Objective To determine relationships between U.S. women’s exposure to midlife work-family demands and subsequent mortality risk. Methods Using Health and Retirement Study women born 1935–1956, we calculated employment, marital, and parenthood statuses for each age between 16–50. Using sequence analysis, we identified seven prototypical work-family trajectories. We calculated age-standardized mortality rates and hazard ratios (HRs) for mortality associated with work-family sequence, adjusting for covariates and potentially explanatory later-life factors. Results Women staying home with children briefly before reentering the workforce had the lowest mortality rates. Compared to these women and adjusting for age, race/ethnicity, and education, HRs for mortality were 2.14 (1.58,2.90) among single non-working mothers and 1.48 (1.06,1.98) among single working mothers. Married stay-at-home mothers were also at increased risk (1.36; 1.02,1.80). Adjusting for later-life behavioral (smoking, BMI) and economic (household wealth) factors partially attenuated risks. Conclusions Women whose lifetime work-family experience is characterized primarily by being a working single mother, non-working single mother, or a never-working married mother may have elevated mortality risk later on, compared with mothers who spent the majority of midlife in the workforce.

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