This study challenges two well-established associations in medical sociology: the beneficial effect of marriage on health and the predictive power of self-rated health on mortality. Using The National Health Interview Survey 1986-2004 with 1986-2006 mortality follow-up (789,096 respondents with 24,095 deaths) and Cox Proportional Hazards Models, we find the protective effect of marriage against mortality decreases with deteriorating health so that the married and unmarried in poor health are at similar risk for death. We also find the power of self-rated health to predict mortality is higher for the married than for any unmarried group. By using ordered logistic regression models, we find thresholds shift such that, compared to the unmarried, the married may not report poorer health until developing more severe health problems. These findings suggest the married tend to overestimate their health status. These two phenomena (diminishing protection and overestimation) contribute to but do not completely explain each other.
BenyaminiYaelIdlerEllen L.1999. “Community Studies Reporting Association between Self-rated Health and Mortality: Additional Studies, 1995 to 1998.” Research on Aging21:392–401.
2.
BerkmanLisa F.BreslowLester1983. Health and Ways of Living: The Alameda County Study. New York: Oxford University Press.
3.
BerkmanLisa F.GlassThomas2000. “Social Integration, Social Networks, Social Support, and Health”. Pp. 137–73 in Social Epidemiology, edited by BerkmanL. F.KawachiI.New York: Oxford University Press.
4.
CohenSheldon2004. “Social Relationships and Health”. American Psychologist59:676–84.
5.
DeegDorly J. H.KriegsmanDidi M. W.2003. “Concepts of Self-rated Health: Specifying the Gender Difference in Mortality Risk”. Gerontologist43:376–86.
6.
DowdJennifer BeamZajacovaAnna2007. “Does the Predictive Power of Self-rated Health for Subsequent Mortality Risk Vary by Socioeconomic Status in the US?” International Journal of Epidemiology36:1214–21.
7.
DupreMatthew E.BeckAudrey N.MeadowsSarah O.2009. “Marital Trajectories and Mortality among US Adults”. American Journal of Epidemiology170:546–55.
8.
FoxJohn2008. Applied Regression Analysis and Generalized Linear Models. Thousand Oaks, CA: Sage.
9.
FranksPeterGoldMarthe E.FiscellaKevin2003. “Sociodemographics, Self-rated Health, and Mortality in the US”. Social Science & Medicine56:2505–14.
10.
GindinJacobWalter-GinzburgAdrianGeitzenMosheEpsteinShulamitLeviShmuelLandiFranciscoBernabeiRoberto2007. “Predictors of Rehabilitation Outcomes: A Comparison of Israeli and Italian Geriatric Post-acute Care (PAC) Facilities Using the Minimum Data Set (MDS)”. Journal of the American Medical Directors Association8:233–42.
11.
GoebelerSirkkaJylhaMarjaHervonenAntti2007. “Self-reported Medical History and Self-rated Health at Age 90. Agreement with Medical Records”. Aging Clinical and Experimental Research19:213–19.
12.
GoodwinJames S.HuntWilliam C.KeyCharles R.SametJonathan M.1987. “The Effect of Marital Status on Stage, Treatment, and Survival of Cancer Patients “JAMA—Journal of the American Medical Association258:3125–30.
13.
GreenB. H.CopelandJ. R. M.DeweyM. E.SharmaV.DavidsonI. A.1994. “Factors Associated with Recovery and Recurrence of Depression in Older People: A Prospective Study”. International Journal of Geriatric Psychiatry9:789–95.
14.
GrundyEmilyGlaserKaren2000. “Socio-demographic Differences in the Onset and Progression of Disability in Early Old Age: A Longitudinal Study”. Age and Ageing29:149–57.
15.
HaysJudith C.SchoenfeldDavidBlazerDan G.GoldDeborah T.1996. “Global Self-ratings of Health and Mortality: Hazard in the North Carolina Piedmont”. Journal of Clinical Epidemiology49:969–79.
16.
HuYuanrengGoldmanNoreen1990. “Mortality Differentials by Marital Status: An International Comparison”. Demography27:233–50.
17.
IdlerEllen L.AngelRonald J.1990. “Self-rated Health and Mortality in the NHANES-I Epidemiologic Follow-up Study”. American Journal of Public Health80:446–52.
18.
IdlerEllen L.BenyaminiYael1997. “Self-rated Health and Mortality: A Review of Twenty-seven Community Studies”. Journal of Health and Social Behavior38:21–37.
19.
IdlerEllen L.HudsonShawna V.LeventhalHoward1999. “The Meanings of Self-ratings of Health”. Research on Aging21:458–76.
20.
JohnsonNorman J.BacklundEricSorliePaul D.LovelessCatherine A.2000. “Marital Status and Mortality: The National Longitudinal Mortality Study”. Annals of Epidemiology10:224–38.
21.
JylhaMarjaVolpatoStefanoGuralnikJack M.2006. “Self-rated Health Showed a Graded Association with Frequently Used Biomarkers in a Large Population Sample”. Journal of Clinical Epidemiology59:465–71.
22.
KawadaTomoyukiSuzukiShosukeTsukiokaTokioIesakiSatoru2006. “Factors Associated with Perceived Health of Very Old Inhabitants of Japan”. Gerontology52:258–63.
23.
KennedyByron S.KaslStanislav V.VaccarinoViloa2001. “Repeated Hospitalizations and Self-rated Health among the Elderly: A Multivariate Failure Time Analysis”. American Journal of Epidemiology153:232–41.
24.
KrauseNeal M.JayGina M.1994. “What Do Global Self-rated Health Items Measure?” Medical Care32:930–42.
25.
LeeSei J.Moody-AyersSandra Y.LandefeldC. SethWalterLouise C.LindquistKarlaSegalMark R.CovinskyKenneth E.2007. “The Relationship between Self-rated Health and Mortality in Older Black and White Americans”. Journal of the American Geriatrics Society55:1624–29.
26.
LindeboomMaartenvan DoorslaerEddy2004. “Cut-point Shift and Index Shift in Self-reported Health”. Journal of Health Economics23:1083–99.
27.
LindstromMartin2009. “Marital Status, Social Capital, Material Conditions and Self-rated Health: A Population-based Study”. Health Policy93:172–79.
28.
LiuHui2009. “Till Death Do Us Part: Marital Status and US Mortality Trends, 1986-2000.” Journal of Marriage and the Family71:1158–73.
29.
LiuHuiUmbersonDebra2008. “The Times They Are a Changin’: Marital Status and Health Differentials from 1972 to 2003.” Journal of Health and Social Behavior49:239–53.
30.
LyyraTiina-MariHeikkinenEinoLyyraAnna-LiisaJylhaMarja2006. “Self-rated Health and Mortality: Could Clinical and Performance-based Measures of Health and Functioning Explain the Association?” Archives of Gerontology and Geriatrics42:277–88.
31.
LyyraTiina-MariLeskinenEskoJylhaMarjaHeikkinenEino2009. “Self-rated Health and Mortality in Older Men and Women: A Time-dependent Covariate Analysis”. Archives of Gerontology and Geriatrics48:14–18.
32.
MacWilliamCynthia H.YoodMarianne U.VernerJames J.McCarthyBruce D.WardRichard E.1996. “Patient-related Risk Factors That Predict Poor Outcome after Total Hip Replacement”. Health Services Research31:623–38.
33.
ManzoliLambertoVillariPaoloPironeGiovanni M.BocciaAntonio2007. “Marital Status and Mortality in the Elderly: A Systematic Review and Meta-analysis”. Social Science & Medicine64:77–94.
34.
MelzerDavidLanTzuo-YunTomBrian D. M.DeegDorly J. H.GuralnikJack M.2004. “Variation in Thresholds for Reporting Mobility Disability between National Population Subgroups and Studies”. Journal of Gerontology: Medical Sciences59:1295–1303.
35.
MinhHoang V.ByassPeterWallStig2010. “Multilevel Analysis of Effects of Individual Characteristics and Household Factors on Self-rated Health among Older Adults in Rural Vietnam”. Geriatrics & Gerontology International10:209–15.
36.
OkamotoKazushiMomoseYumikoFujinoAyumiOsawaYukari2008. “Gender Differences in the Relationship between Self-rated Health (SRH) and 6-year Mortality Risks among the Elderly in Japan”. Archives of Gerontology and Geriatrics47:311–17.
37.
RegidorEnriqueGuallar-CastillonPilarGutierrez-FisacJuan L.BanegasJosé R.Rodriguez-ArtalejoFernando2010. “Socioeconomic Variation in the Magnitude of the Association between Self-rated Health and Mortality”. Annals of Epidemiology20:395–400.
38.
RohrerJames E.BernardMatthew E.ZhangYanRasmussenNorman H.WoroncowHalina2008. “Marital Status, Feeling Depressed and Self-rated Health in Rural Female Primary Care Patients”. Journal of Evaluation in Clinical Practice14:214–17.
39.
RohrerJames E.HermanDavid C.MerryStephen P.NaessensJames M.HoustonMargaret S.2009. “Validity of Overall Self-rated Health as an Outcome Measure in Small Samples: A Pilot Study Involving a Case Series”. Journal of Evaluation in Clinical Practice15:366–69.
40.
SchwerdtfegerAndreasFriedrich-MaiPeter2009. “Social Interaction Moderates the Relationship between Depressive Mood and Heart Rate Variability: Evidence from an Ambulatory Monitoring Study”. Health Psychology28:501–509.
41.
SpiersNicolaJaggerCarolClarkeMichaelArthurAntony2003. “Are Gender Differences in the Relationship between Self-rated Health and Mortality Enduring? Results from Three Birth Cohorts in Melton Mowbray, United Kingdom”. Gerontologist43:406–11.
42.
StrawbridgeWilliam J.WallhagenMargaret I.1999. “Self-rated Health and Mortality over Three Decades: Results from a Time-dependent Covariate Analysis”. Research on Aging21:402.
43.
ThongMelissa, S. Y.KapteinAdrian A.BenyaminiYaelKredietRaymond T.BoeschotenElizabeth W.DekkerFriedo W.2008. “Association between a Self-rated Health Question and Mortality in Young and Old Dialysis Patients: A Cohort Study”. American Journal of Kidney Diseases52:111–17.
44.
UmbersonDebra1992. “Gender, Marital Status and the Social Control of Health Behavior”. Social Science & Medicine34:907–17.
45.
WaiteLinda J.1995. “Does Marriage Matter?” Demography32:483–507.
46.
WalkerJennifer D.MaxwellColleen J.HoganDavid B.EblyErika M.2004. “Does Self-rated Health Predict Survival in Older Persons with Cognitive Impairment?” Journal of the American Geriatrics Society52:1895–1900.
47.
WhitsonHeather E.ThielkeStephenDiehrPaulaO’HareAnn M.ChavesPaulo H. M.ZakaiNeil A.ArnoldAliceChaudhrySarwatIvesDianeNewmanAnne B.2011. “Patterns and Predictors of Recovery from Exhaustion in Older Adults: The Cardiovascular Health Study”. Journal of the American Geriatrics Society59:207–13.
48.
WilcoxVictoria L.KaslStanislav V.IdlerEllen L.1996. “Self-rated Health and Physical Disability in Elderly Survivors of a Major Medical Event”. Journals of Gerontology Series B: Psychological Sciences and Social Sciences51:S96–S104.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
