Marital status,labour force activity and mortality: A study in the USA and six European countries

Abstract

Aims: Labour force activity and marriage share some pathways through which they potentially influence health. In this paper, we examine whether marriage and labour force participation interact in the way they influence mortality in the USA and six European countries. Methods: We used data from the US National Health Interview Survey linked to the National Death Index, and national mortality registry data for Austria, England/Wales, Finland, Hungary, Norway and Spain (specifically, the Basque country) during 1999–2007, for men and women aged 30–59 years at baseline. We used Poisson regression to estimate both the additive (relative excess risk due to interaction) and multiplicative interactions between marriage and labour force activity on mortality. Results: Labour force inactivity was associated with higher mortality, but this association was stronger for unmarried, rather than married, individuals. Likewise, being unmarried was associated with higher mortality, but this association was stronger for inactive than for active individuals. To illustrate, among US women out of the labour force, being unmarried was associated with a 3.98 times (95%CI 3.28–4.82) higher risk of dying than being married; whereas the relative risk (RR) was 2.49 (95%CI 2.10–2.94), for women who were active in the labour market. Although this interaction between marriage and labour force activity was only significant for women on a multiplicative scale, there was a significant additive interaction for both men and women. The pattern was similar across all countries. Conclusions: Marriage attenuated the increased mortality risk associated with labour force inactivity; while labour force activity attenuated the mortality risk associated with being unmarried. Our study emphasizes the importance of public health and social policies that improve the health and well-being of unmarried and inactive men and women.

Keywords

Comparative study employment status marital status mortality public health risk factors unemployment

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References

Goldman

. Mortality differentials by marital status: An international comparison. Demography 1990;27:233–50.

Wyke

Ford

. Competing explanations for associations between marital status and health. Soc Sci Med 1992;34:523–32.

Waldron

Hughes

Brooks

. Marriage protection and marriage selection: Prospective evidence for reciprocal effects of marital status and health. Soc Sci Med 1996;43:113–23.

Ross

Mirowsky

. Does employment affect health? J Health Soc Behav 1995;36:230–43.

Artazcoz

Borrell

Benach

. Women, family demands and health: The importance of employment status and socio-economic position. Soc Sci Med 2004;59:263–74.

Åhs

AMH

Westerling

. Mortality in relation to employment status during different levels of unemployment. Scand J Pub Health 2006;34:159–67.

Umberson

. Gender, marital status and the social control of health behavior. Soc Sci Med 1992;34:907–17.

Arber

. Class, paid employment and family roles: Making sense of structural disadvantage, gender and health status. Soc Sci Med 1991;32:425–36.

Waldron

Jacobs

. Effects of labor force participation on women’s health: New evidence from a longitudinal study. J Occup Med 1988;30:977–83.

10.

Martikainen

. Women’s employment, marriage, motherhood and mortality: A test of the multiple role and role accumulation hypotheses. Soc Sci Med 1995;40:199–212.

11.

Verbrugge

. Role burdens and physical health of women and men. Women Health 1986;11:47–77.

12.

Kostiainen

Martelin

Kestilä

. Employee, partner and mother: Woman’s three roles and their implications for health. J Fam Issues 2009;30:1122–50.

13.

Goode

. A theory of role strain. Am Sociol Rev 1960;25:483–96.

14.

Sorensen

Verbrugge

. Women, work and health. Ann Rev Pub Health 1987;8:235–51.

15.

Harryson

Novo

Hammarström

. Is gender inequality in the domestic sphere associated with psychological distress among women and men? Results from the Northern Swedish Cohort. J Epidemiol Commun Health 2012;66:271–6.

16.

Artazcoz

Borrell

Benach

. Gender inequalities in health among workers: The relation with family demands. J Epidemiol Commun Health 2001;55:639–47.

17.

Aaberge

Björklund

Jäntti

. Income inequality and income mobility in the Scandinavian countries compared to the United States. Rev Income Wealth 2002;48:443–69.

18.

The Organisation for Economic Co-operation and Development (OECD). Benefits and wages: Statistics, www.oecd.org/els/soc/GRR_EN.xlsx. (2013, accessed 1 March 2014).

19.

Knol

VanderWeele

. Recommendations for presenting analyses of effect modification and interaction. Int J Epidemiol 2012;41:514–20.

20.

Eikemo

Mackenbach

. EURO-GBD-SE project final report, www.euro-gbd-se.eu/fileadmin/euro-gbd-se/public-files/EURO-GBD-SE_Final_report.pdf. (2012, accessed 1 December 2013).

21.

Adams

Dey

Vickerie

. Summary health statistics for the US population: National Health Interview Survey, 2005. Vital Health Stat 2007;10:1–104.

22.

Harper

Lynch

Burris

. Trends in the black-white life expectancy gap in the United States, 1983–2003. J Am Med Ass 2007;297:1224–32.

23.

UNESCO. International standard classification of education: ISCED 1997, www.unesco.org/education/information/nfsunesco/doc/isced_1997.htm. (1997, accessed 22 July 2013).

24.

Blot

Day

. Synergism and interaction: Are they equivalent? Am J Epidemiol 1979;110:99–100.

25.

Baxter

. Gender equality and participation in housework: A cross-national perspective. J Comp Fam Stud 1997;28:220–47.

26.

Sung

. A review of the healthy worker effect in occupational epidemiology. Occup Med 1999;49:225–9.

27.

Koskinen

Joutsenniemi

Martelin

. Mortality differences according to living arrangements. Am J Epidemiol 2007;36:1255–64.

28.

The Organisation for Economic Co-operation and Development. SF3.3: Cohabitation rate and prevalence of other forms of partnership, www.oecd.org/els/soc/SF3_3_Cohabitation_rate_and_prevalence_of_other_forms_of_partnership_Jan2013.pdf. (2013, accessed 1 June 2014).

29.

Ingram

Lochner

Cox

. Mortality experience of the 1986–2000 National Health Interview Survey Linked Mortality Files participants. Vital Health Stat 2008;2:1–37.

30.

Rehkopf

Strully

Dow

. The short-term impacts of Earned Income Tax Credit disbursement on health. Int J Epidemiol 2014;43:1884–94.