Sage Journals: Discover world-class research

Abstract

This study examines the relationship between spousal education and hypertension risk among older couples. Using data from the National Social Life, Health & Aging Project (NSHAP) Round 3 (2015–2016), we analyzed 1,214 couples aged 50 and older. Hypertension was assessed through biological and self-reported measures. Spousal education was categorized by college degree attainment. The Actor-Partner Interdependence Mediation Model (APIMeM) was used to examine the mediating roles of economic resources and health behaviors. Results showed that a wife’s college degree was associated with lower hypertension risk for both spouses, whereas a husband’s college degree showed no significant association. Mediation analysis revealed that health behaviors, but not economic resources, partially explained this relationship. Findings suggest that a wife’s education plays a greater role in a couple’s hypertension risk than a husband’s, emphasizing the need for interventions targeting couples with a lower-educated wife to improve cardiovascular health in older adults.

Keywords

education gender hypertension marriage spouse

Get full access to this article

View all access options for this article.

References

Banks

Kelly

Smith

J. P.

(2014). Spousal health effects: The role of selection. In Wise

(Ed.), Discoveries in the economics of aging . University of Chicago Press.

Brown

D. C.

Hummer

R. A.

Hayward

M. D.

(2014). The importance of spousal education for the self-rated health of married adults in the United States. Population Research and Policy Review, 33(1), 127–151. https://doi.org/10.1007/s11113-013-9305-6

Brown

S. L.

Kawamura

(2010). Relationship quality among cohabitors and marrieds in older adulthood. Social Science Research, 39(5), 777–786. https://doi.org/10.1016/j.ssresearch.2010.04.010

Brynin

Francesconi

(2004). The material returns to partnership: The effects of educational matching on labour market outcomes and gender equality. European Sociological Review, 20(4), 363–377. https://doi.org/10.1093/esr/jch031

Brynin

Schupp

(2000). Education, employment, and gender inequality amongst couples: A comparative analysis of Britain and Germany. European Sociological Review, 16(4), 349–365. https://doi.org/10.1093/esr/16.4.349

Choi

A. I.

Weekley

C. C.

Chen

S.-C.

Kurella Tamura

Norris

K. C.

Shlipak

M. G.

(2011). Association of educational attainment with chronic disease and mortality: The kidney early evaluation program (KEEP). American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 58(2), 228–234. https://doi.org/10.1053/j.ajkd.2011.02.388

Diaz

Shimbo

(2013). Physical activity and the prevention of hypertension. Current Hypertension Reports, 15(6), 659–668. https://doi.org/10.1007/s11906-013-0386-8

Domingue

B. W.

Fletcher

Conley

Boardman

J. D.

(2014). Genetic and educational assortative mating among US adults. Proceedings of the National Academy of Sciences of the United States of America, 111(22), 7996–8000. https://doi.org/10.1073/pnas.1321426111

D’souza

(2023). In sickness and health: Spousal concordance of hypertension and shared strategies for management. Journal of the American Heart Association, 12(24), Article e033064. https://doi.org/10.1161/JAHA.123.033064

10.

Elder

G. H.

Johnson

M. K.

Crosnoe

(2003). The emergence and development of life course theory. In Mortimer

J. T.

Shanahan

M. J.

(Eds.), Handbooks of the life course (pp. 3–19). Kluwer Academic/Plenum Publishers.

11.

Greenstone

Looney

(2012). Education is the key to better jobs. Brookings. The Hamilton Project.

12.

Guo

Lin

Zhang

(2020). The cross-spousal effect of education on health. Journal of Development Economics, 146, Article 102493. https://doi.org/10.1016/j.jdeveco.2020.102493

13.

Guo

Yang

(2024). Spousal education and frailty levels among Chinese older adults: A national longitudinal study. SSM - Population Health, 26, Article 101607. https://doi.org/10.1016/j.ssmph.2024.101607

14.

Halperin

R. O.

Michael Gaziano

Sesso

H. D.

(2008). Smoking and the risk of incident hypertension in middle-aged and older men. American Journal of Hypertension, 21(2), 148–152. https://doi.org/10.1038/ajh.2007.36

15.

Hernandez

E. M.

Margolis

Hummer

R. A.

(2018). Educational and gender differences in health behavior changes after a gateway diagnosis. Journal of Aging and Health, 30(3), 342–364. https://doi.org/10.1177/0898264316678756

16.

Horowitz

(2018). Relative education and the advantage of a college degree. American Sociological Review, 83(4), 771–801. https://doi.org/10.1177/0003122418785371

17.

Huang

Liu

P. W.

Zhang

(2009). Why does spousal education matter for earnings? Assortative mating and cross‐productivity. Journal of Labor Economics, 27(4), 633–652. https://doi.org/10.1086/644746

18.

Jaffe

D. H.

Eisenbach

Neumark

Y. D.

Manor

(2006). Effects of Husbands’ and Wives’ education on each other’s mortality. Social Science & Medicine, 62(8), 2014–2023. https://doi.org/10.1016/j.socscimed.2005.08.030

19.

Jaffe

D. H.

Eisenbach

Neumark

Y. D.

Manor

(2005). Does one’s own and one’s spouse’s education affect overall and cause-specific mortality in the elderly? International Journal of Epidemiology, 34(6), 1409–1416. https://doi.org/10.1093/ije/dyi185

20.

Kashy

D. A.

Kenny

D. A.

(2000). The analysis of data from dyads and groups. In Reis

H. T.

Judd

C. M.

(Eds.), Handbook of research methods in social psychology (pp. 451–477): Cambridge University Press.

21.

Kenny

D. A.

Kashy

D. A.

Cook

W. L.

(2006). Dyadic data analysis. The Guilford Press.

22.

Kiely

Gross

Kim

Lipsitz

(2012). The association of educational attainment and SBP among older community-living adults: The maintenance of balance, independent living, intellect and zest in the elderly (MOBILIZE) Boston study. Journal of Hypertension, 30(8), 1518–1525. https://doi.org/10.1097/HJH.0b013e3283550fc0

23.

Kotwal

A. A.

Lauderdale

D. S.

Waite

L. J.

Dale

(2016). Differences between husbands and wives in colonoscopy use: Results from a national sample of married couples. Preventive Medicine, 88, 46–52. https://doi.org/10.1016/j.ypmed.2016.03.011

24.

Lamu

A. N.

Chen

Olsen

J. A.

(2023). Amplified disparities: The association between spousal education and own health. Social Science & Medicine, 323(115832), Article 115832. https://doi.org/10.1016/j.socscimed.2023.115832

25.

Mutchler

J. E.

Miller

E. A.

Tucker-Seeley

Xiao

J. J.

(2023). Financial literacy in the family context: The role of spousal education and gender among older couples. Journal of Family Issues, 44(9), 2469–2491. https://doi.org/10.1177/0192513x221105244

26.

Liao

Zhang

Xie

(2021). Gender specificity of spousal concordance in the development of chronic disease among middle-aged and older Chinese couples: A prospective dyadic analysis. International Journal of Environmental Research and Public Health, 18(6), 2886. https://doi.org/10.3390/ijerph18062886

27.

Liu

Chopik

W. J.

Shrout

M. R.

Wang

(2024). A national longitudinal dyadic analysis of spousal education and cognitive decline in the United States. Social Science & Medicine, 343, Article 116603. https://doi.org/10.1016/j.socscimed.2024.116603

28.

Liu

Waite

(2014). Bad marriage, broken heart? Age and gender differences in the link between marital quality and cardiovascular risks among older adults. Journal of Health and Social Behavior, 55(4), 403–423. https://doi.org/10.1177/0022146514556893

29.

Liu

Yang

Lyu

Zhang

Liu

Lei

Deng

Zhao

Xie

Huang

Zhang

Peng

Wang

(2023). Declined prevalence, improved awareness and control of hypertension are associated with spousal educational attainment: A mega-data study. Social Science & Medicine, 336, Article 116256. https://doi.org/10.1016/j.socscimed.2023.116256

30.

Liu

S. Y.

Buka

S. L.

Linkletter

C. D.

Kawachi

Kubzansky

Loucks

E. B.

(2011). The association between blood pressure and years of schooling versus educational credentials: Test of the sheepskin effect. Annals of Epidemiology, 21(2), 128–138. https://doi.org/10.1016/j.annepidem.2010.11.004

31.

Lutfey

Freese

(2005). Toward some fundamentals of fundamental causality: Socioeconomic status and health in the routine clinic visit for diabetes. American Journal of Sociology, 110(5), 1326–1372. https://doi.org/10.1086/428914

32.

McDoom

M. M.

Palta

Vart

Juraschek

S. P.

Kucharska-Newton

Roux

A. V. D.

Coresh

(2018). Late life socioeconomic status and hypertension in an aging cohort: The atherosclerosis risk in communities study. Journal of Hypertension, 36(6), 1382–1390. https://doi.org/10.1097/HJH.0000000000001696

33.

McEniry

Samper-Ternent

Flórez

C. E.

Pardo

Cano-Gutierrez

(2019). Patterns of SES health disparities among older adults in three upper middle-and two high-income countries. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 74(6), e25–e37. https://doi.org/10.1093/geronb/gby050

34.

McMaughan

D. J.

Oloruntoba

Smith

M. L.

(2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8, 231. https://doi.org/10.3389/fpubh.2020.00231

35.

Meyler

Stimpson

J. P.

Peek

M. K.

(2007). Health concordance within couples: A systematic review. Social Science & Medicine, 64(11), 2297–2310. https://doi.org/10.1016/j.socscimed.2007.02.007

36.

Miller

P. M.

Anton

R. F.

Egan

B. M.

Basile

Nguyen

S. A.

(2005). Excessive alcohol consumption and hypertension: Clinical implications of current research. Journal of Clinical Hypertension, 7(6), 346–351. https://doi.org/10.1111/j.1524-6175.2004.04463.x

37.

Mirowsky

Ross

C. E.

(2003). Education, social status and health. Aldine de Gruyter.

38.

Murakami

Ohkubo

Hashimoto

(2017). Distinct association between educational attainment and overweight/obesity in unmarried and married women: Evidence from a population-based study in Japan. BMC Public Health, 17(1), 1–9. https://doi.org/10.1186/s12889-017-4912-5

39.

Muthén

L. K.

Muthén

B. O.

(2017). Mplus user’s guide. Eighth edition. Muthén & Muthén.

40.

National Institute on Alcohol Abuse and Alcoholism . (2023). Drinking levels defined. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

41.

National Heart, Lung, and Blood Institute . (2003). The seventh report of the joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. U.S. Department of Health and Human Services.

42.

Neufcourt

Zins

Berkman

L. F.

Grimaud

(2021). Socioeconomic disparities and risk of hypertension among older Americans: The health and retirement study. Journal of Hypertension, 39(12), 2497–2505. https://doi.org/10.1097/HJH.0000000000002959

43.

Oliker

(2011). Sociology and studies of gender, caregiving, and inequality. Sociology Compass, 5(11), 968–983. https://doi.org/10.1111/j.1751-9020.2011.00417.x

44.

Ostchega

Fryar

C. D.

Nwankwo

Nguyen

D. T.

(2020). Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. https://www.cdc.gov/nchs/data/databriefs/db364-h.pdf

45.

Pandit

A. U.

Tang

J. W.

Bailey

S. C.

Davis

T. C.

Bocchini

M. V.

Persell

S. D.

Federman

A. D.

Wolf

M. S.

(2009). Education, literacy, and health: Mediating effects on hypertension knowledge and control. Patient Education and Counseling, 75(3), 381–385. https://doi.org/10.1016/j.pec.2009.04.006

46.

Pescatello

Buchner

Jakicic

Powell

Kraus

Bloodgood

Campbell

Dietz

DiPietro

George

Macko

Pate

Piercy

(2019). Physical activity to prevent and treat hypertension: A systematic review. Medicine & Science in Sports & Exercise, 51(6), 1314–1323. https://doi.org/10.1249/MSS.0000000000001943

47.

Roerecke

Tobe

Kaczorowski

Bacon

Vafaei

Hasan

Krishnan

Raifu

Rehm

(2018). Sex‐specific associations between alcohol consumption and incidence of hypertension: A systematic review and meta‐analysis of cohort studies. Journal of the American Heart Association, 7(13), Article e008202. https://doi.org/10.1161/JAHA.117.008202

48.

Schone

B. S.

Weinick

R. M.

(1998). Health-related behaviors and the benefits of marriage for elderly persons. The Gerontologist, 38(5), 618–627. https://doi.org/10.1093/geront/38.5.618

49.

Simon

R. W.

(2002). Revisiting the relationships among gender, marital status, and mental health. AJS; American journal of sociology, 107(4), 1065–1096. https://doi.org/10.1086/339225

50.

Singh

S. K.

Singh

S. K.

Iquebal

M. A.

Jaiswal

Singh

(2022). Prevalence of hyperuricemia and the relationship between serum uric acid and hypertension in new onset diabetic patients: A cross-sectional Indian study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 15, 1809–1817. https://doi.org/10.2147/DMSO.S363311

51.

Smith

K. R.

Zick

C. D.

(1994). Linked lives, dependent demise? Survival analysis of husbands and wives. Demography, 31(1), 81–93. https://doi.org/10.2307/2061909

52.

Spruill

T. M.

Butler

M. J.

Thomas

S. J.

Tajeu

G. S.

Kalinowski

Castañeda

S. F.

Langford

A. T.

Abdalla

Blackshear

Allison

Ogedegbe

Sims

Shimbo

(2019). Association between high perceived stress over time and incident hypertension in black adults: Findings from the Jackson heart study. Journal of the American Heart Association, 8(21), Article e012139. https://doi.org/10.1161/JAHA.119.012139

53.

Sun

Lin

Zhao

Liu

Chen

Shi

L.-X.

Yang

Wan

Wang

Luo

Qin

Tang

Chen

Huo

Ning

(2022). Association of education levels with the risk of hypertension and hypertension control: A nationwide cohort study in Chinese adults. Journal of Epidemiology & Community Health, 76(5), 451–457. https://doi.org/10.1136/jech-2021-217006

54.

Takagi

Kondo

Takada

Hashimoto

(2014). Differences in spousal influence on smoking cessation by gender and education among Japanese couples. BMC Public Health, 14(1), 1184. https://doi.org/10.1186/1471-2458-14-1184

55.

Tebeje

T. M.

Fikreyesus

Lerango

T. L.

Sisay

(2025). Undiagnosed hypertension and associated factors among older adults in Gedeo zone, southern Ethiopia: A mixed methods approach. PLoS One, 20(5), Article e0322610. https://doi.org/10.1371/journal.pone.0322610

56.

Umberson

(1987). Family status and health behaviors: Social control as a dimension of social integration. Journal of Health and Social Behavior, 28(3), 306–319. https://doi.org/10.2307/2136848

57.

Umberson

(1992). Gender, marital status and the social control of health behavior. Social Science & Medicine, 34(8), 907–917. https://doi.org/10.1016/0277-9536(92)90259-S

58.

Varghese

J. S.

Choi

Kobayashi

L. C.

Ali

M. K.

Patel

S. A.

(2023). Spousal concordance of hypertension among middle‐aged and older heterosexual couples around the world: Evidence from studies of aging in the United States, England, China, and India. Journal of the American Heart Association, 12(24), Article e030765. https://doi.org/10.1161/JAHA.123.030765

59.

Wang

Y.-Y.

Kong

Zheng

Zhao

Chen

Wang

Ning

Wang

(2022). Independent associations of education, intelligence, and cognition with hypertension and the mediating effects of cardiometabolic risk factors: A Mendelian randomization study. Hypertension, 80(1), 192–203. https://doi.org/10.1161/HYPERTENSIONAHA.122.20286

60.

Wang

Song

Shen

Zheng

Ding

(2017). Spousal concordance for hypertension: A meta-analysis of observational studies. Journal of Clinical Hypertension, 19(11), 1088–1095. https://doi.org/10.1111/jch.13084

61.

Watanabe

Sugiyama

Takahashi

Noguchi

Tamiya

(2020). Concordance of hypertension, diabetes and dyslipidaemia in married couples: Cross-sectional study using nationwide survey data in Japan. BMJ Open, 10(7), Article e036281. https://doi.org/10.1136/bmjopen-2019-036281

62.

Watson

K. B.

Carlson

S. A.

Gunn

J. P.

Galuska

D. A.

O'Connor

Greenlund

K. J.

Fulton

J. E.

(2016). Physical inactivity among adults aged 50 years and older - United States, 2014. Morbidity and Mortality Weekly Report (MMWR), 65(36), 954–958. https://doi.org/10.15585/mmwr.mm6536a3

63.

World Health Organization . (2023). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension

64.

(2020). Spousal education and cognitive functioning in later life. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 75(7), e141–e150. https://doi.org/10.1093/geronb/gbz014

65.

Yang

Qian

Liu

(2017). Socioeconomic disparities in prevalence, awareness, treatment, and control of hypertension over the life course in China. International Journal for Equity in Health, 16(1), 100. Scopus. https://doi.org/10.1186/s12939-017-0597-8

66.

Zacher

(2023). Educational disparities in hypertension prevalence and blood pressure percentiles in the health and retirement study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 78(9), 1535–1544. https://doi.org/10.1093/geronb/gbad084

67.

Zhang

Dailey

Brook

R. D.

Opara

I. N.

Liu

Carbone

J. T.

Levy

P. D.

(2024). Lower socioeconomic status, psychological distress, and self-reported hypertension: A longitudinal moderated mediation analysis. American Journal of Hypertension, 37(3), 207–219. https://doi.org/10.1093/ajh/hpad113

68.

Zhong

(2015). Does a college education cause better health and health behaviours? Applied Economics, 47(7), 639–653. https://doi.org/10.1080/00036846.2014.978074

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.

0.00 MB

0.74 MB

A National Dyadic Study of Spousal Education and Hypertension Among Older Couples in the United States

Abstract

Keywords

Get full access to this article

References

Supplementary Material