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Sharma S, Hale JM, Myrskylä M, Kulu H. Cognitive impairment and partnership status in the United States, 1998-2016, by sex, race/ethnicity, and education. POPULATION STUDIES 2024; 78:167-177. [PMID: 36812934 DOI: 10.1080/00324728.2023.2174267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/05/2022] [Indexed: 02/24/2023]
Abstract
Cognitively impaired adults without a partner are highly disadvantaged, as partners constitute an important source of caregiving and emotional support. With the application of innovative multistate models to the Health and Retirement Study, this paper is the first to estimate joint expectancies of cognitive and partnership status at age 50 by sex, race/ethnicity, and education in the United States. We find that women live a decade longer unpartnered than men. Women are also disadvantaged as they experience three more years as both cognitively impaired and unpartnered than men. Black women live over twice as long as cognitively impaired and unpartnered compared with White women. Lower-educated men and women live around three and five years longer, respectively, as cognitively impaired and unpartnered than more highly educated men and women. This study addresses a novel facet of partnership and cognitive status dynamics and examines their variations by key socio-demographic factors.
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Affiliation(s)
- Shubhankar Sharma
- Max Planck Institute for Demographic Research
- University of St Andrews
| | - Jo Mhairi Hale
- Max Planck Institute for Demographic Research
- University of St Andrews
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research
- University of Helsinki
- Max Planck - University of Helsinki Center for Social Inequalities in Population Health
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Kulu H, Mikolai J, Franke S. Partnership Status, Health, and Mortality: Selection or Protection? Demography 2024; 61:189-207. [PMID: 38226410 DOI: 10.1215/00703370-11147861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Married individuals have better health and lower mortality than nonmarried people. Studies show that when cohabitants are distinguished from other nonmarried groups, health differences between partnered and nonpartnered individuals become even more pronounced. Some researchers have argued that partnered individuals have better health and lower mortality because a partnership offers protective effects (protection); others have posited that partnered people have better health and lower mortality because healthy persons are more likely to form a union and less likely to dissolve it (selection). This study contributes to this debate by investigating health and mortality by partnership status in England and Wales and analyzing the causes of mortality differences. We use combined data from the British Household Panel Survey and the UK Household Longitudinal Study and apply a simultaneous-equations hazard model to control for observed and unobserved selection into partnerships. We develop a novel approach to identify frailty based on self-rated health. Our analysis shows that partnered individuals have significantly lower mortality than nonpartnered people. We observe some selection into and out of unions on unobserved health characteristics, but the mortality differences by partnership status persist. The study offers strong support for the marital protection hypothesis and extends it to nonmarital partnerships.
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Affiliation(s)
- Hill Kulu
- Centre for Population Change, and School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Júlia Mikolai
- Centre for Population Change, and School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Sebastian Franke
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
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Lindström M, Pirouzifard M, Rosvall M, Fridh M. Marital status and cause-specific mortality: A population-based prospective cohort study in southern Sweden. Prev Med Rep 2024; 37:102542. [PMID: 38169998 PMCID: PMC10758969 DOI: 10.1016/j.pmedr.2023.102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
The aim was to investigate associations between marital status and mortality with a prospective cohort study design. A public health survey including adults aged 18-80 was conducted with a postal questionnaire in southern Sweden in 2008 (54.1% participation). The survey formed a baseline that was linked to 8.3-year follow-up all-cause, cardiovascular (CVD), cancer and other cause mortality. The present investigation entails 14,750 participants aged 45-80. Associations between marital status and mortality were investigated with multiple Cox-regression analyses. A 72.8% prevalence of respondents were married/cohabitating, 9.1% never married, 12.2% divorced and 5.9% widows/widowers. Marital status was associated with age, sex, socioeconomic status (SES) by occupation, country of birth, chronic disease, Body Mass Index (BMI), health-related behaviors and generalized trust covariates. Never married/single, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than the reference category married/cohabitating men throughout the multiple analyses. For men, CVD and other cause mortality showed similar significant results, but not cancer. No significant associations were displayed for women in the multiple analyses. Associations between marital status and mortality are stronger among men than women. Associations between marital status and cancer mortality are not statistically significant with low effect measures throughout the multiple analyses among both men and women.
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Affiliation(s)
- Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
| | - Mirnabi Pirouzifard
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
- Department of Community Medicine and Public Health, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Sweden
| | - Maria Fridh
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö and Centre for Primary Health Care Research, Lund University, S-205 02 Malmö, Sweden
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Vésier C, Urban A. Gender inequalities in heat-related mortality in the Czech Republic. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023:10.1007/s00484-023-02507-2. [PMID: 37428233 PMCID: PMC10386945 DOI: 10.1007/s00484-023-02507-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/22/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023]
Abstract
It is acknowledged that climate change exacerbates social inequalities, and women have been reported as more vulnerable to heat than men in many studies in Europe, including the Czech Republic. This study aimed at investigating the associations between daily temperature and mortality in the Czech Republic in the light of a sex and gender perspective, taking into account other factors such as age and marital status. Daily mean temperature and individual mortality data recorded during the five warmest months of the year (from May to September) over the period 1995-2019 were used to fit a quasi-Poisson regression model, which included a distributed lag non-linear model (DLNM) to account for the delayed and non-linear effects of temperature on mortality. The heat-related mortality risks obtained in each population group were expressed in terms of risk at the 99th percentile of summer temperature relative to the minimum mortality temperature. Women were found generally more at risk to die because of heat than men, and the difference was larger among people over 85 years old. Risks among married people were lower than risks among single, divorced, and widowed people, while risks in divorced women were significantly higher than in divorced men. This is a novel finding which highlights the potential role of gender inequalities in heat-related mortality. Our study underlines the relevance of including a sex and gender dimension in the analysis of the impacts of heat on the population and advocates the development of gender-based adaptation policies to extreme heat.
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Affiliation(s)
- Chloé Vésier
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamycka 129, 165 00, Prague, Czech Republic.
| | - Aleš Urban
- Faculty of Environmental Sciences, Czech University of Life Sciences, Kamycka 129, 165 00, Prague, Czech Republic
- Institute of Atmospheric Physics of the Czech Academy of Sciences, Boční II 1401, 141 00, Prague, Czech Republic
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Zhao J, Law CK, Kelly M, Yiengprugsawan V, Seubsman SA, Sleigh A. How do cohabitation and marital status affect mortality risk? Results from a cohort study in Thailand. BMJ Open 2022; 12:e062811. [PMID: 36123057 PMCID: PMC9486337 DOI: 10.1136/bmjopen-2022-062811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the relationship between baseline union status (ie, including marriage and cohabitation) and mortality, paying attention to gender differentials, through an 11-year follow-up of a large cohort in Thailand. DESIGN Cohort data from Thai Cohort Study (TCS) were linked official death records over an 11-year follow-up period. SETTING Community-based adults in Thailand. PARTICIPANTS 87 151 Thai adults participated in TCS cohort. METHOD Cox regression models measured longitudinal associations between union status and 11-year mortality. RESULTS From 2005 (baseline) to 2016, persons who cohabited and lived with a partner, married persons but not living with a partner and separated/divorced/widowed people were more likely to die compared with those married and living together with a partner. Those who did not have good family support had a higher death risk than those having good family support.Single or cohabiting women had higher risks of mortality than women who were married and living together with a partner throughout follow-up, while separated/divorced/widowed men had higher risks of mortality than counterpart males. CONCLUSIONS Our study reveals the protective effect of marriage and living together on mortality in Thailand, an understudied setting where institutionalisation of cohabitation is low leading to a limited mortality protection. Public policies for moderating mortality should thus be gender nuanced, culturally and institutionally specific. Also, we demonstrate that in settings such as Thailand, where marital status is not always defined in the same way as in western cultures, the need to measure cohabitation in locally relevant terms is important.
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Affiliation(s)
- Jiaying Zhao
- School of Demography, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Chi Kin Law
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Kelly
- Department of Global Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Vasoontara Yiengprugsawan
- Australian Research Council Centre of Excellence on Population Ageing Research, Business School, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Adrian Sleigh
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Davidsen K, Carstensen S, Kriegbaum M, Bruunsgaard H, Lund R. Do partnership dissolutions and living alone affect systemic chronic inflammation? A cohort study of Danish adults. J Epidemiol Community Health 2022; 76:jech-2021-217422. [PMID: 35012967 DOI: 10.1136/jech-2021-217422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Partnership breakups and living alone are associated with several adverse health outcomes. The aim of this study, carried out in Denmark, is to investigate whether accumulated numbers of divorces/partnership breakups or years lived alone across 26 years of adult life are associated with levels of inflammation, and if vulnerability with regards to gender or educational level can be identified. METHODS 4835 participants from the Copenhagen Aging and Midlife Biobank (CAMB) aged 48-62 years were included. Data on accumulated numbers of partnership breakups and years living alone were retrieved from a national standardised annual register. Inflammatory markers interleukin 6 (IL-6) and high sensitivity C-reactive protein (hsCRP) were measured in blood samples. Multivariate linear regression analyses were adjusted for age, educational level, early major life events, body mass index, chronic diseases, medicinal intake affecting inflammation, acute inflammation and personality scores. RESULTS For men, an association was found between an increasing number of partnership breakups or number of years living alone and higher levels of inflammatory markers. No such association was found for women, and no evidence of partnership breakups and educational level having a joint effect was found for either gender. CONCLUSION The findings suggest a strong association between years lived alone or accumulated number of partnership breakups and low-grade inflammation for middle-aged men, but not for women. Among those of either sex with a lower level of education, no specific vulnerability to accumulated years lived alone or number of breakups was identified.
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Affiliation(s)
- Karolina Davidsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Simon Carstensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Bruunsgaard
- Department of Clinical Immunology; Centre of Inflammation and Metabolism; Centre for Physical Activity Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rikke Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Social Medicine, Department of Public Helath, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Kobenhavn, Denmark
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Abell JG, Steptoe A. Why is living alone in older age related to increased mortality risk? A longitudinal cohort study. Age Ageing 2021; 50:2019-2024. [PMID: 34304269 PMCID: PMC8675439 DOI: 10.1093/ageing/afab155] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Living alone has been associated with increased mortality risk, but it is unclear whether this is a result of a selection effect or the impact of stressful life changes such as widowhood or divorce leading to changes in living arrangements. We therefore examined the association between living alone, transitions in living arrangements and all-cause mortality. METHOD We analysed data from 4,888 individuals who participated in both wave 2 (2004-2005) and wave 4 (2008-2009) of the English Longitudinal Study of Ageing. Transitions in living arrangements over this period were identified. Mortality status was ascertained from linked national mortality registers. Cox proportional hazards analysis was used to examine the association between living alone and mortality over an average 8.5 year follow-up period. RESULTS An association was found between living alone at wave 4 and mortality (hazard ratio (HR): 1.20, 95% CI 1.04-1.38) in a model adjusted for multiple factors including socioeconomic status, physical health, health behaviours and loneliness. We also found that participants who moved to living alone after divorce or bereavement had a higher risk of mortality compared with those who lived with others at both time points (HR: 1.34, 95% CI 1.01-1.79), while those who moved to living alone for other reasons did not show an increased mortality risk. CONCLUSIONS The relationship between living alone and mortality is complicated by the reasons underlying not living with others. A greater understanding of these dynamics will help to identify the individuals who are at particular health risk because of their living arrangements.
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Affiliation(s)
- Jessica G Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
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Alnakhi WK, Mamdouh H, Hussain HY, Ibrahim GM, Ahmad AS, Ali R, Abdulle A. The Socio-Demographic Characteristics Associated with Non-Communicable Diseases among the Adult Population of Dubai: Results from Dubai Household Survey 2019. Healthcare (Basel) 2021; 9:1139. [PMID: 34574913 PMCID: PMC8471096 DOI: 10.3390/healthcare9091139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading causes of death worldwide. In the UAE, NCDs account for nearly 77% of all deaths. There is limited empirical research on this topic in the UAE. We aimed to examine the association of non-communicable diseases and the sociodemographic characteristics among the adult population of Dubai. METHODS The study used secondary data from the Dubai Household Health Survey (DHHS), 2019. DHHS is a cross-sectional complex design, stratified by geographic area, and uses multistage probability sampling. In this survey, 2247 families were interviewed and only adults aged 18+ were included for the analysis. The quasi-binomial distribution was used to identify the socio-demographic characteristics association with NCDs. RESULTS The prevalence of NCDs among the adult population of Dubai was 15.01%. Individuals aged 60+, local Arabs (Emirati), divorced and widowed individuals, and individuals who were not currently working reported NCDs more than the other groups. In the regression analysis, the association with NCDs were reported among elderly people, males, unmarried individuals, older individuals who are unmarried, and Emiratis. CONCLUSION The study identified several socio-demographic characteristics associated with reporting NCDs. This is one of the few studies related to NCDs in Dubai. Allocating appropriate resources to the population groups identified is crucial to reduce the incidence of NCDs in the Emirate.
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Affiliation(s)
- Wafa K. Alnakhi
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Heba Mamdouh
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
- Department of Family Health, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt
| | - Hamid Y. Hussain
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
| | - Gamal M. Ibrahim
- Department of Data Analysis, Research and Studies Department, Dubai Health Authority, Dubai 7272, United Arab Emirates; (H.M.); (H.Y.H.); (G.M.I.)
- High Institute for Management Sciences, Belqas 35631, Egypt
| | - Amar Sabri Ahmad
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates; (A.S.A.); (R.A.); (A.A.)
| | - Raghib Ali
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates; (A.S.A.); (R.A.); (A.A.)
| | - Abdishakur Abdulle
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates; (A.S.A.); (R.A.); (A.A.)
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Hale JM, Bijlsma MJ, Lorenti A. Does postponing retirement affect cognitive function? A counterfactual experiment to disentangle life course risk factors. SSM Popul Health 2021; 15:100855. [PMID: 34258375 PMCID: PMC8255239 DOI: 10.1016/j.ssmph.2021.100855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/31/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022] Open
Abstract
Evidence suggests that contemporaneous labor force participation affects cognitive function; however, it is unclear whether it is employment itself or endogenous factors related to individuals’ likelihood of employment that protects against cognitive decline. We exploit innovations in counterfactual causal inference to disentangle the effect of postponing retirement on later-life cognitive function from the effects of other life-course factors. With the U.S. Health and Retirement Study (1996–2014, n = 20,469), we use the parametric g-formula to estimate the effect of postponing retirement to age 67. We also study whether the benefit of postponing retirement is affected by gender, education, and/or occupation, and whether retirement affects cognitive function through depressive symptoms or comorbidities. We find that postponing retirement is protective against cognitive decline, accounting for other life-course factors (population: 0.34, 95% confidence interval (CI): 0.20,0.47; individual: 0.43, 95% CI: 0.26,0.60). The extent of the protective effect depends on subgroup, with the highest educated experiencing the greatest mitigation of cognitive decline (individual: 50%, 95% CI: 32%,71%). By using innovative models that better reflect the empirical reality of interconnected life-course processes, this work makes progress in understanding how retirement affects cognitive function. Research is inconclusive as to employments' protection against cognitive decline. Causal inference models can better reflect interconnected life-course processes. The parametric g-formula shows a substantial protective effect of ongoing employment. Protective effect holds for all subgroups, but is greatest for the highest educated.
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Affiliation(s)
- Jo Mhairi Hale
- School of Geography and Sustainable Development, University of St Andrews, Scotland, UK.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Maarten J Bijlsma
- Max Planck Institute for Demographic Research, Rostock, Germany.,Groningen Research Institute of Pharmacy, Unit Pharmacotherapy, Epidemiology & Economics (PTEE), University of Groningen, The Netherlands
| | - Angelo Lorenti
- Max Planck Institute for Demographic Research, Rostock, Germany
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Partnership and mortality in mid and late life: Protection or selection? Soc Sci Med 2021; 279:113971. [PMID: 33984691 DOI: 10.1016/j.socscimed.2021.113971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/21/2021] [Accepted: 04/24/2021] [Indexed: 11/22/2022]
Abstract
The main goal of this paper is to address how different partnership statuses impact the likelihood of death among mature adults and elderly persons in Spain circa 2012 using a massive new dataset of administrative registers linked to census data. First, gross and net effects of having a partner on mortality risks of partnered and non-partnered persons are evaluated; then the characteristics and the importance of selection and protection effects of marriage and partnership with regard to the likelihood of death are assessed. We make use of exact matching methods in order to avoid the selection bias associated with the non-random assignment of persons to different partnership statuses. Protection effects decline gradually with age, but always remain positive. Selection effects show a far more pronounced decline with age leading to a pattern in which selection is much stronger than protection during the mature adult ages, but then disappear entirely and even become negative as people age. While both sexes show similar patterns, the protection effect is slightly higher among men while the selection effect is much higher among women, especially before 65 years of age.
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Patterson SE, Margolis R, Verdery AM. Family embeddedness and older adult mortality in the United States. POPULATION STUDIES 2020; 74:415-435. [PMID: 33016247 PMCID: PMC7642151 DOI: 10.1080/00324728.2020.1817529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Do different operationalizations of family structure offer different understandings of the links between family structure and older adult mortality? Using the American Health and Retirement Study (N = 29,665), we examine mortality risks by three measures of family structure: whether respondents have different family statuses (e.g. married vs. unmarried), volume of family members available (e.g. having one vs. two living immediate family members), and family embeddedness (e.g. having neither spouse nor child vs. having spouse but no child). We focus on three kin types: partner/spouse, children, and siblings. We find that differences in empirical estimates across measures of family structure are not dramatic, but that family embeddedness can show some additional heterogeneity in mortality patterns over family status variables or the volume of ties. This paper tests different ways of operationalizing family structure to study mortality outcomes and advances our understanding of how family functions as a key social determinant of health.
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12
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Trends in living arrangements and their impact on the mortality of older adults: Belgium 1991‒2012. DEMOGRAPHIC RESEARCH 2020. [DOI: 10.4054/demres.2020.43.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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13
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Zueras P, Rutigliano R, Trias-Llimós S. Marital status, living arrangements, and mortality in middle and older age in Europe. Int J Public Health 2020; 65:627-636. [PMID: 32350551 PMCID: PMC7360666 DOI: 10.1007/s00038-020-01371-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We study the role of marital status and living arrangements in mortality among a 50+ population living in Europe by gender and welfare states. METHODS Using data from waves 4, 5, and 6 of the Survey of Health Age and Retirement in Europe (n = 54,171), we implemented Cox proportional hazard models by gender and age groups (50-64 and 65-84). We estimated pooled models and separated models for two regions representing different welfare states (South-East and North-West). RESULTS Among people aged 50-64, nonpartnered individuals (except never-married women) showed a higher mortality risk as compared with those partnered. Among the older population (65-84), divorce was associated with higher mortality among men, but not among women, and living with someone other than a partner was associated with higher mortality risk as compared to those partnered. In the South-East region living with a partner at ages 50-64 was associated with lower mortality. CONCLUSIONS Partnership and residential status are complementary for understanding the role of family dimensions in mortality. The presence of a partner is mortality protective, especially among 50-64-year-old men in South-East Europe.
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Affiliation(s)
- Pilar Zueras
- Centre d’Estudis Demogràfics (a Member of the CERCA Programme/Generalitat de Catalunya), Barcelona, Spain
| | - Roberta Rutigliano
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Sergi Trias-Llimós
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Abstract
OBJECTIVES To address how different residential situations impact the likelihood of death among mature adults and elderly persons. DESIGN Population-based study with administrative data linked to census data. SETTING Spain. PARTICIPANTS Spanish population alive on 1 January 2012, observed between 1 January 2012 and 31 December 2012. A 10% random sample of the Spanish population, including 2 054 427 person years and 28 736 deaths, is used. MAIN OUTCOME MEASURE Registered deaths in the 2012 Spanish vital statistics. METHODS Using a new data set based on linked administrative registers, we estimate unadjusted and adjusted mortality rates by coresidential situation. Differential mortality is measured by rate ratios (RR) estimated with Poisson regression. Cause of death data are used to explore the mechanisms involved in excess mortality by residential status. RESULTS Compared with men 45-54 living with partners, the risk of death is much higher for those without partners living with others (RR 2.0, 95% CI 1.7 to 2.4) or for those living alone (RR 1.9, 95% CI 1.5 to 2.4). After 84, excess mortality among men living with others persists (RR 1.4, 95% CI 1.3 to 1.5), but disappears for those living alone (RR 1.0, 95% CI 0.9 to 1.1). Both among women 45-64 living with others but without partner (RR 1.8, 95% CI 1.5 to 2.3) and among those living alone (RR 2.2, 95% CI 1.5 to 3.1) the pattern is similar to men. At higher ages, however, excess mortality for women living alone decreases (RR 1.2, 95% CI 1.1 to 1.2), though it persists for women living with others (RR 1.9, 95% CI 1.7 to 2.0). CONCLUSIONS These findings indicate direct effects of living arrangements on mortality and health-related selection effects influencing residential choices. These effects may be partially affected by age and prevailing societal and cultural contexts.
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Affiliation(s)
- Miguel Requena
- Sociologia II, Universidad Nacional de Educacion a Distancia, Madrid, Spain
| | - David Reher
- Sociologia Aplicada, Universidad Complutense de Madrid, Madrid, Spain
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Gagné T, Schoon I, Sacker A. Health and voting over the course of adulthood: Evidence from two British birth cohorts. SSM Popul Health 2019; 10:100531. [PMID: 32405526 PMCID: PMC7211898 DOI: 10.1016/j.ssmph.2019.100531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
Systematic differences in voter turnout limit the capacity of public institutions to address the needs of under-represented groups. One critical question relates to the role of health as a mechanism driving these inequalities. This study explores the associations of self-rated health (SRH) and limitations in everyday activities with voting over the course of adulthood in the 1958 National Child Development Study and the 1970 British Cohort Study. We used data from participants who reported voting in the last general election at least once between the ages of 23 and 55 in the 1958 cohort and between the ages of 30 and 42 in the 1970 cohort. We examined associations controlling for a range of early-life and adult circumstances using random-effects models. Compared with those in good or better health: those in fair health had 15% and 18% lower odds of voting in the 1958 and 1970 cohorts; those in poor or worse health had 17% and 32% lower odds of voting in the 1958 and 1970 cohorts. These effects varied with age and were most marked among those in poor health at the ages of 23/30 in the 1958 and 1970 cohorts. Controlling for SRH, having limitations in everyday activities was not associated with voting in main models. Examining age-based differences, however, we found that reporting limitations was associated with a higher probability of voting at the age of 55 in the 1958 cohort and at the age of 30 in the 1970 cohort. Building on the qualities of the British birth cohorts, we offer nuanced evidence about the role of health on voting, which involves considerable life-course processes. Future studies need to examine how these findings progress after the age of 55, extend to mental wellbeing and health practices, and contribute to explain social inequalities in voter turnout.
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Affiliation(s)
- Thierry Gagné
- International Centre for Lifecourse Studies in Society and Health, University College London, UK
- Research Department of Epidemiology and Public Health, University College London, UK
- Corresponding author. Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT, London, United Kingdom.
| | - Ingrid Schoon
- International Centre for Lifecourse Studies in Society and Health, University College London, UK
- Institute of Education, University College London, UK
| | - Amanda Sacker
- International Centre for Lifecourse Studies in Society and Health, University College London, UK
- Research Department of Epidemiology and Public Health, University College London, UK
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Affiliation(s)
- James O'Keefe
- University of Missouri-Kansas City, Kansas City, Missouri, USA.,Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | | | - Carl J Lavie
- Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA
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17
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Gumà J, Solé-Auró A, Arpino B. Examining social determinants of health: the role of education, household arrangements and country groups by gender. BMC Public Health 2019; 19:699. [PMID: 31170953 PMCID: PMC6555096 DOI: 10.1186/s12889-019-7054-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/27/2019] [Indexed: 11/18/2022] Open
Abstract
Background The majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities. We go beyond this by exploring how the combination of education (micro level) and household arrangements (mezzo level) is associated with self-perceived health. Methods Our data source is the 2014 cross-sectional data from the European Survey of Living Conditions (EU-SILC). We calculate the predicted probabilities of poor self-perceived health for the middle-aged European population (30–59 years) as a function of the combination of the two SDHs. This is done separately for five European country groups (dual-earner; liberal; general family support; familistic; and post-socialist transition) and gender. Results We observe a double health gradient in all the country groups: first, there is a common health gradient by education (the higher the education, the lower the probability of poor health); second, household arrangements define a health gradient within each educational level according to whether or not the individual lives with a partner (living with a partner is associated with a lower probability of poor health). We observe some specificity in this general pattern. Familistic and post-socialist transition countries display large differences in the predicted probabilities according to education and household arrangements when compared with the other three country groups. Familistic and post-socialist transition countries also show the largest gender differences. Conclusions Health differences in European populations seem to be defined, first, by education and, second, by living or not living with a partner. Additionally, different social contexts (gender inequalities, educational profile, etc.) in European countries change the influences on health of both the SDHs for both women and men. Electronic supplementary material The online version of this article (10.1186/s12889-019-7054-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jordi Gumà
- Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Carrer Ramón Trias Fargas 25-27, 08005, Barcelona, Spain. .,Sociodemography Research group (DemoSoc), University Pompeu Fabra (UPF), Barcelona, Spain. .,Research and Expertise Centre for Survey Methodology (RECSM), Barcelona, Spain.
| | - Aïda Solé-Auró
- Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Carrer Ramón Trias Fargas 25-27, 08005, Barcelona, Spain.,Sociodemography Research group (DemoSoc), University Pompeu Fabra (UPF), Barcelona, Spain
| | - Bruno Arpino
- Research and Expertise Centre for Survey Methodology (RECSM), Barcelona, Spain.,Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
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Allan R, Williamson P, Kulu H. Gendered mortality differentials over the rural-urban continuum: The analysis of census linked longitudinal data from England and Wales. Soc Sci Med 2018; 221:68-78. [PMID: 30572150 DOI: 10.1016/j.socscimed.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/20/2018] [Accepted: 10/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous research shows that mortality varies significantly by residential context; however, the nature of this variation is unclear. Some studies report higher mortality levels in urban compared to rural areas, whereas others suggest elevated mortality in rural areas or a complex U-shaped relationship. Further, the extent to which compositional factors explain urban-rural mortality variation, the extent to which contextual factors play a role and whether and how the patterns vary by gender also remain unclear. This study investigates urban-rural mortality variation in England and Wales and the causes of this variation. METHOD The study applies survival analysis to the Office for National Statistics Longitudinal Study; the population aged 20 and older in 2001 is followed for 10 years. RESULTS AND CONCLUSIONS The analysis demonstrates a clear urban-rural mortality gradient, with the risk of dying increasing with each level of urbanisation. The exceptions are those living in areas adjacent to London, who consistently exhibit lower mortality than anticipated. Once the models are adjusted to individuals' socio-economic characteristics, the variation across the urban-rural continuum reduces substantially, although the gradient persists suggesting contextual effects. Females are found to be influenced more by their surrounding environment and males by their socio-economic position, although both experience lower mortality in rural compared to urban areas.
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Affiliation(s)
- Rebecca Allan
- Centre for Spatial Demographics Research, School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, L69 7ZT, United Kingdom.
| | - Paul Williamson
- Centre for Spatial Demographics Research, School of Environmental Sciences, University of Liverpool, Roxby Building, Liverpool, L69 7ZT, United Kingdom
| | - Hill Kulu
- School of Geography and Sustainable Development, University of St Andrews, Irvine Building, North Street, St Andrews, KY16 9AL, United Kingdom
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Franke S, Kulu H. Cause-specific mortality by partnership status: simultaneous analysis using longitudinal data from England and Wales. J Epidemiol Community Health 2018; 72:838-844. [DOI: 10.1136/jech-2017-210339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/04/2018] [Accepted: 05/14/2018] [Indexed: 11/04/2022]
Abstract
BackgroundThis paper examines cause-specific mortality by partnership status. Although non-marital cohabitation has spread rapidly in industrialised countries, only a few studies have investigated mortality by partnership status and no recent study has investigated cause-specific mortality by partnership status.MethodsWe use data from the Office for National Statistics Longitudinal Study and apply competing risks survival models.ResultsThe simultaneous analysis shows that married individuals have lower mortality than non-married from circulatory, respiratory, digestive, alcohol and accident related causes of deaths, but not from cancer. The analysis by partnership status reveals that once we distinguish premarital and postmarital cohabitants from other non-married groups, the differences between partnered and non-partnered individuals become even more pronounced for all causes of death; this is largely due to similar cause-specific mortality levels between married and cohabiting individuals.ConclusionsWith declining marriage rates and the spread of cohabitation and separation, a distinction between partnered and non-partnered individuals is critical to understanding whether and how having a partner shapes the individuals’ health behaviour and mortality. The cause-specific analysis supports both the importance of selection into partnership and the protective effect of living with someone together.
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