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Health Effects Associated with Marital Status Transition Among Elders in China

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Health Effects Associated with Marital Status Transition Among Elders in China Health effects associated with marital status transition among elders in China Yu Sun, Virginia Tech, [email protected] Wen You, Virginia Tech, [email protected] Selected Paper prepared for presentation at the 2018 Agricultural & Applied Economics Association Annual Meeting, Washington, D.C., August 5-August 7 Copyright 2018 by [Yu Sun, Wen You.]. All rights reserved. Readers may make verbatim copies of this document for non-commercial purposes by any means, provided that this copyright notice appears on all such copies. 1. Introduction Elderly people’s health is determined not only by genetic factors, but also by nutritional and socioeconomic factors (Lindeboom, Portrait, and van den Berg 2002). Marital status is shown to be an essential determinant of health (Zella 2017; Kiecolt- Glaser and Newton 2001). Marriage has a protective effect on the elders’ health through daily care, financial and spiritual support (Zhou and Hearst 2016b). In addition, the transition of marital status have a particularly great impact on the health of older individuals. The loss of a spouse increases greatly the risk of depression or anxiety (Fried 2015; Turvey et al. 1999). If the martial status transition has a large effect on health among the aged people, the transition may be a useful signal for the health care workers to provide special health service on the occurrence of such an event. Insight in the effect of marital status transitions on health among the elder people is vital to monitor future needs of health care for the elders and carry out prevention of relevant diseases. This issue is especially vital to the Chinese health policy designers as rapid population aging and high divorce rate are two of the most pressing challenges in China. Rapid population aging has brought up not only challenges of health service and care but also rising economic burdens in China. The demands for health care for the aged individuals are determined by the distribution of health status among the elder population. According to the Social Service Development Statistical Bulletin, the proportion of population aged 60 and over has risen up to 16.7% of the total population by the end of 2016 (Ministry of Civil Affairs of the People's Republic of China 2017). The prevalence rate of chronic diseases among Chinese elders has been increasing dramatically from 50.1% in 2003 to 71.8% in 2013 (Department of Family Development 2016). The 13th Five-Year Plan of Healthy Aging in China highlights the needs of systematic research on understanding the effects of various factors on elder health to address the widespread concerns of healthy aging (The State Council 2017). Studies investigating the effects of marital status on health among Chinese elders are relatively rare in the current literature. Changes in marriage culture and patterns have led to decreasing marriage rate and rising divorce rate. According to data from Population Census of the People’s Republic of China, the number of divorced population aged 60 and older has increased from 0.79 million in 1990 to 1.38 million in 2010 (Sun 2015). Hence, there is an urgent need to explore the health effects of marital status transition among elderly population in China in order to promote the health of vulnerable elders by meeting their medical and economic needs. The purpose of this study is to further investigate the effects of marital status transition on health outcomes among Chinese elders. We will take into account the sequencing of marital statuses instead of current or initial marital status to provide a further understanding of how marital status transition affect health among elders. One problem with current marital status is that it does not consider the marital event sequence an individual has experienced (Burman and Margolin 1992). Specifically, stably married and one exit followed by remarriage can both lead to a current marital status of being married. Failing to consider the marital history may lead to biased conclusion that those drastically different marital history has the same effects on health outcomes. Following the labor economics literature, we hypothesize that marital transitions from married to divorce or to widowhood have negative effect on health among Chinese elders and much larger than other marital status sequences. In addition, marriage duration is positively associated with health, whereas the duration of divorce and widowhood has negative effects. Uncovering these associations is essential to better understand subsequent morbidity and mortality to assess the various needs of health care for elders. Furthermore, our study will provide information for pinpointing vulnerable elders who suffer more from the marital transitions with unmet needs of support from family and social security. Public health policies including psychological services, medical care and financial support should be provided with special attention to those population. We also investigate the gender discrepancy in the effects of the marital transition. 2. Literature on marriage and health Several theories and models are proposed to explain the association between health outcomes and marriage, including the stress/social support model (Berkman 1984), marriage protection theory (Umberson 1992; Ross, Mirowsky, and Goldsteen 1990; Va et al. 2011) and marital resource model (Gary 1981; Liu and Umberson 2008; Liu 2012) . The basic ideas are similar and indicate that social relationship is essential to health outcomes. In particular, marriage has a protective effect on health due to improved social support (Mirowsky and Ross 1989; Schieman, Van Gundy, and Taylor 2002), greater economic resources (Waite 2009; Mandara et al. 2010; Vespa and Painter 2011)and shift to healthy lifestyle (Schone and Weinick 1998; Umberson, Crosnoe, and Reczek 2010). A range of studies show support of the protective effect of marriage on health. For instance, married patients were associated with healthier dietary behaviors in a study examining the marital status differences in management of a chronic disease (August and Sorkin 2010). Similarly, marital dissolution has detrimental effects on health. Less social support and reduced economic resource due to divorce or widowhood may lead to poor health among the divorced or widowed (Waite and Gallagher 2000). Those predictions are in line with the crisis model, suggesting that the negative effects on health will be alleviated overtime (Thierry 1999). A more recent research stream indicates that researchers begin to analyze the relationship between marriage and health from a life course perspective and take into account of the marital trajectories. The main reason for those emerging literature is that the association of marital status and health may vary in response to changes in some individual characteristics. By including different components of marriage, the knowledge of the effects of marriage on health will be advanced (Dupre and Meadows 2007). Essential elements of marital trajectory consist of marital sequencing, timing, transitions and duration (Dupre and Meadows 2007). Transitions have been examined in the majority of current literature, including the effects of transition into marriage (marital formation) and out of marriage (marital dissolution). Kalmjin reports that more studies have investigated the effect of marriage exit on health than that of marriage entry and a majority of these studies show supports for marital protective effects (Kalmijn 2017). However, Western marriages are different from Chinese marriages in some aspects, such as conjugal bonds are stronger in Western marriages (Pimentel 1994; Chen et al. 2015). An investigation in a non-Western setting is needed to illuminate the relationship between marriage and health. Some studies have explored the relationship between marriage and health in the aging literature by using static marital status. Va et al. investigate the association between marriage and health among middle age and elderly residents in China. Their results show that being married reduces all-cause mortality and being divorced or widowed increases mortality risks (Va et al. 2011). However, this study focuses on marriage and mortality by using marital status at baseline and is limited to a sample of permanent residents in Shanghai. Another study based on samples from three provinces (Jiangsu, Henan and Qinghai) find that widowed individuals aged 60 and over in rural areas have lower quality of life relative to the married counterparts (Zhou and Hearst 2016a). Moreover, most of past studies utilize cross-sectional analyses of marriage and health outcomes among elder adults. Far fewer studies has focused on the effect of marital transition on elder health in China. The present study will provide a dynamic analysis of whether the marital transition have effects on elder health by using China Health and Retirement Longitudinal Study (CHARLS). 3. Empirical model specification To make a causal inference about the effect of marital transition on health status, one could utilize the following basic model: Hi01 MT i u i (1) where Hi is the health status of individual i, the MTi is the marital transition for individual i. The ui term includes individual unobservable characteristics. If marital transition (MTi) is uncorrelated with unobservable characteristics ui, OLS estimation of this simple model will give rise to an unbiased and consistent estimator. Unfortunately, this model has to deal with a major econometric challenge because health status also affects the decision to stay
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