001).
While a number of studies have considered
historical trends in marital status and mortali-
ty, researchers have devoted little attention to
historical trends in the link between marital
status and physical health over time. Linda
Waite (2000) conducted the only study we were
able to identify that considers marital status
trends in self-rated health status over historical
time in the United States. Comparing the mar-
ried to the previously-married and the never-
married, she reports a stable rather than chang-
ing marital benefit for self-rated health over the
1972 to 1996 period. Waite (2000) found mar-
ginally significant (p= .076) evidence for a
shrinking health difference between married
and never-married men over time, but the
change was not evident among women. She
classified all of the previously-married cate-
gories into one unmarried group without dis-
tinguishing among the divorced, separated, and
widowed. Yet one would expect health differ-
ences across these marital status groups as well
as varying patterns of change in those differ-
ences over time.
Most research on historical trends in marital
status and mortality works from a demograph-
ic perspective and analyzes vital statistics.
However, most research on marital status and
self-rated health works from a social-psycho-
logical perspective, relies on panel data, and
looks at individual change over shorter periods
of time in the life course, particularly as indi-
viduals make transitions from one marital sta-
tus to another. These two literatures are gener-
ally consistent with one another in that the
married appear to be better off in terms of self-
rated health and mortality. However, neither of
these literatures informs us about historical
trends in the link between marital status and
self-rated health.
Change in Family Structures and Norms:
Implications for Marital Status and Health
Trends
During the past half century, the United
States has experienced tremendous change in
marriage. Median age at first marriage in-
creased, the proportion of never-married (espe-
cially for African Americans) increased, and
cohabitation and marital dissolution rose dra-
matically (Teachman, Tedrow, and Crowder
2000). Some family scholars argue that these
changes provide evidence that marriage has be-
come less popular and less valued among
Americans (Thornton 1989). Happiness asso-
ciated with marriage seems to have waned
from 1972 to 1986 (Glenn and Weaver 1988),
suggesting that the benefits of marriage may
have lessened over time. As the proportion of
individuals who divorce and never marry in-
creases, these statuses also become more nor-
mative and less stigmatized (Thornton 1989).
As a result, these statuses may be less stressful
and more rewarding than in the past and in re-
lation to being married. Research on the links
between marriage and health provides a foun-
240 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
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dation for predicting the specific direction of
change in marital status and health that one
might expect to see over time.
Why the Married are Healthier—Predicting
the Direction of Change
A substantial literature establishes an em-
pirical relationship between marital status
and self-rated health and focuses on identify-
ing and understanding key reasons for the as-
sociation between marital status and health
(Waite and Gallagher 2000). Although some
studies emphasize the possibility of selection
effects, suggesting that individuals in better
health or with more favorable health charac-
teristics are more likely to get and stay mar-
ried (Joung et al. 1998), most researchers em-
phasize one of two models to explain why
marital status has a causal effect on health:
the marital resource model and the marital
dissolution/stress model.
The marital resource model. According to
the marital resource model, marriage provides
social, psychological, and economic resources
that in turn promote physical health and
longevity (Ross, Mirowsky, and Goldsteen
1990). Linda Waite (Waite and Gallagher
2000) argues that marriage offers unique insti-
tutional, economic, and psychosocial benefits
that cannot be obtained from other types of re-
lationships (such as cohabitation). Yet some in-
direct evidence suggests that access to these re-
sources has changed over time for the married
as well as the unmarried.
Many scholars point to economic benefits as
a key reason for better health among the mar-
ried. Gary Becker (1981) argues that marriage
leads to an increase in economic resources
through specialization, economies of scale, and
the pooling of wealth. Economic resources
may enhance health by improving nutrition,
providing care in the event of illness, allowing
the purchase of medical care or other health en-
hancing resources, and increasing the proba-
bility of access to health insurance (Ross et al.
1990).
Beckers (1981) influential work attributes
recent declines in the propensity to get and stay
married to a decline in the economic benefits
of marriage. He contends that, as the division
of household labor decreases with increases in
womens education and employment, special-
ization between the husband and wife declines
and economic gains from marriage diminish.
In turn, marriage becomes less valued as a
source of economic stability (Teachman et al.
2000) and individuals are less inclined to get
and stay married. If the economic resources as-
sociated with marriage have declined over
time, then any positive effects of marriage on
health should decrease over time. While
Beckers arguments are widely cited and sup-
ported from cross-sectional aggregate-level ev-
idence, longitudinal analysis of individual-
level data fails to support his hypothesis (see a
review in Oppenheimer 1997).
Marriage may benefit health by increasing
access to social support and social control and
enhancing a sense of personal control (Ross et
al. 1990). Social support is defined as the
commitment, caring, advice and aid provided
in personal relationships (Ross et al.
1990:1062). In turn, social support from mar-
riage may benefit mental health, and mental
health is positively correlated with physical
health (Bloom 1990). Social control refers to
the deliberate efforts of others to control ones
health and health behaviors (Umberson 1987).
Personal control refers to the sense that one has
mastery over his or her social environment and
can influence personal outcomes, including
health (Mirowsky and Ross 2003). Marriage is
associated with higher levels of social support,
social control, and personal control, and all of
these resources are positively associated with
health (Umberson 1987).
Empirical evidence on change in social and
psychological resources (e.g., social support)
is not as well documented as change in eco-
nomic gains from marriage, but some indirect
evidence is suggestive. For example, increas-
ing labor force participation of women over
time may mean that partners, especially wives,
have less time and energy to provide these re-
sources to one another (Bianchi et al. 2000). At
the same time, alternatives to marriage such as
cohabitation, committed same-sex relation-
ships, and a larger population of unmarried
persons (providing a larger pool of potential
friends) may all contribute to greater access to
social resources for the unmarried (Musick and
Bumpass 2006). These trends suggest the pos-
sibility of a closing gap in health between the
married and the unmarried.
On the other hand, in the context of increas-
ing geographic mobility, marriage may have
become more important as a source of support
and of network connection (McPherson,
Smith-Lovin, and Brashears 2006). In this
sense, marriage could have become even more
MARITAL STATUS AND HEALTH DIFFERENTIALS 1972–2003 241
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important for health over time, leading to an in-
creasing gap between the health of the married
and the unmarried. This could help explain
findings from mortality studies showing that
mortality rates of the married, relative to the
unmarried, have actually declined over time.
The stress model. The stress model (also re-
ferred to as the crisis model) focuses more
on the event of marital dissolution rather than
on marital status per se. The crisis model sug-
gests that the strains of marital dissolution un-
dermine the health of the divorced, the separat-
ed, and the widowed, which in turn leads to
marital status differences in health (Williams
and Umberson 2004). In this view, the stress of
marital dissolution rather than marriage, per se,
is responsible for the health gap between the
married and the unmarried. However, divorce
and separation have become more acceptable
over time (Thornton 1989) and this may have
reduced the stress of divorce and may be re-
flected in the improved health status of the di-
vorced relative to the married. These aspects of
the stress model suggest that the health gap be-
tween the married and previously-married
would decrease over time. Moreover, the nev-
er-married are relatively immune to any appar-
ent disadvantage associated with the stress of
marital dissolution. A stress model, then, sug-
gests that the gap between the married and the
never-married will be smaller than the gap be-
tween the married and the previously-married
throughout the study period.
In sum, a long sociological tradition con-
tends that marriage benefits health, and recent
research on mortality and marriage (e.g.,
Martikainen et al. 2005) suggests a diver-
gence hypothesisthat the marital advantage
in health has increased over time. Other recent
work suggests that the marital advantage in
health should at least be sustained over time
(Waite 2000). In contrast, recent research on
the stress of marital dissolution (e.g., Williams
2003) and many of the sociodemographic
trends reviewed above (e.g., rising divorce and
never-married rates, a possible decline in eco-
nomic benefits from marriage) point to a con-
vergence hypothesis: that is, health differen-
tials between the married and other marital
groups have narrowed since the early 1970s.
We test these competing hypotheses with na-
tional data collected over the past three decades
in the United States. Our primary goal is to
document the nature of historical trends in the
association of marital status with health. It is
beyond the scope of the present paper (and our
data) to test a full range of explanations for
change in the marital status/health association
over time. However, we do analyze family in-
comethe mechanism that is most often cited
as an explanation for the marital advantage in
health.
Gender and Race Variation
A long-standing sociological tenet is that
marriage enhances the health of men more than
women and the adverse effects of marital dis-
solution on health are greater for men
(Williams and Umberson 2004). Moreover,
marriage may benefit health in different ways
depending on gender. Compared to men,
women tend to obtain more economic re-
sources from marriage. In contrast, marriage
tends to provide men with more social support
and social control of health behavior (Ross et
al. 1990). If economic resources associated
with marriage play a more important role in ac-
counting for the marital advantage in health for
women (Lillard and Waite 1995), an historic
decline in economic benefits from marriage
may reduce the marital advantage in health for
women more than for men. Furthermore,
norms and attitudes about non-married status-
es have changed more over time for women
than for men because of womens greater im-
provement in social and financial status
(Thornton 1989). Taken together, research lit-
erature leads us to hypothesize that, compared
to men, women are more likely to experience a
convergence in health by marital status over
time.
Marriage patterns and experiences also dif-
fer for African Americans and whites. African
American status is associated with a higher
risk of marital dissolution (Raley and Bumpass
2003) as well as lower marriage rates in gener-
al (Oppenheimer 1997), and these patterns
have become stronger over time (Raley and
Bumpass 2003). Among whites, declines in
marriage rates largely represent delays in mar-
riage, whereas, among African Americans, de-
clines reflect both delays and decreased proba-
bility of ever marrying (Oppenheimer 1997).
Indeed, in terms of economic benefits, African
American women gain significantly less from
marriage than do white women (Farley 1988).
African Americans also report higher levels of
marital strain, which in turn reduces the bene-
fits of marriage for health (Umberson et al.
2005). The more common occurrence of di-
242 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
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vorce, separation, cohabiting, and never-mar-
ried status among African Americans, com-
pared to whites, also suggests that being un-
married may be more normative and socially
accepted in African American communities
(Bennet, Bloom, and Craig 1989). If this is the
case, unmarried statuses may be less detrimen-
tal to health among African Americans com-
pared to whites. We hypothesize, then, that
health differentials by marital status are more
likely to narrow among African Americans
than whites over the 1972 to 2003 period.
DATA, MEASURES, AND ANALYTIC
APPROACH
Data
We use repeated cross-sectional data from
the National Health Interview Survey (NHIS)
from 1972 to 2003 to analyze historical trends
in marital status differentials in health. The
NHIS is a multistage probability survey con-
ducted annually by the National Center for
Health Statistics and is representative of the
civilian noninstitutionalized population of the
United States (U.S. Department of Health and
Human Services, National Center for Health
Statistics 2000). All analyses presented here
are weighted to adjust for the multistage sam-
pling design, and robust standard errors are
used for tests of significance.
In this study, we include only those who are
non-Hispanic white or African American and
between the ages of 25 and 80 when the sur-
veys were conducted. In total, we eliminated
242,985 Hispanics and 93,800 participants
identified in other race-ethnicity groups from
the sample because of their tremendous het-
erogeneity and because of limited information
on within-group differences in the earlier years
of the NHIS. The National Health Interview
Survey collects health information for all fam-
ily members, but information on each family
member is reported by one primary respon-
dent. Due to concerns about validity and relia-
bility of proxy reports on health status, our
analyses are limited to the primary respon-
dentsreports on their own health status, and
no couples are included in the sample. We ex-
clude cohabiting respondents from the analysis
(.7% of the sample) because the NHIS did not
collect information on cohabiting status prior
to 1997. We conducted sensitivity tests for co-
habitation cases and found that including co-
habitors in the married category does not mod-
ify results. In addition, including cohabitors as
a separate group results in no change in the re-
sults for other marital status groups and reveals
a similar level and change in self-rated health
for cohabitors and the married over time.
Individuals with missing data on health or mar-
ital status were dropped from the analysis
(about 1% of the sample). In total, 1,119,266
observations are included in the analysis.
Measures
Health. Self-rated health is the primary out-
come variable in our analyses. Between 1972
and 1981, response options for self-rated
health included four categories: (1) excellent,
(2) good, (3) fair, and (4) poor. Between 1982
and 2003, response options included five cate-
gories: (1) excellent, (2) very good, (3) good,
(4) fair, and (5) poor. For the 19822003 data,
we combine very good and excellent into
one category so that response categories are
comparable to those used between 1972 and
1981. Final statistical models include a dummy
variable to indicate whether self-rated health
was recoded from the five- to the four-catego-
ry response format (1 = recoded; 0 = not re-
coded). Self-rated health is reverse coded so
that higher values represent better health. The
reliability and validity of the self-rated health
measure is well-established (Idler and
Benyamini 1997).
Marital status. Our measure of marital sta-
tus is based on the survey question, Are you
now married, widowed, divorced, separated or
never-married? We consider five categories of
marital status: married, widowed, divorced,
separated, and never-married, with the married
as the reference group in regression models.
Period time. Time is indicated by a variable
identifying the survey year from 1972 (coded
as 0) to 2003 (coded as 31).
Other sociodemographic covariates. We a l -
so include measures of gender (female = 1,
male = 0), race (non-Hispanic African Ameri-
can = 1, non-Hispanic white = 0), age (centered
at mean age of 48), education (no high school
diploma, high school graduate, some college,
and college graduate, with the last category as
the reference) and interaction terms between
age and marital status. About 1 percent of ob-
servations have missing information on educa-
tion, and for those cases we substituted the
mean value of education for the given survey
year. In the remainder of the article we refer to
non-Hispanic whites as whites and to non-
MARITAL STATUS AND HEALTH DIFFERENTIALS 19722003 243
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Hispanic African Americans as African
Americans.
Family income. Because of the endogenous
relationship between income and marital status
(Becker 1981), we add family income into the
analyses in order to examine if and how
changes in economic resources mediate the
pattern of change in health differences by mar-
ital status over time. The NHIS measure of
family income is not consistent across survey
year in that both the cut points and the total
number of categories were modified over time.
We use the midpoint of each income category
and then convert it into 2003 U.S. dollars using
the consumer price index as a standard. The
median family income in the total sample is
$40,422 based on the 2003 U.S. dollar. We then
use the logarithmic transformation of family
income to address the skewed distribution.
Table 1 presents summary statistics for other
variables in the analysis.
Analytic Design
We use ordered logistic regression models to
estimate trends in self-rated health by marital
status. The model is specified in the following
way:
P(ykXi,M
j, T)
log P(y< kXi,M
j, T) =
k+ T + jMj+ jMjT+ iXi
where yrepresents the self-rated health status;
krepresents the category of health status; k
represents the intercept corresponding to the
kth health category; Tis the period time vari-
able and is the coefficient; Mjrepresents the
set of marital status dummy variables and j
represents the corresponding coefficients
(married is the reference group); jrepre-
sents the corresponding coefficients for the set
of interaction terms between marital status and
time; and Xistands for the other covariates in-
cluded in the model and ifor the correspond-
ing coefficients. The jterm is of the most in-
terest for this study, as it reflects trends in
health differences by marital status.
We estimate two models. In the first model,
we examine health trends by marital status,
controlling only the basic sociodemographic
covariates (i.e., age, gender, race, education,
and age ×marital status interaction terms).
Results from model 1 reflect the overall trend
in the association between marital status and
health. We add family income in the second
model to see how income may modify health
trends by marital status. A reduction in signif-
icance levels from model 1 to model 2 would
suggest that family income plays a role in ex-
plaining trends in marital status and health. In
both models, we include a dummy variable in-
dicating the 1982 NHIS change in self-rated
health categories. We run parallel regressions
for women, men, African Americans, and
whites to determine if trends differ on the ba-
sis of gender and race. We conducted two-
tailed t-tests to consider whether the differ-
ences in trends between subgroups are statisti-
cally significant.
RESULTS
Estimated Trends for Total Sample
Tables 2 through 4 show the regression co-
efficients for trends in self-rated health by mar-
ital status from the ordered logistic regression
models. For interpretation, the odds ratios can
be derived from the reported coefficients by
exponentiation. Table 2 shows self-rated health
trends by marital status for the total sample
over the 1972 to 2003 period. Tables 3 and 4 in-
dicate that there is significant gender and race
variation in trends; we will discuss those in a
later section. The first set of covariates in
244 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
TABLE 1. Weighted Percentages for Variables
Analyzed (Pooled NHIS 1972–2003),
N = 1,119,266
Marital status
Married 67.18
Widowed 10.58
Divorced 9.31
Separated 3.04
Never married 9.89
Health status
Excellent 48.12
Good 34.87
Fair 12.61
Poor 4.40
Gender
Women 64.83
Men 35.17
Race
African Americans 11.11
Whites 88.89
Education
No high school diploma 29.11
High school graduate 36.53
Some college 17.14
College graduate 17.22
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Tables 24 (i.e., year ×marital status) are of the
greatest interest for this study because they re-
flect trends in self-rated health by marital sta-
tus. The main effect of year indicates the trend
for the married. For example, the coefficient of
.003 for year in model 1 of Table 2 can be in-
terpreted as follows: The odds of reporting
excellent/good health (hereafter good health)
increased .30 percent (i.e., [exp(.003) 1] ×
100) each year for the married. The interaction
terms of year with other marital statuses repre-
sent the differences in self-rated health trends
between each specific marital group and the
married. For example, the coefficient of .023
for year ×widowed in model 1 of Table 2 indi-
cates that the odds of reporting good health de-
creases 2.27 percent (i.e., [1 exp(.023)] ×
100) more for the widowed than for the mar-
ried each year. The main effects of the marital
status variables in Tables 24 reflect the base-
line level (i.e., in 1972) of the health difference
between specific marital groups and the mar-
ried. Other covariates can be interpreted in the
same way that coeff icients in conventional or-
dered logistic regression models are interpret-
ed. Exponentiation of the values for intercept
13 represents odds of reporting different lev-
els of health status for the reference group.
Estimated effects of all of the covariates are
in the expected direction. Specifically, the odds
of reporting good health decline with age, and
they are smaller for African Americans and
women compared to whites and men. In com-
parison to college graduates, each of the lower
education groups exhibits lower odds of re-
porting good health.
Table 2 shows the estimated trends in self-
rated health differences by marital status for
the total sample over the 1972 to 2003 period,
net of the effects of age, age ×marital status,
gender, race, and education. We calculate the
probability of reporting good health based on
the results in Table 2, and we illustrate the over-
all pattern of these results in Figure 1. These
results indicate that, over the 1972 to 2003 pe-
riod, the probability of reporting good health
increased modestly among the married while it
increased at a fairly rapid rate among the nev-
er-married, leading to a narrowing gap in self-
rated health between the never-married and
married over time.
In contrast, over the past three decades, the
probability of reporting good health declined
among the divorced, separated, and, especially,
the widowed. Therefore, the self-rated health
difference between the married and the wid-
owed/divorced/separated widened over the
1972 to 2003 period. The gap in self-rated
health between the married and formerly-mar-
ried increased most for the widowed. Net of so-
ciodemographic characteristics, the widowed
and the married reported similar levels of
health in the early 1970s, but as the years
passed, the self-rated health of the widowed de-
creased more rapidly than for any other marital
status group.
We add family income as an additional co-
variate in model 2 of Table 2 to see if and how
family income contributes to trends in self-rat-
ed health between marital status groups. A
comparison of models 1 and 2 shows that con-
trolling for family income results in little
change in self-rated health trends by marital
status. These results suggest that marital status
differences in family income do not explain ei-
ther the convergence between the married and
never-married or the divergence between the
MARITAL STATUS AND HEALTH DIFFERENTIALS 19722003 245
TABLE 2. Regression Coefficients for Trends in
Self-Rated Health by Marital Status
from Ordered Logistic Regression
Models, 19722003
Model 1 Model 2
Year marital status (0 = married)
Year .003*** .009***
Year widowed .023*** .028***
Year divorced .008*** .012***
Year separated .008*** .010***
Year never married .004*** .002*
Marital status (0 = married)
Widowed .013 .250***
Divorced .026 .269***
Separated .202*** .110***
Never married .158** .138***
Basic demographic variables
Age .029*** .026***
Age widowed .023*** .025***
Age divorced .004*** .003***
Age separated .002 .001
Age never married .008*** .005***
Women .041*** .009
African American .576*** .476***
Education (0 = college graduate)
——No high school diploma 1.514*** 1.224***
——High school graduate .779*** .636***
——Some college .429*** .348***
Health measure recoded (0 = no) .555*** .497***
Log of family income .474***
Intercept 1 4.077 1.131
Intercept 2 2.480 2.759
Intercept 3 .572 4.705
Pseudo R2.081 .091
N1119266
Two-tailed tests: *** p< .001; ** p< .01; * p< .05.
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married and each of the formerly-married
groups over time.
Gender and Race Variation
Tables 3 and 4 present the estimated trends
in self-rated health differences by marital sta-
tus from the ordered logistic regression models
for separate social groups. Results from two-
tailed t-tests for group differences are present-
ed in each table.
Gender. Table 3 shows the estimated trends
in self-rated health from 1972 to 2003 by mar-
ital status separately for women and men.
246 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
FIGURE 1. Estimated Trends in Self-Rated Health by Marital Status, 19722003
TABLE 3. Regression Coefficients for Trends in Self-Rated Health by Marital Status and Gender
from Ordered Logistic Regression Models, 19722003
Model 1 Model 2
Women Men mwaWomen Men mwa
Year
marital status (0 = married)
Year .005*** .001 ††† .012*** .004*** †††
Year widowed .024*** .019*** †† –.030*** .023*** †††
Year divorced .010*** .005*** †† –.014*** .006*** †††
Year separated .008*** .007** .011*** .008***
Year never married .000 .009*** ††† –.002 .008*** †††
Marital status (0 = married)
Widowed .016 .092* †† .295*** .060 †††
Divorced .011 .091*** ††† .339*** .128*** †††
Separated .255*** .081* ††† .083** .158***
Never married .052** .315*** ††† .249*** .027 †††
Basic demographic variables
Age .029*** .030*** ††† –.026*** .027*** ††
Age widowed .023*** .021*** .025*** .026***
Age divorced .007*** .001 ††† .005*** .000 †††
Age separated .004** .006*** ††† .000 .005**
Age never married .011*** .003*** ††† .008*** .001 †††
African American .695*** .351*** ††† –.599*** .251*** †††
Education (0 = college graduate)
——No high school diploma 1.550*** 1.433*** ††† –1.261*** 1.137*** †††
——High school graduate .770*** .796*** .623*** .653***
——Some college .409*** .464*** ††† –.329*** .377*** ††
Health measure recorded (0 = no) .538*** .586*** †† .478*** .534*** †††
Log of family income .453*** .512*** †††
Intercept 1 4.184 3.838 .790 1.740
Intercept 2 2.475 2.413 2.526 3.201
Intercept 3 .503 .618 4.533 5.038
Pseudo R2.080*** .083 .090 .096
N722695 396571 722695 396571
Notes: Two-tailed tests: *** p< .001; ** p< .01; * p< .05.
Two-tailed tests for group differences: ††† p< .001; †† p< .01; p< .05.
amw indicates the tests for group differences between men and women.
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Results from model 1 of Table 3 are illustrated
in Figure 2 and show that the probability of re-
porting good health increases over historical
time for married women while the probability
remains stable for married men. Notably, the
married remain more likely than any other
marital status group to report good health for
both men and women over the entire study pe-
riod.
Never-married men and women became in-
creasingly more likely to report good health
over time. Furthermore, because the probabili-
ty of reporting good health remains stable for
married men, there is a trend toward conver-
gence in self-rated health for married and nev-
er-married men over time. In contrast, the gap
between married and never-married women re-
mained stable from 1972 to 2003, suggesting
that, contrary to our predictions, the difference
in self-rated health between the married and
never-married has narrowed for men but not
for women over the past three decades.
Formerly-married men and womenthe
separated, divorced, and widowedexhibit a
decline in self-rated health over time relative to
the married. Two-tailed t-tests show that diver-
gence between the married and widowed/di-
vorced is more pronounced for women than for
men. Indeed, over the 32-year period, the gap
between the separated and the divorced is al-
ways larger for women than for men, with sep-
arated women less likely than divorced women
to report good health at any time point. This
finding supports a stress model interpretation
in that the process and dynamics of separation
may be more stressful and detrimental to health
than divorce for women whereas, among men,
it appears that separation and divorce are more
similar in their association with self-rated
health.
In model 2 of Table 3, we add family income
as an additional covariate. This results in little
change in the estimated trends for either
women or men.
Race. Table 4 compares the estimated trends
in self-rated health by marital status for whites
and African Americans. Overall, African
Americans are less likely than whites to report
being in good health. However, over time, the
probability of reporting good health was more
likely to increase for African Americans rela-
tive to whites.1
Trends in self-rated health by marital status
follow very different patterns for African
Americans compared to whites. The general
pattern of race differences (from Table 4, mod-
el 1) can be seen in Figure 3, which shows the
probability of reporting good health by race
and marital status over time. Married African
Americans exhibit a dramatic increase in the
probability of reporting good health over the
32-year period, while improvement in self-rat-
ed health over time occurs at a much slower
rate for married whites. The gap in self-rated
health between married whites and married
African Americans nar rowed signif icantly over
the thirty year period. This narrowing race gap
in self-rated health is also seen for the never-
married and the divorced/separated, but not for
the widowed.
MARITAL STATUS AND HEALTH DIFFERENTIALS 19722003 247
FIGURE 2. Estimated Trends in Self-Rated Health by Marital Status and Gender, 19722003
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Consistent with our hypothesis about race
differences, Figure 3 also illustrates a strong
convergence between the never-married and
married in the probability of reporting good
health for African Americans, but this trend is
much less pronounced among whites. The two-
tailed t-test (shown in model 1 of Table 4)
shows that this race difference between the
never-married and the married is statistically
significant.
While the probability of reporting good
health increased for divorced/separated
African Americans over the 32-year period, it
decreased for divorced/separated whites. For
both African Americans and whites, the wid-
owed became less likely to report good health
over time. Furthermore, for both whites and
African Americans, there is a widening gap in
self-rated health between the married and wid-
owed/divorced from 1972 to 2003. Two-tailed
t-tests show that those race differences in
changes in the self-rated health gap between
the married and each of the formerly-married
are not statistically significant.
Results from model 2 of Table 4 show that
the modest convergence between the never-
married and married among whites is ex-
plained by change in family income. As shown
in model 2 of Table 4, if never-married whites
had the same family income as married whites,
there would be a stable gap between never-
married and married whites in self-rated health
over time, but family income does not explain
changing trends in the self-rated health gap of
married and never-married African Americans.
DISCUSSION
In the context of rapid family change, one
would expect change in the costs and benefits
of marriage, yet the research literature reveals
surprisingly little about how the association be-
tween marital status and health has changed
over time. Our analysis, based on pooled data
from the NHIS 19722003, shows that differ-
248 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
TABLE 4. Regression Coeff icients for Trends in Self-Rated Health by Marital Status and Race from
Ordered Logistic Regression Models, 19722003
Model 1 Model 2
African American White waaaAfrican American White waaa
Year
marital status (0 = married)
Year .011*** .002** ††† .014*** .008*** †††
Year widowed .023*** .022*** .028*** .027***
Year divorced .005** .008*** .008*** .012***
Year separated .004 .009*** .005* .011***
Year never married .008*** .003** .007*** .001 ††
Marital status (0 = married)
Widowed .030 .004 .206*** .266***
Divorced .003 .028 .234*** .279***
Separated .222*** .186*** .022 .134***
Never married .247*** .149*** .004 .151*** †††
Basic demographic variables
Age .033*** .029*** ††† –.031*** .026*** †††
Age widowed .028*** .022*** †† .030*** .024***
Age divorced .008*** .004*** †† .008*** .002** †††
Age separated .004* .001 .003 .002
Age never married .002 .009*** ††† .000 .006*** †††
Women .330*** .002 ††† –.282*** .027*** †††
Education (0 = college graduate)
——No high school diploma 1.358*** 1.542*** ††† –1.045*** 1.252*** †††
——High school graduate .804*** .784*** .611*** .644***
——Some college .447*** .433*** .335*** .353***
Health measure recoded (0 = no) .333*** .587*** ††† .315*** .522*** †††
Log of family income .385*** .491*** †††
Intercept 1 3.534 4.083 .690 1.302
Intercept 2 1.910 2.488 2.343 2.926
Intercept 3 .182 .551 4.101 4.903
Pseudo R2.069 .078 .078 .088
N144044 975222 144044 975222
Notes: Two-tailed tests: *** p< .001; ** p< .01; * p< .05.
Two-tailed tests for group differences: ††† p< .001; †† p< .01; p< .05.
awaa indicates the tests for group differences between whites and African Americans.
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ences in self-rated health by marital status have
changed substantially over the past 32 years.
These findings suggest that the relative advan-
tage of the married over the never-married has
decreased for men but not for women, while
the relative advantage in self-rated health of the
married over the formerly-married (the di-
vorced, separated, and widowed) has increased.
Better health for the never-married. For
each race and gender group examined, we find
that the self-rated health of the never-married
improved over the past three decades.
Moreover, the gap between the married and the
never-married has steadily converged over time
for men but not for women, primarily because
never-married men report better health over
time. Our analysis further suggests that con-
vergence in self-rated health between the nev-
er-married and married resulted, in part, from
a relative decline in family income among the
married compared to the never-married for
whites but not for African Americans. In the
NHIS sample, the ratio of median family in-
come of married whites relative to never-mar-
ried whites decreased from 1.47 in 1972 to
1.33 in 2003. This is consistent with the con-
vergence hypothesis, which is partially based
on an argument about a decline in the econom-
ic benefits from marriage.
One of the traditional explanations (resource
model) for the benefits of marriage for health
is that marriage enhances mental health, which
then has positive effects on physical health
(Waite 1995). Future research should examine
whether improvement in the self-rated health
status of the never-married partly reflects im-
provement in the mental health of the never-
married relative to the married (Glenn and
Weaver 1988). We were unable to test this pos-
sibility with the NHIS data (no consistent mea-
sure of mental health in the NHIS from 1972 to
2003), but this is an important question for fu-
ture research seeking to explain changing
trends in marital status and health over time.
Future research should also consider the influ-
ence of changes in the social meaning of the
never-married status (perhaps more normative
and less stigmatizing over time), more access
to social resources (potential friends and sup-
port networks) of the never-married as the
ranks of the never-married have grown, and
changing selection processes for individuals
who remain in the never-married status.
Worse health for the previously-married.
The growing divergence in self-rated health
between the married and formerly-married is
primarily due to declines in self-rated health
among the formerly-married, and this decline,
especially among the widowed, is dramatic.
Consistent with previous studies on mortality
trends (e.g., Van Poppel and Joung 2001), we
find that the widowed exhibit the most precip-
itous declines in self-rated health over the 1972
to 2003 study period. The widowed were about
as likely as the married to report being in good
health in 1972, but the widowed were about 7
percent less likely than the married to report
being in good health in 2003. Although the
sickest divorced and widowed individuals are
least likely to remarry (Joung et al. 1998), re-
MARITAL STATUS AND HEALTH DIFFERENTIALS 19722003 249
FIGURE 3. Estimated Trends in Self-Rated Health by Marital Status and Race, 19722003
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marriage rates declined from 1970 to 1990
(U.S. Census Bureau 1999), thus one would ex-
pect that selection of the least healthy individ-
uals staying in divorce/widowhood (rather than
remarrying) would have diminished over time.
If this is the case, it is unlikely that selection of
the least healthy divorced/widowed individuals
away from remarriage would explain the his-
toric decline in health for the divorced or wid-
owed, although this selection process may be
relevant in explaining the relative improvement
in health for the remarried. One possibility is
that the widowed who are in poor health, with
serious chronic conditions and disabilities, are
living longer than ever before, and that this is a
type of selection effect. Even if this is the case,
it may be that the stress of widowhood leads to
greater health problems (then sustained over
time) for the widowed relative to their married
peers.
Recent research (Williams and Umberson
2004) suggests that the stress associated with
the transition out of marriage is primarily re-
sponsible for health declines among the for-
merly-married, but it is not clear why marital
dissolution (reflected in marital status in the
present study rather than as a transition event)
would be more detrimental to self-rated health
(that is, more of a stressor) now than in the
past. The growing gap in self-reported health
of the married and the formerly-married is un-
expected, based on predictions from the stress
model. Identifying the reasons for the growing
gap between the formerly-married and the
married is a research agenda that should be ac-
tively pursued because the implications for
population health are potentially serious. Self-
reported health is associated with morbidity,
disability, and mortality, and the present f ind-
ings suggest growing disparities between the
married and the formerly-married, especially
for the widowed and for women.
Gender
We find three noteworthy gender differences
in marital status/health trends that challenge
some long-held assumptions about gender and
the benefits of marriage for health. First, our
findings suggest that the self-rated health of
the married remained stable for men from 1972
to 2003 while it appears to have improved for
women. Second, while the apparent advantage
of the married over the never-married re-
mained stable for women over time, this ad-
vantage diminished for men. Third, the grow-
ing gap between the married and previously-
married in self-reports of health is even more
pronounced for women than men.
Since the early 1970s, sociologists have em-
phasized that marriage benefits the health of
men more than women and that marital disso-
lution undermines the health of men more than
women (Bernard 1972). We do not find that
men benefit more from marriage than do
women over time. We did f ind a wide gap be-
tween married and never-married men on self-
reported health in the 1970s. However, this gap
narrowed greatly over time, primarily because
of improvements in self-rated health among
never-married menwith relative stability in
self-reports of health among married men. On
the other hand, we find improvements in self-
reported health among married and never-mar-
ried women over the past 32 years, with a sta-
ble gap between the two groups. Moreover, al-
though marital dissolution appears to be more
strongly associated with lower self-reported
health for men than women in the 1970s, this
gender difference has diminished over time. A
similar conclusion is reached in research show-
ing that marriage benefits mental health equal-
ly for men and women in recent data sets
(Williams 2003).
Family scholars argue that women benefit
more from the material well-being offered by
marriage whereas men benefit more from the
social and emotional support and health regu-
lation offered by marriage (Waite 1995).
Future research should consider the possibility
that never-married men have greater access to
social resources and support that were, in the
past, found primarily in a spouse, or that previ-
ously-married women may have experienced a
greater decline in material well-being other
than family income (e.g., wealth, health insur-
ance). Indeed, the economic cost of marital dis-
solution for women has not lessened in spite of
increased opportunities for women outside of
marriage (Smock 1993).
Race
Among African Americans, all marital status
groups except for the widowed are more likely
to report being in good health over time. Our
results show that improvements in self-rated
health among African Americans largely re-
flect general advances in health among African
Americans in the United States over the past
few decades, even though overall levels of self-
rated health remain lower for African
250 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
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Americans than for whites. The most notewor-
thy race difference in marital status/health pat-
terns is that the convergence in self-rated
health of the never-married and married over
time is much more dramatic for African
Americans than for whites. Moreover, a rela-
tive decline in family income of the married
explains the modest convergence in self-rated
health between the married and never-married
for whites but not for African Americans.
Limitations
The repeated cross-sectional data that we
use in this study are a valuable resource for an-
alyzing historical trends in the association be-
tween marital status and health. These data in-
clude substantial numbers of individuals in
each marital status and cover a 32-year period.
However, these data are limited in important
ways, particularly in the absence of measures
that would allow us to test a range of mecha-
nisms that might help to explain the historical
trends that we identify. We were able to empir-
ically explore only one of the potential expla-
nationseconomic resourcesfor changing
trends in the association of marital status and
health. While economic resources are probably
the most frequently cited factor to explain the
benefits of marriage for health, we did not find
evidence that economic resources, at least as
measured in family income, provide much in
the way of explanation for changing marital
status and health trends. We caution, however,
that the measure of income in the NHIS is lim-
ited in important ways due to substantial cod-
ing changes (e.g., cut points and the total num-
ber of categories) from 1972 to 2003; and that
future research should further explore the role
of economic resources in explaining marital
status and health trends. Moreover, future re-
search should use other data sets that include
measures of socialpsychological factors such
as social support, mental health, marital quali-
ty, and marital status duration to assess the rel-
ative importance of other potential explana-
tions for changing trends in the link between
marital status and self-rated health over signif-
icant periods of time. Indeed, recent studies
suggest that marriage has become more impor-
tant as a source of support and network con-
nection (McPherson et al. 2006).
Although we control for sociodemographic
characteristics in the analysis, we cannot rule
out the possibility that selection processes play
a role in marital status/self-rated health trends.
In the context of rapid social change, the rela-
tive number of individuals selected into or out
of marriage changes, suggesting that selection
criteria may have changed over the past three
decades, and this may partly explain some of
the trends in health differences by marital sta-
tus. In fact, given the high probability of di-
vorce and the growing acceptance of divorce,
those who get and remain married (or remar-
ried) may be in better-quality marriages now
than in the past. This intensified process of se-
lection into marriage could be of relevance in
explaining the improved health of the married,
especially for African Americans and women.
Finally, the measure of self-rated health sta-
tus may pose unique problems for an analysis
of historical trends. Historical improvements in
medical technology, public health campaigns,
and personal knowledge about health may have
led individuals to be better informed about
their health status and, thus, provide more ac-
curate reports of health over time. The stan-
dards for classifying oneself as in good or bad
health may also have changed over time.
Despite these limitations, self-rated health is a
reliable and valid measure of health status
(Idler and Benyamini 1997), and our study is
valuable in informing us about changes in the
relationships between marital status and self-
rated health over time. In addition, it is unclear
why historical change in self-assessments of
health would vary systematically by marital
status. We are now examining trends in mor-
tality and activity limitations by marital status
in an effort to broaden our assessment of his-
torical change in marital status and a range of
health outcomes.
CONCLUSION
Politicians and scholars continue to debate
the value of marriage for Americans, with
some going so far as to establish social pro-
grams and policies to encourage marriage
among those social groups less inclined to
marry, particularly the poor and minorities.
Our findings highlight the complexity of this
issue. We find that self-rated health of never-
married men became increasingly similar to
that of the married men over time, suggesting
more minimal benefits of marriage for mens
health now than ever before, at least relative to
never marrying. In contrast, the self-rated
health of the widowed, divorced, and separated
worsened over time, relative to the married, in-
dicating growing social disparities between the
MARITAL STATUS AND HEALTH DIFFERENTIALS 19722003 251
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married and the formerly-married, especially
for women. It behooves scholars and politi-
cians to consider the growing gap between the
previously-married, especially the widowed,
and the married in efforts to promote popula-
tion health. Moreover, convergence in self-rat-
ed health between the never-married and mar-
ried (especially for men) has important impli-
cations for current policies designed to en-
courage marriage. These policies are based, in
part, on the assumption that marriage provides
a haven in a heartless world, a haven that pro-
tects health in our mobile society (Lasch 1977;
Waite and Gallagher 2000). However, our re-
sults show that the self-rated health status of
the never-married has improved for all race and
gender groups examined, and it is more similar
to the married for men now than ever before,
which suggests that encouraging marriage in
order to promote health may be misguided. In
fact, getting married increases ones risk for
eventual marital dissolution, and marital disso-
lution seems to be worse for self-rated health
now than at any point in the past three decades.
NOTE
1. The more rapid improvement in self-rated
health among African Americans compared
to whites may have occurred because the
probability of reporting good health was al-
ready high for whites at the beginning of the
study period and there was not much room
for improvement. This ceiling effect is es-
pecially likely among married whites.
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252 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
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Tue, 12 Aug 2008 15:53:45
Hui Liu is assistant professor of sociology at the Michigan State University. Her research examines how
social factors are related to health, health behavior, and mortality. Her recent interests focus on historical
changes in the relationships between health outcomes and social factors such as marital status and educa-
tion. She also conducts methodological work on modeling over-dispersed count data.
Debra Umberson is professor of sociology and a faculty associate in the Population Research Center at the
University of Texas at Austin. Her research focuses on relationships and health across the life course. Her
current research, supported by the National Institute on Aging, considers how different types of relation-
ships influence health behaviors over the life course.
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... Thus, the higher commitment of marriage may reduce life uncertainty and increase general well-being, which could then have positive effects on health (Liu and Umberson 2008). ...
... Men and women may receive different benefits from being in a cohabiting partnership or marriage (Liu and Umberson 2008). Previous studies have argued that marriage provides men with more social support and control of their behavior, thereby positively influencing their health. ...
... Our results corroborate previous studies which find a strong association between marriage and positive health outcomes in these countries (e.g. Umberson 2008, Grundy andTomassini 2010 However, the findings are not necessarily the same for men and women; the Australian and UK results suggest that the association between marriage and health can vary by gender, as found in other studies (Liu and Umberson 2008). In Australia, any economic benefits that may have positively affected married women's health appear to have diminished, while health benefits to marriage for men seem to remain, at least before additional controls. ...
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Research Proposal
Extensive research has found that marriage provides health benefits to individuals. The rise of cohabitation, however, raises questions about whether simply being in an intimate co-residential partnership conveys the same health benefits as marriage. Here we use OLS regression to compare differences between cohabitation and marriage with respect to self-rated health in mid-life, an understudied part of the lifecourse. We pay particular attention to selection mechanisms arising in childhood to investigate how early life conditions shape later life outcomes. We compare results in five countries with different social, economic, and policy contexts. Results show no differences in self-rated health between cohabiting and married people in Norway, Germany, and for Australian women. In the U.K, and U.S., and for Australian men, however, marriage is significantly associated with better health. Much of this association disappears when accounting for childhood disadvantage and union duration in the U.S., Australia, and for British women, but differences persist for British men. Our study indicates that early life conditions can be an important source of selection for explaining marriage benefits, and that policy makers should focus on reducing disadvantage in childhood rather than legislating incentives to marry in adulthood., all rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including  notice, is given to the source.
... For women, cognitive decline was associated with living with adult children, living with spouse and adult children and living with others, but not related to living alone. Women are usually in charge of household affairs and family activities and are more likely to provide physical care and emotional support to their spouses, which could protect the cognitive function of their male partners [59][60][61]. Correspondingly, women may be able to live alone in old age as a result of their life experience managing a household. Also, women tend to enjoy more extensive social networks than men through their participation in social activities and intimate friendships [62,63], which likely compensates for the loneliness and the lack of intimacy of older women living alone. ...
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Article
Abstract Background Living arrangements are critical to the survival and well-being of older people, especially in China where the filial piety culture demands adult children care for and serve their parents. The study aimed to explore the association between living arrangements and cognitive decline among older people in China. Methods Participants included 6,074 older adults over 60 years old (49.65% male, mean age 67.2 years [range 60–98]) from four waves (2011–2018) of the China Health and Retirement Longitudinal Study. Two to four assessments were conducted over a follow-up of an average of 5.3 years (range, 2–7). Cognitive function was assessed using an adapted Chinese version of Mini-Mental State Examination (MMSE). Living arrangements were classified as follows: living alone, living with spouse, living with adult children, living with spouse and adult children and living with others. Multilevel models were used to investigate the relationship between living arrangements and cognitive decline, as well as the gender difference. Results As the main type of living arrangements of the study participants (44.91%), living with spouse was taken as the reference group. Compared to the reference group, living alone (β=-0.126, P
... Economic resources may enhance health by improving nutrition, providing care in the event of illness, and allowing the purchase of medical care or other health-enhancing resources (Waite & Gallagher, 2000). In terms of social and psychological resources, a marital relationship increases access to social support (i.e., providing love, advice, and care), social integration (i.e., feeling connected to others), and social control of health behaviors (i.e., the deliberate efforts of others to control one's health and health behaviors) -all factors that may promote health and well-being (Liu & Umberson, 2008). ...
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Article
Background Widowhood, a marital status that disproportionately affects older women, has been associated with poorer health compared to married individuals. However, relatively little is known about the association between widowhood in later-life and cognitive health in low- and middle-income countries. Methods To address this research gap, we used data from the Longitudinal Aging Study in India (2017–19) to investigate the widowhood disparity in cognitive health among mid-aged and older women in India, including how this relationship varies by the duration of widowhood. We further examined the extent to which economic, social, and health conditions mediate this association. Results Cognition scores for widowed women were on average lower by almost 0.1 standard deviations compared to married women. Overall, this disparity increased with widowhood duration, with non-linearities in this association. The disparity in cognition scores increased with widowhood duration up to twenty years but did not increase further among those with longer widowhood duration. Worse physical and mental health were found to mediate almost thirty percent of the total association between widowhood and cognition. These mediators were most useful in explaining the association between lower cognition and widowhood among women who experienced widowhood for ten years or longer. Conclusion The study highlights the significant disadvantage in cognitive functioning among older widowed women in India. The study also provides evidence on potential mediators, suggesting differential effects of mediators at different stages of widowhood.
... The relationship of differential marital status with health has been a subject of discussion for a long time [1][2][3][4]. Numerous approaches and methods have been used to evaluate the association between marital status and health, eventually developing two major schools of opinion. ...
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Article
Background The link between marital status and health differences has long been a topic of debate. The substantial research on marriage and health has been conducted under two important hypotheses: marital protection and marriage selection. While the majority of evidence on the marriage-health relationship using these hypotheses comes from developed countries, there is a lack of evidence from Asia, particularly from India. Objectives The current study examines theoretical frameworks of marriage i.e., marital protection and marriage selection in the Indian setting concurrently, bringing substantial empirical evidence to explore the link between marriage and health, considering this subject in the context of self-reported health (SRH). Secondly, this study will aid in investigating age and gender differences in marriage and health. Methods Using the Study on Global AGEing and Adult Health (SAGE), a cohort study of individuals aged 50 years and older with a small section of individuals aged 18 to 49 for comparative reasons, the present study population was 25 years and above individuals with complete marital information. Logistic regressions were employed to explore the connection between marital status and self-reported health. In the marriage protection hypothesis, the follow-up poor SRH was the dependent variable, whereas the initial unmarried status was the independent variable. For the marriage selection effects, initial poor SRH as the independent variable and follow-up unmarried status as the dependent variable had considered. Results Examining the marital protection hypothesis, the initial unmarried status (OR: 2.14; CI at 95%: 1.17, 3.92) was associated with the followed-up SRH transition from good to poor between 2007 and 2015 for young men, while initial unmarried status was linked with a lower likelihood of stable good SRH and a higher likelihood of stable poor SRH status across all age categories among women. Focusing on the marriage selection hypothesis, among young men, a significant association exists between the initial poor SRH and departure in marital status from married to unmarried. Young women with initial poor SRH (OR: 0.68; CI at 95%: 0.40, 1.00) had lower odds of stable married. In comparison, women with initially poor SRH, irrespective of age, were more likely to have higher odds of being stably unmarried. Conclusion Marriage indeed protects health. There are also shreds of evidence on health-selected marital status in India. Taken together, the aspect of marital protection or marriage selection is gender and age-specific in India. The findings contribute to a more comprehensive understanding of the relationship between marriage and health, which may have significant implications for health-related public policies aimed at unmarried women.
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While prior studies have examined sleep across the lifecourse, few studies have investigated sleep around the birth of a child, one of the most important events to cause sleep deprivation. This study investigates changes in sleep hours and quality, paying attention to differences by gender and partnership status. Using the UK Household Longitudinal Study, we follow approximately 1,000 participants as they transition into parenthood in a three-year window. We use OLS and logistic regression to analyze changes in sleep hours and sleep quality. Results suggest that women’s sleep is reduced by an average of 0.7 hours (42 minutes) on becoming a mother. Whilst before parenthood women sleep more than men, after childbirth women and men sleep similar amounts. Cohabiting men experience a greater reduction in sleep by around 0.5 hours (30 minutes) than married men, to the level similar to women, suggesting that new cohabiting fathers may experience more sleep disturbances.
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