Residential status and health in middle and late life: a population-based study with new data from Spain

Abstract

ObjectivesTo address how different residential situations impact the likelihood of death among mature adults and elderly persons.DesignPopulation-based study with administrative data linked to census data.SettingSpain.ParticipantsSpanish population alive on 1 January 2012, observed between 1 January 2012 and 31 December 2012. A 10% random sample of the Spanish population, including 2 054 427 person years and 28 736 deaths, is used.Main outcome measureRegistered deaths in the 2012 Spanish vital statistics.MethodsUsing a new data set based on linked administrative registers, we estimate unadjusted and adjusted mortality rates by coresidential situation. Differential mortality is measured by rate ratios (RR) estimated with Poisson regression. Cause of death data are used to explore the mechanisms involved in excess mortality by residential status.ResultsCompared with men 45–54 living with partners, the risk of death is much higher for those without partners living with others (RR 2.0, 95% CI 1.7 to 2.4) or for those living alone (RR 1.9, 95% CI 1.5 to 2.4). After 84, excess mortality among men living with others persists (RR 1.4, 95% CI 1.3 to 1.5), but disappears for those living alone (RR 1.0, 95% CI 0.9 to 1.1). Both among women 45–64 living with others but without partner (RR 1.8, 95% CI 1.5 to 2.3) and among those living alone (RR 2.2, 95% CI 1.5 to 3.1) the pattern is similar to men. At higher ages, however, excess mortality for women living alone decreases (RR 1.2, 95% CI 1.1 to 1.2), though it persists for women living with others (RR 1.9, 95% CI 1.7 to 2.0).ConclusionsThese findings indicate direct effects of living arrangements on mortality and health-related selection effects influencing residential choices. These effects may be partially affected by age and prevailing societal and cultural contexts.

The COVID-19 pandemic in an aging world

“…Whether or not elderly living on their own are more or less likely to become infected is a matter of conjecture and theoretical arguments can be given both in favour and against. It is well known that the baseline health of elderly people living alone tends to be higher than it is for those living with others, mostly because during old age prior health is a pre-requisite for living alone (Reher and Requena, 2020). Moreover, at least in theory, individuals living alone have greater opportunities to self-isolate and this could potentially reduce their rates of COVID-19 contagion.…”

“…In the long run, individuals living with spouses are likely to be better placed both for shortrun and for long-run health and wellbeing and, conversely, individuals living in multigenerational families -and certainly those in institutions-are the most poorly positioned, at least in times of epidemic disease (Requena and Reher, 2020;Frisch and Simonsen, 2013;Koskinen et al, 2007). Elderly individuals in living arrangements that expose them to contagion, either from younger household members or staff at institutions, are likely to constitute a highly vulnerable group.…”

Marital status, living arrangements, and mortality in middle and older age in Europe

“…Furthermore, a meta-analysis found different mortality risk associated with widowhood across European regions (Shor et al 2012 ). Overall, the health benefits associated with family structure are found to be stronger in familialistic countries, i.e., South-East Europe, with less generous welfare states and where more people subscribe to norms of strong family obligations, than in more individualistic countries in the North-West, with more socially oriented welfare states (Requena and Reher 2020 ). Because of these well-established differences in the role of family and welfare states across European regions, studying the role of both marital status and living arrangements in health outcomes is assumed to be particularly relevant.…”

“…Although living arrangements and marital status in both mid- and later life largely result from individual choices over the life course, institutional and normative factors also play a role (Pfau-Effinger 2005 ). However, mainly due to data limitations, the variation in the association between family structure and mortality across different welfare states is currently under researched (Hank and Steinbach 2018 ; Requena and Reher 2020 ). This study contributes to the growing body of the literature examining the relationship between family structure, living arrangements, and mortality.…”

“…However, most research about differential mortality by marital status or living arrangements has a national scope and overlooked a comparative perspective (see Hu and Goldman 1990 ; Murphy et al 2007 ; Noale et al 2005 ; Valkonen et al 2004 for some exceptions). Therefore, understanding the interrelation between partnership or residential status and mortality across societal settings remains an open question (Hank and Steinbach 2018 ; Requena and Reher 2020 ).…”