Marriage protection and marriage selection--prospective evidence for reciprocal effects of marital status and health

Effects of family life cycle events on individual Body Mass Index trajectories: Evidence from China

PURPOSE

Body mass index (BMI) is an important predictor of one's physiological health. China is a family-centric nation compared to Western societies and has already entered an aged society. Exploring the characteristics and patterns of BMI changes during household events in China provides critical insights into the biological and social determinants of health, which can help enhance the scientific validity of health promotion measures and contribute to the realization of healthy aging goals in China.

METHODS

Using data from the China Health and Nutrition Survey (CHNS) from 1993 to 2015, this article utilizes two-level growth curve models with piecewise spline specifications for age to examine the effects of family life cycle events on BMI trajectories for age groups and gender differences.

RESULTS

Compared to continuing status, experiencing transition in an individual's family life cycle could lead to more fluctuating variations in their BMI trajectories, generally, there is a faster increase in BMI during youth and a faster decline during old age. As for gender heterogeneity, males are more affected by divorce, widowhood, and empty nest, whereas females' BMI changes are influenced by entering/maintaining marriage and parenthood.

CONCLUSIONS

A long-term perspective has revealed the significance of family events on BMI throughout the life course. Future research should focus on the nutrition and health of specific populations, especially elderly individuals in vulnerable groups.

The relationship between Marriage and Body Mass Index in China：Evidence from the China Health and Nutrition Survey

This study investigates the impact of marriage on the body mass index (BMI) of individuals aged 18-45 in China. We used data from ten rounds of the China Health and Nutrition Survey spanning from 1989 to 2015, and applied Difference-in-Differences (DID) model to examine the impact of marriage on BMI. Our findings reveal that marriage has a significant positive effect on BMI, especially among males, with post-marriage elevation of male BMI continuing to increase over time. Moreover, marriage is associated with a 5.2% increase in the prevalence of overweight and a 2.5% rise in the incidence of obesity among males. While energy intake levels for Chinese women did not undergo significant changes after marriage, nor did their energy expenditure levels, men experienced a marked alteration in energy balance, characterized by an increase in caloric intake and a decrease in physical activity. Furthermore, our study confirms significant period differences in the effect of marriage on BMI, with post-marriage elevation of male BMI continuing to rise over time. In contrast, there was no clear trend for female BMI after marriage. Our research highlights the importance of promoting physical fitness and health management within families while fostering intimate relationships through marriage. Public health policies should consider the potential impact of marriage as an intervention window for addressing individuals' weight management needs. Distinct post-marriage body management plans should be designed for both genders.

Partnership Status, Health, and Mortality: Selection or Protection?

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.

Marital status and cause-specific mortality: A population-based prospective cohort study in southern Sweden

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.

Marital transitions during earlier adulthood and subsequent health and well-being in mid- to late-life among female nurses: An outcome-wide analysis

Comparing outcomes for individuals remaining married to those for single or divorced individuals might overstate the positive effects of the decision to marry, since marriage carries an inherent risk of divorce and its associated negative outcomes. While a growing literature has examined marital transitions, confounding by past marital history remains a concern and only a limited set of outcomes have been examined. To address these issues, this study examined incident first-time marriage and incident divorce/separation in relation to multiple subsequent physical health, health behavior, psychological distress, and psychosocial well-being outcomes in a large sample of female nurses in the U.S.. Data from the Nurses' Health Study II were studied (1993 to 2015/2017 questionnaire wave, Nmarriage analyses = 11,830, Ndivorce/separation analyses = 73,018, interquartile range of baseline age = 35 to 42 years). A set of regression models were used to regress each outcome on marital transition status, adjusting for a wide range of initial health and wellbeing status in addition to other covariates. Bonferroni correction was performed to account for multiple testing. Among the initially never married, those who became married had lower mortality (RR = 0.65, 95%CI = 0.50, 0.84), lower risks of cardiovascular diseases (e.g., RRstroke = 0.64, 95%CI = 0.50, 0.82), greater psychological wellbeing and less psychological distress (e.g., ßdepressive symptoms = -0.10, 95%CI = -0.15, -0.06). Among the initially married, those who became divorced/separated had lower social integration (β = -0.15, 95%CI = -0.19, -0.11), greater psychosocial distress (e.g., RRdepression = 1.23, 95%CI = 1.10, 1.37), and possibly greater risks of mortality, cardiovascular diseases, and smoking. Future research could study similar questions using data from more recent cohorts, examine potential mechanisms and heterogeneity, and also examine alternative social relationship types.

(Un)Health from parental intervention: Does the marriage formation pathway influence married people's health?

The relationship between marriage and its health consequences has been well documented. Yet, little is known about whether health disparities still exist among married people due to different marriage formation pathways. Using data from a special module of the Chinese General Social Survey, this study examines the health effects of parental intervention in children's marriage formation. Results show that parental intervention in marriage formation is negatively associated with married people's self-rated health, but the association disappears after the selection effect is controlled for. These results suggest that the selection effect largely explains the association between parent-intervened marriage and its negative health outcomes among married people. That is to say, people with poorer health are more likely to rely on their parents for marriage formation. The findings are found in both husbands and wives and hold robust in multiple robustness tests. This study extends marriage-health research from the comparison between married and single people to the comparison within the married group.

Socially bonded females face more sexual coercion in a female-philopatric primate

Sexual coercion is a manifestation of sexual conflict increasing male mating success while inflicting costs to females. Although previous work has examined inter-individual variation in male sexually coercive tactics, little is known about female counter-strategies. We investigated whether social bonding mitigates the extent of sexual coercion faced by female mandrills (Mandrillus sphinx), as a putative mechanism linking sociality to fitness. Surprisingly, females faced the most coercion from those males with whom they formed the strongest bonds, while the strength of a female-male bond was also positively correlated with coercion from all other males. Finally, greater social integration in the female network was positively correlated with coercion, through a direct 'public exposure' mechanism and not mediated by female reproductive success or retaliation potential. Altogether, this study shows that neither between- nor within-sex bonds are protective against sexual coercion and identifies, instead, a hidden cost of social bonding.

Unplanned Costs and Benefits: Gender and Spousal Spillover Effects of Retirement on Health

Objective

Our study assesses how women and men's health indicators are shaped by their spouse's retirement.

Background

The retirement process can reshape the health of a retiree, but these effects can also extend onto the health of spouses. Although past research has largely focused on how men's retirement might negatively shape their wife's health outcomes, it is possible that wives' retirement has detrimental effects on their husband's health as well.

Method

Using data from the Health and Retirement Study (HRS), we employ a fuzzy regression discontinuity design to identify the causal effects of spousal retirement on indicators of physical and mental health in married older adults.

Results

Our results suggested that men, not women, experience the most negative spousal spillover effects of retirement on their health outcomes. We found the most support for spillover effects on spouses' physical health outcomes. Additionally, men who are not working when their spouse retires experienced the most negative health effects.

Conclusion

Women and men's health is differentially affected by spousal retirement, where men might be the most negatively affected by their spouses' transition in the U.S. context. These results contradict conventional wisdom that undergirds numerous untested assumptions underlying prior research on this significant life transition.

Prevalence of Frailty Among Chinese Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Objectives: To systematically review the epidemiology of frailty in China, one of the world's most populous countries, and to provide insightful guidance for countries to deal with fast population ageing. Methods: Six electronic databases were searched until November 2022. Data from cross-sectional studies with a clear definition of frailty and a mean age ≥60 years were pooled using meta-analysis. Results: 64 studies (n = 106,826 participants) from 23 (67.6%) of China's provinces were included. The overall prevalence of frailty and prefrailty among older community dwellers was 10.1% (95% CI: 8.5%-11.7%) and 43.9% (95% CI: 40.1%-47.8%), respectively. Adults over 70 years, women, unmarried, living alone, and those with less education had higher odds of being frail. Furthermore, regional disparities in frailty were observed; people in rural areas or areas with worse economic conditions had a higher prevalence of frailty. Conclusion: A great variation in frailty prevalence was observed between subgroups of older adults stratified by common risk factors. The Chinese government should pay more attentions to seniors at high risk and regions with a high prevalence of frailty.

Union Status and Disability Pension

A lot is known about the association between marital status and mortality, and some of these studies have included data on cohabitation. Studies on the association with health problems, rather than mortality, are often based on self-reported health outcomes, and results from these studies are mixed. As cohabitation is now widespread, more studies that include data on cohabitation are needed. We use Norwegian register data that include detailed information about union status and all cases of disability pensioning from 2005 to 2016. We employ Cox regression analysis and a within-family design in order to control for hard to measure childhood characteristics. Compared to the married, the cohabiting have a somewhat higher risk of receiving disability pension due to mental disorders, and for men also due to physical disorders. Receipt of disability pension is most common among the never married, especially for men. The association between union status and disability pensioning is stronger for mental than for physical disorders.

Healthcare Access and Utilization Among Glaucoma Patients in a Nationwide Cohort

PRCIS

Despite having lower socioeconomic status on several measures, glaucoma patients do not report more barriers to healthcare access and utilization than non-glaucoma patients.

PURPOSE

To characterize measures of socioeconomic status and barriers to healthcare access and utilization between patients with and without a diagnosis of glaucoma.

METHODS

Patients aged 65 years and over who enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, were extracted. We analyzed demographic information and several measures of socioeconomic status and healthcare access and utilization. Survey responses were compared by glaucoma status (any type) with Pearson χ 2 tests, univariable logistic regression, and multivariable logistic regression adjusting for age, gender, race/ethnicity, and insurance status.

RESULTS

Of the 49,487 patients who answered at least 1 question on the All of Us Healthcare Access and Utilization Survey, 4441 (9.0%) had a diagnosis of glaucoma. Majority of the cohort was female (28,162, 56.9%) and nonHispanic White (42,008, 84.9%). Glaucoma patients were observed to have lower rates of education ( P =0.004), employment ( P <0.001), and home ownership ( P <0.001) on χ 2 tests. On multivariable logistic regression models, those with glaucoma were significantly more likely to speak to an eye doctor (Odds ratio: 2.46; 95% confidence interval: 2.16 to 2.81) and significantly less likely to have trouble affording eyeglasses (OR: 0.85 95% CI: 0.72 to 0.99) in the prior year than those without a diagnosis of glaucoma. No significant association was found for other measures of healthcare access and utilization by glaucoma status.

CONCLUSION

Although glaucoma patients aged 65 years and over fared worse on several measures of socioeconomic status, no significant difference was found in measures of healthcare access and utilization.

Marital experiences and depressive symptoms among older adults in rural South Africa

This paper advances the understanding of how marital transitions may influence mental health by investigating these associations among a population of rural, Black South Africans aged 40+ that was directly impacted by apartheid. Using two waves of data from 4,176 men and women in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we investigated associations between marital experiences and depressive symptoms, by gender, and explored whether economic resources is a moderator of these associations. We found that experiencing a marital dissolution was associated with more depressive symptoms than remaining married for both men and women. We also found that men, but not women, report greater depressive symptoms if they remained separated/divorced, remained widowed, or remained never married between waves. We found no evidence that a decline in wealth moderated the impact of marital dissolution on depressive symptoms for women or men. These findings suggest that the documented benefits of marriage for mental health, and differences by gender in those benefits, may extend to older, rural South Africans, despite the unique experiences of this population.

The pattern in prevalence and sociodemographic factors of smoking in Malaysia, 2011–2019: Findings from national surveys

INTRODUCTION

Smoking is a major contributor to morbidity and mortality worldwide, with Malaysia no exception. Through the Ministry of Health and other ministries in the government of Malaysia, numerous anti-smoking measures have been introduced to prevent and control smoking in the country. Continuous monitoring of smoking prevalence in the community is essential in order to evaluate the effectiveness of anti-smoking policies. This study aims to update the sociodemographic factors associated with smoking in the past decade in Malaysia.

METHODS

The study utilized data from three national household surveys in Malaysia, namely the Global Adult Tobacco Survey (GATS) 2011, the National Health and Morbidity Survey (NHMS) 2015 and the National Health and Morbidity Survey (NHMS) 2019. These surveys adopted a multistage stratified sampling design that represents the population in Malaysia. Smoking status was determined based on the GATS protocol and definitions. Complex sample design estimates and complex multivariable logistic regression were used in the analysis.

RESULTS

A total of 4250, 21410 and 11111 respondents aged ≥15 years participated in GATS 2011, NHMS 2015 and NHMS 2019, respectively, with a response rate between 85% and 87%. The prevalence of smoking was 23.1% (95% CI: 21.2–25.2) in 2011, 22.8% (95% CI: 21.9–23.8) in 2015 and 21.3% (95% CI: 19.9–22.8) in 2019. The prevalence was consistently higher in males (40.5–43.9%), adults aged 25–44 years (25.4–29.0%), Malay (22.6–24.7%), other ethnicities (30.0–35.0%), and the self-employed (33.7–44.6%). Multiple logistic regression analysis showed that the adjusted odds ratio (AOR) of smoking was higher in males, in younger and middle age groups, Malays, and those with lower education level.

CONCLUSIONS

There were slight changes in the sociodemographic factors of smoking in the past decade in Malaysia. Stern measures and more aggressive strategies are needed to address all the risk factors in controlling smoking behavior in the country.

Association between poor self-reported health and unmarried status among adults: examining the hypothesis of marriage protection and marriage selection in the Indian context

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14170-0.

Association of Marital Status With Total and Cause-Specific Mortality in Asia

IMPORTANCE

Marital status has been shown to be associated with mortality, but evidence in Asian populations is limited.

OBJECTIVE

To examine the association of marital status with total and cause-specific mortality.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included individual participant data from 16 prospective studies in the Asia Cohort Consortium conducted between 1963 and 2015. Asian participants with complete information on marital and vital status were included. Study-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards model and then pooled using a random-effects meta-analysis. The analysis began in February 2021 and ended in August 2021.

EXPOSURES

Marital status.

MAIN OUTCOMES AND MEASURES

All-cause and cause-specific mortality.

RESULTS

Of 623 140 participants (326 397 women [52.4%] and 296 743 men [47.6%]; mean [SD] age, 53.7 [10.2] years; mean [SD] follow-up time, 15.5 [6.1] years), 123 264 deaths were ascertained. Compared with married individuals, those who were unmarried had pooled HRs of 1.15 (95% CI, 1.07-1.24) for total mortality, 1.12 (95% CI, 1.03-1.22) for cerebrovascular disease mortality, 1.20 (95% CI, 1.09-1.31) for coronary heart disease mortality, 1.17 (95% CI, 1.07-1.28) for circulatory system diseases mortality, 1.06 (95% CI, 1.01-1.11) for cancer mortality, 1.14 (95% CI, 1.05-1.23) for respiratory diseases mortality, and 1.19 (95% CI, 1.05-1.34) for external causes of death. Positive associations with total mortality were also observed for those who were single (HR, 1.62; 95% CI, 1.41-1.86), separated (HR, 1.35; 95% CI, 1.13-1.61), divorced (HR, 1.38; 95% CI, 1.13-1.69), and widowed (HR, 1.09; 95% CI, 1.04-1.13). In subgroup analyses, the positive association persisted across baseline health conditions, and the risk of death was more pronounced among men or people younger than 65 years.

CONCLUSIONS AND RELEVANCE

This large pooled cohort study of individual participant data provides strong evidence that being unmarried, as well as belonging to the unmarried subcategories, was positively associated with total and cause-specific mortality. Investment of targeted social support services might need to be considered in light of the mortality differences between married and unmarried individuals.

Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach

Background: Eliminating inequality in health service utilization is an explicit goal of China’s health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems—particularly for some marginal groups in China.

The association of marital status with cognitive function and the role of gender in Chinese community-dwelling older adults: a cross-sectional study

BACKGROUND

Evidence of the association between marital status and cognitive function in Chinese older adults is limited.

AIMS

To examine the relationship between marital status and cognitive function and to explore the role of gender amongst older adults from three Chinese communities.

METHODS

A total of 1376 participants aged 60 years or over were included in this cross-sectional study. Cognitive function was assessed using the Chinese version of the mini-mental state examination (MMSE). Marital status and other variables were collected using a standardized questionnaire. Multiple linear regression models were used to examine associations between marital statuses and cognitive function amongst the target population. The moderating role of gender in these potential associations has also been explored.

RESULTS

In univariate linear regression models, compared to being married, both being widowed (β [95% CI]: -1.46[-2.78 to - 0.13]) and being single (β [95% CI]: - 4.88[-6.43 to - 3.38]) were associated with lower MMSE scores. After adjustment for confounding factors, the significant association of being widowed with MMSE scores disappeared (β [95% CI: - 0.08[- 1.04 to 0.86]), but the association of being single with MMSE scores still existed (β [95% CI]: - 1.87[- 3.17 to - 0.58]). Furthermore, the association of being single with MMSE scores was statistically significant in men (β [95% CI]: - 5.25[- 7.17 to - 3.33]) but not in women (β [95% CI: 0.88[- 0.87 to 2.64]).

DISCUSSION AND CONCLUSIONS

Being single was associated with poorer cognitive function compared with their married counterparts in older Chinese men but not in women. More preventive measurements should be implemented for single men to reduce or delay cognitive decline. This is particularly important in the context of an aging population in China.

Interdependent pathways between socioeconomic position and health: A Swedish longitudinal register-based study

Health inequalities are generated by the conditions in which people are born, grow, live, work and age. From a life-course perspective, these conditions are formed by complex causal relationships with mutual and intertwined paths between socioeconomic position and health. This study attempts to disentangle some of these processes by examining pathways between socioeconomic position and health across the life-course. We used yearly Swedish national register data with information from over 31 years for two cohorts born 1941-1945 and 1961-1965. We analyzed associations between several indicators of childhood and adult socioeconomic position and health, measured by number of in-patient hospitalizations. We estimated within- and between-person associations using random intercept cross-lagged panel models. The results showed bi-directional associations between socioeconomic position and health that varied in strength across the life-course. Age variations in the associations were primarily observed when individuals aged into or out of age-stratified institutions. In ages where transitions from education to the labor market are common, the associations from health to income and education were strong. Around and after retirement age, the between-person association from health to income was weak, while the association from income to health strengthened. Within-person estimates showed no association between income and subsequent hospitalization among older persons, indicating no direct causal effect of income change on health in this age group. For persons of middle age, the associations were of similar strength in both directions and present at both the between- and within-person level. Our findings highlight the importance of theoretical frameworks and methods that can incorporate the interplay between social, economic, and biological processes over the life-course in order to understand how health inequalities are generated.

Partnership and mortality in mid and late life: Protection or selection?

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.

The Association between Neighborhood Disorder and Health: Exploring the Moderating Role of Genotype and Marriage

The present study extends prior research on the link between neighborhood disorder and health by testing an integrated model that combines various social and biological factors. Hypotheses were tested using a sample of 325 African American women from the Family and Community Health Study (FACHS). As expected, inflammatory burden was the biophysiological mechanism that mediated much of the association between neighborhood physical disorder and perceived physical health. This finding provided additional support for the view that global self-ratings of health are powerful predictors of morbidity because, in large measure, they are indicators of chronic, systemic inflammation. Further, both genetic variation and marital status served to moderate the association between neighborhood disorder and health. Finally, being married largely eliminated the probability that neighborhood disorder would combine with genetic vulnerability to increase inflammatory burden and perceived illness. Overall, the findings demonstrate the value of constructing integrated models that specify various biophysiological mechanisms that link social conditions to physical health.

Marital dissolutions and changes in mental health: Evidence from rural Malawi

BACKGROUND

Advancing efforts to unpack the complex relationship between marital dissolutions and health outcomes increasingly requires assessing the marital histories and health of individuals who have lived long enough to experience divorce or widowhood ‒ or even multiples of each ‒ and measurable changes in health.

OBJECTIVE

To explore this line of inquiry, we chose a sample from rural Malawi where a high prevalence of marital dissolutions and remarrying exists, as an ideal theoretical foil to the predominant literature found in high-income countries (HICs). We examine if changes in having experienced a marital dissolution, one's total number of dissolutions, and the percentage of one's life spent outside of marriage since first becoming married are associated with changes in mental health.

METHODS

Our analyses focus on 1,266 respondents aged 45 years and older who participated in the 2012 Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC), linked back to cohort information from 2008 and 2010 available through the MLSFH. Fixed-effects regressions guide our inferences over the 2008, 2010, and 2012 waves of data.

RESULTS

For men, spending more life outside of marriage is associated with worse mental health, while more marital dissolutions are surprisingly associated with better mental health for women.

CONCLUSIONS

These results could suggest that larger portions of one's life spent unmarried are associated with a type of role strain for men or simply that men are burdened with taking up tasks that their spouses had previously done in order to survive. For women, many may have gotten out of 'bad' marriages that otherwise would have been detrimental to their mental health and/or those in good mental health are the ones able to remarry.

CONTRIBUTIONS

Our research from rural Malawi provides a type of litmus test for many HICs where marriage, remarriage, and dissolution rates are lower but quite consequential for mental health outcomes. Measuring time outside of marriage should be more strongly considered in such settings. These results also inform increasingly important research on the relationship between marital dissolutions and mental health in other African nations as noncommunicable diseases play a continually more important role in people's lives.

The effect of bereavement on cognitive functioning among elderly people: Evidence from Australia

This paper explores the effects of experiencing the death of a spouse, relative or close friend on cognitive functioning of Australian elderly. Using rich longitudinal data, we show that experiencing a loss is associated with a modest decline in cognitive function. Our results show that on average the effects are more pronounced for males and the strongest effects are associated with the loss of the spouse or a close friend. These events have significant effects on working memory and speed of information processing. We show that the decrease in cognitive functioning is accompanied by decreases in engagement in cognitive activities and declines in socialization. Our results are suggestive that programmes to support grieving individuals, including support for socialization activities, and extending active aging programmes could be important for promoting successful cognitive aging for the growing population of older adults.

Family embeddedness and older adult mortality in the United States

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.

The impact of marital transitions on vegetable intake in middle-aged and older Japanese adults: a five-year longitudinal study

Background

Marital transitions are associated with adverse health events, such as mortality and cardiovascular disease. Since marital transitions (eg, becoming widowed) are unavoidable life events, it is necessary to identify modifiable intermediate outcomes. Thus, we examined the association between marital transitions and vegetable intake among middle-aged and older Japanese adults.

Methods

This longitudinal study included Japanese adults aged 40–79 years who received an annual health checkup between 2007 and 2011 (baseline) and 5 years later (follow-up). Marital transitions were classified as whether and what type of transition occurred during the 5-year period and comprised five groups: consistently married, married to widowed, married to divorced, not married to married, and remained not married. Changes in total vegetable, green and yellow vegetable, and light-colored vegetable intake from baseline to follow-up were calculated using the Food Frequency Questionnaire.

Results

Data from 4,813 participants were analyzed (mean age, 59.4 years; 44.1% women). Regarding marital transitions, 3,960 participants were classified as “consistently married,” 135 as “married to widowed,” 40 as “married to divorced,” 60 as “not married to married,” and 529 as “remained not married.” Multivariable linear regression analysis revealed that compared to consistently married, married to widowed was inversely associated with the change in total vegetable intake (β = −16.64, SE = 7.68, P = 0.030) and light-colored vegetable intake (β = −11.46, SE = 4.33, P = 0.008).

Conclusion

Our findings suggest that being widowed could result in a reduced intake of vegetables. Hence, dietary counseling according to marital situation is necessary.

Older Men Living with Spouse and Older Women Living with Spouse and Children Have Lower Frailty Prevalence: The Korean Frailty and Aging Cohort Study (KFACS)

Background

In older adults, the risk of frailty is higher among those who are unmarried than among those who are married. However, no study has reported about the relationship between cohabitation status and frailty.

Methods

This cross-sectional study included 2,128 community-dwelling adults aged between 70 and 84 years who underwent interviews and physical function assessments for the Korean Frailty and Aging Cohort Study. The definition of frailty was derived from the Fried frailty phenotype. Cohabitation was categorized as “living alone”, “with spouse only”, “with children only”, and “with spouse and children”.

Results

The mean age was 76 years, and 46.3% of the adults were men. After adjusting for age, education, income, nutritional status, alcohol, smoking history, Geriatric Depression Scale, Mini-Mental State Examination, Korean Activities of Daily Living, Korean Instrumental Activities of Daily Living, urinary incontinence, and polypharmacy, the odds ratios of frailty were 0.323 (95% confidence interval [CI], 0.137–0.763; p<0.001) and 1.089 (95% CI, 0.671–1.769; p=0.730) for men and women living with a spouse, respectively. The odds ratios of frailty were 0.329 (95% CI, 0.117–0.927; p=0.035) and 0.332 (95% CI, 0.123–0.891; p=0.029) for men and women living with spouse and children, respectively.

Conclusion

Men living with a spouse or with a spouse and children had a lowered prevalence of frailty, and women living with a spouse and children together had a lowered prevalence of frailty.

Impacts of Remaining Single above the Mean Marriage Age on Mental Disorders and Suicidality: a Nationwide Study in Korea

BACKGROUND

This study investigated the impact of getting older than the mean marriage age on mental disorders and suicidality among never-married people.

METHODS

We performed an epidemiological survey, a nationwide study of mental disorders, in 2016. In this study, a multi-stage cluster sampling was adopted. The Korean version of the Composite International Diagnostic Interview was conducted with 5,102 respondents aged 18 years or above. The associations between never-married status, mental disorders, and suicidality were explored according to whether the mean age of first marriage (men = 32.8 years; women = 30.1 years) had passed.

RESULTS

Never-married status over the mean marriage age was associated with agoraphobia, obsessive-compulsive disorder, mood disorders, and major depressive disorder after adjusting for sociodemographic factors. Respondents with never-married status above the mean marriage age were associated with suicide attempts (adjusted odds ratio [aOR], 3.21; 95% confidence interval [CI], 1.36-7.60) after controlling for sociodemographic factors and lifetime prevalence of mental disorders, while respondents with never-married status under the mean marriage age were not. Moreover, in respondents with never-married status, getting older than the mean marriage age was associated with suicidal ideations (aOR, 1.49; 95% CI, 1.04-2.15) and suicide attempts (aOR, 3.38; 95% CI, 1.46-7.84) after controlling for sociodemographic factors and lifetime prevalence of mental disorders.

CONCLUSION

Never-married status above the mean first marriage age was associated with mental disorders and suicidality. These findings suggest the need for a national strategy to develop an environment where people with never-married status do not suffer even if their marriage is delayed.

Chronic conditions, couple-level factors and union dissolution

This paper examines the association between chronic illness and union dissolution by examining rich, longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey. Using competing-risks discrete-time event-history models on longitudinal, dyadic data, we find the risk of union dissolution to be approximately 40 percent higher when either partner reports an illness than in the absence of an illness. We then examine whether the observed associations are mediated by variations in paid work, housework, financial stress and time stress. Financial stress is the factor that contributes most to the indirect associations between dissolution and partner's health condition, but overall these factors account for only 18.5 percent of the association between chronic illness and relationship dissolution. Our results provide further insight into the factors undermining relationship stability and highlight the importance of reducing financial stress associated with chronic illness.

The strain of sons' incarceration on mothers' health

Research on disadvantage across generations typically focuses on the resources that parents pass on to their children. Yet, social disadvantage might also result from the transmission of adverse experiences from children to their parents. This paper explores one such adverse experience by examining the influence of a son's incarceration on his mother's health. Using panel data from the 1979 National Longitudinal Survey of Youth and its young adult follow up (n = 2651 mothers; 18,390 observations), the paper shows that mothers are more likely to suffer health limitations after a son is incarcerated. A time-distributed fixed effects analysis indicates that the effect on maternal health may persist or even grow over time. Rather than a short-term shock whose effect soon diminishes, a son's incarceration is a long-term strain on mothers' health. The disproportionate incarceration of young men in disadvantaged communities is thus likely to contribute to cumulative adversity among mothers already at risk of severe hardship. More broadly, the results suggest how children's adverse experiences may influence parental well-being, producing further disadvantage across generations.

Cohabiting and becoming a parent: associations with changes in physical activity in the 1970 British cohort study

Background

We examined the association between family–related life events (cohabitation/marriage and becoming a parent) and change in physical activity.

Methods

Longitudinal data (n = 8045) from the 1970 British Cohort Study (30 and 34 years) were included. Life events (beginning cohabitation/marriage and becoming a parent) were reported and coded: 0 no, 1 yes, for each event occurring between 30 and 34 years. Participants reported frequency of participation in leisure-time physical activity at 30 and 34 years (Likert scale: mean change calculated ranging between − 4 and 4). Linear regression models were used to examine the association between life events and physical activity change (comparing individuals experiencing events between 30 and 34 years versus never experiencing the event - excluding participants that experienced previous events – with a final analysis sample of n = 3833 in parenthood analysis; n = 1137 in cohabitation analysis). Interaction terms were used to analyse combined parenthood and cohabitation status. Analyses were adjusted for level of education achieved, ethnicity, country of origin and other life events. ANCOVA was used to examine associations between change in physical activity and child age.

Results

Compared to remaining without children, becoming a parent was associated with a greater reduction in physical activity among men [β:-0.234(95%CI:-0.396 to − 0.072)] but not women [0.126(− 0.048;0.301)]. No associations were found between cohabitation and physical activity. Men who became fathers both while cohabitating [− 0.201(− 0.383;-0.020)] and without cohabiting [− 0.937(− 1.623;-0.250)] experienced greater physical activity declines than those remaining single and without children; the decline was greatest among non-cohabiting fathers. These associations did not differ by child age.

Conclusions

Parenthood appears to differentially impact physical activity for men and women; this association also differs by cohabitation status. Parenthood appears to be most detrimental to physical activity levels among men. Interventions for physical activity could target new or soon-to-be parents, especially fathers. Further analyses with device-measured physical activity data would be valuable to advance understanding of these associations.

Actor-Partner Effects of Childhood Disadvantage on Later Life Subjective Well-Being Among Individuals in Coresidential Unions

OBJECTIVES

Prior research on cumulative disadvantage has primarily focused on individuals' own childhood adversity for their later-life outcomes. Nevertheless, partner's childhood disadvantage may also shape respondent's later-life well-being.

METHODS

Drawing on a household-level dataset, I examine respondent's own childhood adversity as well as their partner's childhood adversity (poor childhood health, parental divorce, or father's long-term unemployment) on respondent's subjective well-being, at aged 50 and older.

RESULTS

Findings from the actor-partner interdependence model (APIM) show poor childhood health of the male partner as associated with worse mental health and self-rated health of the female partner in later life. For both outcome measures, the partner effects were attenuated after adjusting for the female partner's report of perceived social support. For self-rated health, adjusting for variation in the presence of a chronic illness and household income also attenuated the association.

DISCUSSION

Partnered individuals are nested within a specific context, whereby stress and implications of early life disadvantage may be conceptualized at the couple-level. Future research that assesses how early life experiences of individuals may have implications for family members' later-life well-being may be valuable.

Scale for Measuring Role Strain in Women With Diabetes: Development and Psychometric Testing of the Chinese Version

BACKGROUND

Women with diabetes (type 1 and type 2) have excessive risk of developing cardiovascular disease compared with men with diabetes, so optimizing diabetes control is crucial for women to reduce this risk. Women with diabetes experience role strain, and a scale to measure role strain in the context of diabetes control could help healthcare providers improve diabetes control in women with diabetes.

OBJECTIVE

The aims of the study were to develop a short-form scale for measuring role strain in Taiwanese women with diabetes and test its psychometric properties.

METHODS

This study was conducted from October 2018 to May 2019 and used a cross-sectional design. Based on literature reviews and results of focus groups, a 28-item role strain scale was developed and administered to 519 women with diabetes in Taiwan. Item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability testing were used to examine the psychometric characteristics of the scale.

RESULTS

A 9-item role strain scale including subscales for role guilt and role conflict, supported by exploratory factor analysis and confirmatory factor analysis, was produced. High role strain significantly correlated with high depression (r = 0.399, P < .001) and high hemoglobin A1c levels (r = 0.169, P < .001). The overall and subscale Cronbach's α ranged between 0.78 and 0.86, with test-retest reliability ranging between 0.64 and 0.81.

CONCLUSIONS

The role strain scale for women with diabetes is reliable and valid and can be used to evaluate role strain in women with diabetes.

Health behaviors and illness according to marital status in middle-aged Koreans

Background

Marital status influences health and this association might differ by time and/or country. Divorce rates have increased abruptly in Korea. We investigated relationships between marital status and health behaviors and illness among middle-aged Koreans.

Methods

Data from the fifth Korean National Health and Nutrition Examination Survey 2010-12 was used. Participants were middle-aged (40-65 years) Koreans (3015 male and 4498 female) who had been married. Health behaviors and physical and mental health status were evaluated separately for each gender according to marital status (currently married versus separated, divorced or widowed) using logistic regression analyses adjusted for age, income level and region.

Results

About 5.4% of men and 13.0% of women lived without their spouses. Odd ratios (ORs) for smoking, binge drinking, inadequate sleep, hypertriglyceridemia and depression were significantly higher in participants not living with their spouses. ORs for non-participation in regular health examinations and cancer screenings, anemia, elevated alanine aminotransferase and suicidal ideation were significantly higher in men not living with their spouses.

Conclusions

Health behaviors and illness were significantly worse in middle-aged Koreans not living with their spouses. Men were more susceptible to poor health screening, nutritional deficiencies and mental illness. Preventive services are necessary to improve their health status.

"He can send her to her parents": The interaction between marriageability, gender and serious mental illness in rural Ethiopia

BACKGROUND

For women in most low- and middle-income countries, the diagnosis with serious mental illness (SMI) leads to stigma and challenges related to starting or maintaining marriages. The purpose of this qualitative study was to explore perspectives on marriage, divorce and family roles of women with SMI in rural Ethiopia.

METHODS

A qualitative study was conducted in a rural setting of Butajira, South Central Ethiopia. A total of 39 in-depth interviews were carried out with service users (n = 11), caregivers (n = 12), religious leaders (n = 6), health extension workers (n = 4), police officers (n = 2), teachers (n = 2) and government officials (n = 2). Data were analyzed using a thematic approach.

RESULTS

Three themes emerged. (1) Marriage and SMI: Chances of getting married for individuals with SMI in general was perceived to be lower: Individuals with SMI experienced various challenges including difficulty finding romantic partner, starting family and getting into a long-term relationship due to perceived dangerousness and the widespread stigma of mental illness. (2) Gendered experiences of marriageability: Compared to men, women with SMI experienced disproportionate levels of stigma which often continued after recovery. SMI affects marriageability for men with SMI, but mens' chances of finding a marital partner increases following treatment. For women in particular, impaired functioning negatively affects marriageability as ability to cook, care and clean was taken as the measure of suitability. (3) Acceptability of divorce and separation from a partner with SMI: Divorce or separation from a partner with SMI was considered mostly acceptable for men while women were mostly expected to stay married and care for a partner with SMI. For men, the transition from provider to dependent was often acceptable. However, women who fail to execute their domestic roles successfully were considered inept and would be sent back to their family of origin.

CONCLUSION

Women with SMI or those married to partners with SMI are at greater disadvantage. Reducing vulnerabilities through stigma reduction efforts such as community outreach and mental health awareness raising programs might contribute for better social outcomes for women with SMI.

Health Status and Transitions in Cohabiting Relationships of American Young Adults

OBJECTIVE

This study examines whether individual health predicts cohabitors' union transitions to marriage in American young adults.

BACKGROUND

Associations between health and subsequent marital transitions are well documented, but less is known about how health influences transitions of cohabiting relationships. As cohabitation has become a common relationship experience, understanding how health may influence cohabitors' union transitions is an important component of how health shapes relationship exposures more broadly.

METHOD

Data were taken from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (http://www.cpc.unc.edu/projects/addhealth), including the supplemental collection of relationship partners conducted during Wave III. Competing risk regressions for the transition of cohabiting unions to marriage were estimated in two samples: one of individuals and a smaller one of cohabiting couples with information from both partners.

RESULTS

Healthier cohabiters are more likely to marry than are their less healthy counterparts, but only women's health is significantly associated with the transition to marriage. In the dyadic sample with information from both partners, the significant association between the female partner's health and the transition to marriage is robust to male partner characteristics, including health.

CONCLUSION

Health is an important predictor of cohabitation transitions in early adulthood, but these transitions may only be sensitive to the female partner's health.

Socioeconomic inequities in health services' utilization following the Health Transformation Plan initiative in Iran

Health equity has become a progressively popular research topic in recent years. Therefore, this study was made to identify the contributions made by socioeconomic determinants in order to quantify their roles to healthcare utilization inequity and to show their status especially after the recent reform in Iran, i.e. Health Transformation Plan, which one of its main goals is providing access to healthcare for all people. This study is a cross-sectional study conducted on a national level in Iran in 2015. For the sampling frame, three-stage cluster sampling was used. A total of 22 470 households from the whole country were surveyed by questionnaires through face-to-face interviews. A total of 78 378 subjects responded to the survey, 18 984 subjects (24.2%) reported the need to outpatient healthcare services in the 2 weeks preceding the interview and 12 944 (68.2%) of them had utilized the outpatient services. In addition, 5928 participants (7.6% of total population) reported the need to inpatient healthcare in the 15-month interval prior to the interview. Of these, 5405 subjects (91.2%) had received the inpatient cares. Several factors such as age group, education, marital status and status of household economy play significant roles in seeking inpatient cares. In addition, age group and household economic status have significant impacts on the utilization of outpatient services. While there are several variables that have different effects in determining the need for both outpatient and inpatient services, most of them are not any more significant than what are on the receiving end of these services.

Subjective Well-being and Partnership Dynamics: Are Same-Sex Relationships Different?

We analyze Dutch panel data to investigate whether partnership has a causal effect on subjective well-being. As in previous studies, we find that, on average, being in a partnership improves well-being. Well-being gains of marriage are larger than those of cohabitation. The well-being effects of partnership formation and disruption are symmetric. We also find that marriage improves well-being for both younger and older cohorts, whereas cohabitation benefits only the younger cohort. Our main contribution to the literature is on well-being effects of same-sex partnerships. We find that these effects are homogeneous to sexual orientation. Gender differences exist in the well-being effects of same-sex partnerships: females are happier cohabiting, whereas marriage has a stronger well-being effect on males.

Relation of Marital Status and QT Interval Prolongation (from the Third National Health and Nutrition Examination Survey)

Although the link between marital status and mortality is well established, the pathophysiological basis is unclear. An investigation of the association of marital status with prolonged QT interval may highlight the underlying mechanism for poor outcomes associated with being unmarried. This analysis included 6,562 participants (mean age 58.6 years, 52% women, 50.1% non-Hispanic whites) without a history of cardiovascular disease from the Third National Health and Nutrition Examination Survey. QT was automatically measured from digital 12-lead electrocardiogram in a central reading center. Marital status was defined by self-report as married and unmarried (never married, divorced/separated or widowed). A multivariable logistic regression model was used to examine cross-sectional association between marital status and prolonged QT interval (≥450 ms in men, ≥460 ms in women). Compared with married, unmarried was associated with 46% higher odds of the prolonged QT interval (odds ratio [OR] 95% confidence interval [95% CI]: 1.46[1.16-1.83]). This association was stronger among men versus women (OR[95% CI]: 1.75[1.27-2.41] vs 1.26[0.92-1.73] respectively; interaction p value = 0.03) and in younger versus older participants (OR [95% CI]: 1.72[1.21-2.42] vs 1.40[1.05-1.88], respectively; interaction p value = 0.002). When the types of unmarried were compared to married, a dose-response relation with prolonged QT was observed with the highest odds in never married followed by divorced/separated, and then widowed. In conclusion, marital status is associated with a prolonged QT interval, especially among men and younger participants. Prolonged QT interval may indicate a biologic substrate through which social isolation defined by unmarried state increases the risk of poor outcomes in the future.

Association of Preterm Birth and Low Birth Weight With Romantic Partnership, Sexual Intercourse, and Parenthood in Adulthood: A Systematic Review and Meta-analysis

IMPORTANCE

Social relationships are important determinants of well-being, health, and quality of life. There are conflicting findings regarding the association between preterm birth or low birth weight and experiences of social relationships in adulthood.

OBJECTIVE

To systematically investigate the association between preterm birth or low birth weight and social outcomes in adulthood.

DATA SOURCES

PubMed, PsycINFO, Web of Science, and Embase were searched for peer-reviewed articles published through August 5, 2018.

STUDY SELECTION

Prospective longitudinal and registry studies reporting on selected social outcomes in adults who were born preterm or with low birth weight (mean sample age ≥18 years) compared with control individuals born at term.

DATA EXTRACTION AND SYNTHESIS

The meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The data were collected and extracted by 2 independent reviewers. Pooled analyses were based on odds ratios (ORs) with 95% confidence intervals and Hedges g, which were meta-analyzed using random-effects models.

MAIN OUTCOMES AND MEASURES

Ever being in a romantic partnership, ever having experienced sexual intercourse, parenthood, quality of romantic relationship, and peer social support.

RESULTS

Twenty-one studies were included of the 1829 articles screened. Summary data describing a maximum of 4 423 798 adult participants (179 724 preterm or low birth weight) were analyzed. Adults born preterm or with low birth weight were less likely to have ever experienced a romantic partnership (OR, 0.72; 95% CI, 0.64-0.81), to have had sexual intercourse (OR, 0.43; 95% CI, 0.31-0.61), or to have become parents (OR, 0.77; 95% CI, 0.65-0.91) than adults born full-term. A dose-response association according to degree of prematurity was found for romantic partnership and parenthood. Overall, effect sizes did not differ with age and sex. When adults born preterm or with low birth weight were in a romantic partnership or had friends, the quality of these relationships was not poorer compared with adults born full-term.

CONCLUSIONS AND RELEVANCE

These findings suggest that adults born preterm or with low birth weight are less likely to experience a romantic partnership, sexual intercourse, or to become parents. However, preterm birth or low birth weight does not seem to impair the quality of relationships with partners and friends. Lack of sexual or partner relationships might increase the risk of decreased well-being and poorer physical and mental health.

Marital status and outcomes in patients with cardiovascular disease

The national burden of cardiovascular disease (CVD) continues to impose significant risk of morbidity, mortality and increased costs. While traditional risk factors have been well-established, the evolving role of non-traditional risk factors, including socioeconomic and psychosocial factors, is increasingly being recognized. Several studies have acknowledged an association between marital status and the presence of CVD and its associated adverse outcomes. Across multiple U.S. and international cohorts, patients who are unmarried, including those who are divorced, separated, widowed, or never married, have an increased rate of adverse cardiovascular events when compared to their married counterparts. Some studies suggest that marriage may have a more protective role for men compared to women. Furthermore, dissatisfaction in a marriage and marriage quality have significant impact on cardiovascular risk. Psychosocial and socioeconomic factors, as well as other acute stressors, may contribute to the association between marital status and CVD outcomes, but the underlying mechanisms are not completely clear. Further investigation is required to identify potential targets for intervention and to determine whether more aggressive targeting of standard anti-atherosclerotic therapies can favorably impact CVD risk in unmarried patients.

Structure of Online Dating Markets in U.S. Cities

We study the structure of heterosexual dating markets in the United States through an analysis of the interactions of several million users of a large online dating website, applying recently developed network analysis methods to the pattern of messages exchanged among users. Our analysis shows that the strongest driver of romantic interaction at the national level is simple geographic proximity, but at the local level, other demographic factors come into play. We find that dating markets in each city are partitioned into submarkets along lines of age and ethnicity. Sex ratio varies widely between submarkets, with younger submarkets having more men and fewer women than older ones. There is also a noticeable tendency for minorities, especially women, to be younger than the average in older submarkets, and our analysis reveals how this kind of racial stratification arises through the messaging decisions of both men and women. Our study illustrates how network techniques applied to online interactions can reveal the aggregate effects of individual behavior on social structure.

Perceived Stigma in Health Care Settings and the Physical and Mental Health of People of Color in the United States

Purpose: Addressing perceived and enacted stigma in clinical settings is critical to ensuring delivery of high-quality patient-centered care, reducing health disparities, and improving population health outcomes.

Methods: Data from the Behavioral Risk Factor Surveillance System's (2012–2014) Reaction to Race module were analyzed to test the hypothesis that perceived stigma in health care settings would be associated with poorer physical and mental health. Poor health was measured by (1) the number of days the respondent was physically or mentally ill over the past month and (2) depressive disorder diagnosis. Multivariate linear and logistic regression models were employed.

Results: Effects of stigma on physical and mental health were significant. Perceived stigma was associated with additional 2.79 poor physical health days (β=2.79, confidence interval [CI]=1.84–3.75) and 2.92 more days of poor mental health (β=2.92, CI=1.97–3.86). Moreover, perceived stigma in health care settings was associated with 61% higher odds of reporting a depressive disorder (adjusted odds ratio=1.61, CI=1.29–2.00). Among other findings, individuals who were married, younger, had higher income, had college degrees, and were employed reported significantly fewer poor physical and mental health days and had lower odds of self-reported depressive disorder.

Conclusions: Reducing stigma against people of color in health care settings (environments that should be pro-patient) must be a top priority for population health scholars and clinicians. Reducing perceived stigma in clinical settings may produce better mental and physical health outcomes in minority patients thereby reducing health disparities. In addition, fewer days lost to poor health could positively influence the health care system by decreasing utilization and may improve economic productivity through increasing days of good health.

The impact of marital status on health care utilization among Medicare beneficiaries

To explain prior literature showing that married Medicare beneficiaries achieve better health outcomes at half the per person cost of single beneficiaries, we examined different patterns of healthcare utilization as a potential driver.Using the Medicare Current Beneficiary Survey (MCBS) data, we sought to understand utilization patterns in married versus currently-not-married Medicare beneficiaries. We analyzed the relationship between marital status and healthcare utilization (classified based on setting of care utilization into outpatient, inpatient, and skilled nursing facility (SNF) use) using logistic regression modeling. We specified models to control for possible confounders based on the Andersen model of healthcare utilization.Based on 13,942 respondents in the MCBS dataset, 12,929 had complete data, thus forming the analytic sample, of whom 6473 (50.3%) were married. Of these, 58% (vs. 36% of those currently-not-married) were male, 45% (vs. 47%) were age >75, 24% (vs. 70%) had a household income below $25,000, 18% (vs. 14%) had excellent self-reported general health, and 56% (vs. 36%) had private insurance. Compared to unmarried respondents, married respondents had a trend toward higher odds of having a recent outpatient visit (unadjusted odds ratio (OR) 1.11, 95% confidence interval (CI) 1.04-1.19, adjusted odds ratio (AOR) 1.10, (CI) 0.99-1.22), and lower odds in the year prior to have had an inpatient stay (AOR 0.84, CI 0.72-0.99) or a SNF stay (AOR 0.55, CI 0.40-0.75).Based on MCBS data, odds of self-reported inpatient and SNF use were lower among married respondents, while unadjusted odds of outpatient use were higher, compared to currently-not-married beneficiaries.

The parental co-immunization hypothesis: An observational competing risks analysis

The main interest of this study is the hypothesis that contact with small children may be beneficial for the parents’ later health and mortality (because of changes in their immune system). For this purpose, we document the relationship of a set of individual characteristics—including parenthood and marital state—and socioeconomic status with an individual’s cause of death. Using a novel and rich data set made available by the Office for National Statistics Longitudinal Study (ONS-LS), which follows 1% of the population of England and Wales along five census waves 1971, 1981, 1991, 2001, and 2011, our competing risks analysis yields several striking results: (1) Females with children have a 72.5% reduced risk of dying of cancer compared to childless females (for childless females of age 70, this corresponds to a risk of dying of cancer of 1.3% compared to a risk of about 1.3 × 0.275 = 0.4% for females with children). (2) Males have a 171% increased chance of dying of cancer when they are married (e.g., a baseline probability of 1.2% when 75 year old) compared to unmarried males. (3) Females with children have only a 34% risk of dying of heart disease (corresponding to a conditional probability of 0.3% when aged 65) relative to females without children and (4) a 53% chance of dying of infections (i.e., 0.1% at 65 years of age) compared to the risk for females without children. (5) At the same age, married men have an increased expectation of 123% of dying of heart disease (corresponding to an expected death probability of 0.7%) compared to unmarried men. (6) High income and house ownership is always associated with higher survival but less so than having children. While these results document a relationship between the presence of children and mortality, the specific transmission mechanisms remain unclear and we cannot make causality assertions.

Examining Associations Between State-Level Transgender Policies and Transgender Health

Compared with their cisgender counterparts, transgender individuals face both structural-level discrimination and health disparities across health domains. We used recent population-level data to examine associations between state-level policy ratings regarding transgender people and transgender health (poor physical and mental health days, health behaviors, and health care utilization). We hypothesized more inclusive and protective state-level policies would predict better health of transgender individuals. The sample (N=1116) was approximately half white (n=572, 51.2%) and half transgender women (n=551, 49.3%). More transgender-inclusive and protective state-level policies predicted better health in three of four health domains. Policy and research implications are discussed.

Women's spousal choices and a man's handshake: Evidence from a Norwegian study of cohort differences

Both high grip strength and being married independently relate to better functional capacity and health at older ages, but the combined effect of marital status and strength have not been investigated. Especially at older ages, declining strength can have adverse health and social consequences, where having a spouse could potentially help with everyday support and alleviate some of the negative effects of sarcopenia. We investigate how grip strength relates to being married among two cohorts of 59–71 year olds (born 1923-35 and 1936-48) in the Norwegian city of Tromsø, controlling for a broad set of health variables and sociodemographic characteristics. The baseline included N = 5009 participants of whom 649 died during follow-up. We find that for men, particularly among younger cohorts, the physically stronger are more likely to be married, but no relation is found for women. This is consistent with a hypothesis that women increasingly have selected male marital partners based on preferred individual traits, whereas men do not emphasize strength when selecting women. We find that both marital status and grip strength independently affect mortality, but there is no significant joint effect. However, the distribution of strength and marital status implies that more men than women and increasing shares of later born cohorts have a “double-burden” of low strength and a lack of support from a spouse.