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

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

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? • Selection Healthy people are more likely to marry and stay married than unhealthy people • Causality • Married people have healthier behaviour because they… • are cared for and corrected by their partner; • feel the obligation of being a healthy spouse/parent; • 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 • Those who live alone are more likely to die than those who live with others. • Unmarried adults (never married, divorced or widowed) who live with others are no more likely to die than married adults who live with others. • Living with other adults is more protective than living with children. • 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

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

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 Definitions

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

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

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. Source: ONS Longitudinal Study of England and Wales

H3: Living with other adults is more protective than living with children. Source: ONS Longitudinal Study of England and Wales

H4: Living arrangement in the past influences current health. Source: ONS Longitudinal Study of England and Wales

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 • 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. • 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).

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