Marital status,health and mortality

Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual's health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual's transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual's life course rather than simply focussing at one stage of the life course.     

Self-rated health, subjective social status, and middle-aged mortality in a changing society

In this study, the authors examined the relationships between self-rated health and subjective and objective socioeconomic status (as measured by income and education) in relation to middle-aged mortality differences in men and women across 20 counties in Hungary through a cross-sectional, ecological study. The authors interviewed 12,643 people in a Hungarostudy 2002 survey, profiling the Hungarian population according to gender, age, and county. They found that mean self-rated health and self-rated disability at the county level were significantly associated with middle-aged mortality differences among counties, with male mortality more closely associated with self-rated health. The authors also noted that self-rated health and socioeconomic status of the opposite gender were significantly associated with middle-aged mortality, but the strength of the association differed by gender. Finally, male middle-aged mortality was more strongly connected to female subjective and objective social status than female mortality was connected with male social status.     

Informal care,health and mortality

Informal care provision is an activity in which individuals are increasingly likely to become involved across their life course, and particularly in later life, as a result of demographic changes such as increasing longevity and changes in co-residential living arrangements in later life. Academic research so far has highlighted the adverse impact of informal care provision on the financial position of the carer, however, the evidence on the impact of informal care provision on the carer's physical, mental and emotional health, and on their mortality, presents a more complex picture. This paper reviews research from the UK and beyond on the provision of informal care and its subsequent impact on health and mortality outcomes. Two key findings emerge from this review paper. Firstly, the cross-sectional analysis of data shows mixed associations between informal care provision and poor health outcomes for the carer. Such research highlights the importance of the demographic and socio-economic characteristics of the carer and the person cared for, and of the specific characteristics and nature of the care provided (e.g. duration, level). Secondly, longitudinal analysis, which typically benefits from a longer timeframe to follow up the impact of caring, shows that although informal care provision is not per se associated with adverse health and mortality outcomes, nevertheless particular types and durations of caring have shown negative outcomes.     

Subjective health status as a determinant of mortality among African-American elders.

This study examines the efficacy of self-rated health as a determinant of 6-year survival among the 1209 African-American respondents in the Longitudinal Study on Aging (LSOA). The association between self-rated health and mortality risk has been established previously; however, this relationship has not been directly tested in a nonwhite sample. Findings indicate that self-rated health is a predictor of mortality that is independent of several control variables (income, sex, age, education, and marital status) and two objective health status indicators (bed days and doctor visits). However, it is not independent of limitations with activities of daily living. When all three objective health measures were included in a single model, self-rated health was not an independent predictor of mortality. However, when the full model was specified on sex-specific subsamples, the analysis found that self-rated health was an independent predictor of mortality for women, but not for men.     

Marital status and variability in cortisol excretion in postmenopausal women

Based on the premise that acute and chronic stresses stimulate and suppress cortisol secretion, respectively, and the hypothesis that marriage provides a buffer to stress, we tested whether extreme values of serum cortisol concentrations would be less likely in married women than in unmarried women. Three hundred women were recruited from two central Connecticut communities. Cortisol was measured in overnight urine samples using liquid chromatography-tandem mass spectrometry. Information on each subject's demographic characteristics, such as income and education level was collected. Mean log urinary cortisol was virtually identical in married and unmarried women, however, as predicted, the variance was significantly larger in the unmarried group (p=0.01). After adjustment for potential confounders, multivariate logistic regression still revealed that absolute deviation of log(10) cortisol from the mean was smaller for married versus unmarried women (p<0.01); deviation from the mean cortisol was also higher for non-working than working women. These results support the idea that marriage and employment reduce the extreme levels of cortisol secretion, and by extension, this may reflect differences in levels of stress in married and in working women compared to unmarried and non-working women.     

Labour market status, insecurity and health

Workplace closure results in unselective unemployment. This unique feature has enabled studies of workplace closure to make a significant contribution to knowledge about the effect of unemployment on health. A review of recent longitudinal, controlled studies of workplace closure documents their contribution to this knowledge. It also identifies a number of methodological problems and the scarcity of data on white- collar workers and gender differences. Results are presented from a study of the health effects of job insecurity, change and loss among white- collar men and women which was able to address some of the methodological disadvantages of previous studies.     

Coping style,cognitive hardiness,and health status

This study investigates the effects of coping style and cognitive hardiness on physical and psychological health status. Measures of coping styles (intrusive positive thoughts, intrusive negative thoughts, avoidance, problem-focused coping), cognitive hardiness, stress, health habits, psychological distress, and physical illness were collected for 194 professional employees. Multiple regression analyses revealed that intrusive negative thoughts and avoidance coping approaches significantly contributed to predictions of psychological distress and physical illness outcomes, respectively. Cognitive hardiness significantly contributed to predictions of psychological distress but not physical illness outcomes. Health habits were significantly related to both measures of health status. Two coping approaches, intrusive positive thoughts and problem-focused coping, did not significantly contribute to predictions of either physical or psychological health status.     

Marital status and age at natural menopause: Considering pheromonal influence

Married women generally report a later mean age at menopause. The results reported here, from a study carried out in Greene County, New York, are no exception. Married and widowed women report a later mean age at natural menopause compared to single and divorced women (P < 0.05). To better understand the relationship between marital status and age at menopause, possible mechanistic and confounding variables are examined, in particular parity, sexual activity, smoking habits, level of education, and income. Parity and income 10 years prior to interview are significant factors, along with marital status, that explain part of the variation in age at natural menopause. An alternative explanation is the pheromonal influence of a male in the household. This would explain the consistency of results across populations. This pilot study supports further biochemical investigation. Am. J. Hum. Biol. 13:479–485, 2001. © 2001 Wiley‐Liss, Inc.     

Legal status, emotional well-being and subjective health status of Latino immigrants

Among the many stresses that undocumented Latino immigrants experience, worries about their legal status and preoccupation with disclosure and deportation can heighten the risk for emotional distress and impaired quality of health. To better document these effects, this study examined the relationship between deportation concern and emotional and physical well-being among a group of Latino immigrants in a midwestern city. One-hundred-forty-three persons were recruited through community sources. Fifty-six participants (39%) expressed concern with seeking services for fear of deportation, while 87 did not endorse this concern. Measures of emotional distress, Hispanic immigrant stress and subjective health status were administered. Results indicate that Latino immigrants with concerns about deportation are at heightened risk of experiencing negative emotional and health states (particularly anger), Hispanic immigrant stress associated with extrafamilial factors and substandard health status. Findings inform policymakers of culturally relevant stressors of undocumented Latino immigrants that help to create and perpetuate the health and mental health disparities of this group.     

Marital psychological and physical aggression and children's mental and physical health: direct, mediated, and moderated effects

Relations between marital aggression (psychological and physical) and children's health were examined. Children's emotional insecurity was assessed as a mediator of these relations, with distinctions made between marital aggression against mothers and fathers and ethnicity (African American or European American), socioeconomic status, and child gender examined as moderators of effects. Participants were 251 community-recruited families, with multiple reporters of each construct. Aggression against either parent yielded similar effects for children. Children's emotional insecurity mediated the relation between marital aggression and children's internalizing, externalizing, and posttraumatic stress disorder symptoms. No differences were found in these pathways for African American and European American families or as a function of socioeconomic status or child gender.     

Measures of racial/ethnic health disparities in cancer mortality rates and the influence of socioeconomic status

OBJECTIVES: In the 1990s, U.S. cancer mortality rates declined due to reductions in tobacco use among men and beneficial cancer interventions, such as mammography and Pap smears. We examined the cancer rates by racial/ethnic group, socioeconomic status and time period to identify disparities underlying the overall mortality trend. METHODS: We examined racial/ethnic disparities by measuring excess cancer burden [rate ratio (RR) and ratio differences (RD)] and trends in their cancer rates for nine cancer sites. The trend (T) is calculated as a ratio of the average annual cancer mortality rate for 1995-2000 relative to the rate for 1990-1994 for three levels of poverty (counties with <10% living below the poverty level, 10% - <20% and > or =20%) for the major racial/ethnic populations. We also compared the trend for each racial/ethnic SES group to the trend for lowest SES white group (TD). RESULTS: Blacks have RR disparities relative to whites for each cancer site examined, except for female lung cancer, while the other minorities had RR disparities for cervical cancer (RR>1). There are increases in RR disparities from 1990-1994 to 1995-2000 (RD>0) for colorectal cancer, prostate cancer and breast cancer for each racial/ethnic minority. Whites and blacks had declining trends for every SES group (T<1) and positive high SES gradients (the highest SES group had the best trend and the lowest SES group had the worst trend) at each cancer site, except female lung cancer (T>1). In contrast, American Indians/Alaska natives, Hispanics and Asians/ Pacific Islanders had increasing trends for some of their cancer sites, and their trends did not have the SES gradients. CONCLUSIONS: Increases in racial/ethnic disparities (RD>0) for colorectal, breast and prostate cancer were largest in the lowest SES groups. At some cancer sites, the highest SES group for minorities had worse trend results than the trends for the lowest SES white group (TD>0).