Abstract
Health concordance–health similarity between intimate partners–is understudied among different-sex cohabiting, same-sex cohabiting, and same-sex married couples due to an overwhelming focus on different-sex married couples. I explore whether existing research and theory extends to health concordance among different-sex cohabiting and same-sex couples. Additionally, I examine health concordance as a site of population health disparities at the couple level. I use the 2008–2018 IPUMS National Health Interview Surveys to perform multinomial logistic regressions of poor-to-fair health and activity limitations concordance on union status, demographic similarity, and socioeconomic resources. Health concordance is common among all couples, characterizing at least 86% of each union status. Marital status differentiates concordance risk for different-sex couples, but not same-sex couples. Same-sex female couples face higher risks of health discordance and concordant disadvantaged health than many other couples, both of which represent major health disadvantages. Union status affects health concordance risk for couples in ways that cannot be easily reduced to marriage, gender, or sex composition. Negative health concordance, especially for same-sex female couples and different-sex cohabitors, warrants further attention as a site of health inequalities. Socioeconomic resources may play a major role in promoting positive health concordance among couples, which could inform policy levers to improve couple health. Health concordance is a site of health disparities because the risk of partners’ concordance in poor health varies considerably depending on union status.
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References
Ash, M. A., & Badgett, M. V. L. (2006). Separate and unequal: The effect of unequal access to employment-based health insurance on same-sex and unmarried different-sex couples. Contemporary Economic Policy, 24, 582–599. https://doi.org/10.1093/cep/byl010
Becker, G. (1981). A treatise on the family. Harvard University Press.
Black, D., Gates, G., Sanders, S., & Taylor, L. J. (2000). Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources”. Demography, 37, 139–154. https://doi.org/10.2307/2648117
Black, D., Sanders, S., & Taylor, L. J. (2007). The economics of lesbian and gay families. The Journal of Economic Perspectives, 21(2), 53–70. https://doi.org/10.1257/jep.21.2.53
Blackwell, D. L., & Lichter, D. T. (2004). Homogamy among dating, cohabiting, and married couples. The Sociological Quarterly, 45, 719–737. https://doi.org/10.1111/j.1533-8525.2004.tb02311.x
Blewett, L. A., Drew, J. A. R., Griffin, R., King, M. L., & Williams, K. C. W. (2019). IPUMS Health Surveys: National Health Interview Survey, Version 6.2. University of Minnesota. https://doi.org/10.18128/D070.V6.2
Booth, A., & Edwards, J. N. (1992). Starting over: Why remarriages are more unstable. Journal of Family Issues, 13, 179–194. https://doi.org/10.1177/019251392013002004
Breen, R., Karlson, B. K., & Holm, A. (2018). Interpreting and understanding logits, probits, and other non-linear probability models. Annual Review of Sociology, 44, 39–54. https://doi.org/10.1146/annurev-soc-073117-041429
Case, A., & Paxson, C. (2005). Sex differences in morbidity and mortality. Demography, 42, 189–214. https://doi.org/10.1353/dem.2005.0011
Cherlin, A. J. (2004). The deinstitutionalization of American marriage. Journal of Marriage and Family, 66, 848–861. https://doi.org/10.1111/j.0022-2445.2004.00058.x
Collins, P. H. (2009). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. Routledge.
Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241–1299. https://doi.org/10.2307/1229039
Denney, J. K., Gorman, B. K., & Barrera, C. B. (2013). Families, resources, and adult health: Where do sexual minorities fit? Journal of Health and Social Behavior, 54, 46–63
Gates, G. J. (2015). LGBT adult immigrants in the United States. Los Angeles: UCLA Williams Institute. Retrieved from https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBTImmigrants-Gates-Mar-2013.pdf.
Gonzales, G., & Blewett, L. A. (2014). National and state-specific health insurance disparities for adults in same-sex relationships. American Journal of Public Health, 104, e95–e104
Gonzales, G., & Henning-Smith, C. (2017). The Affordable Care Act and health insurance coverage for lesbian, gay, and bisexual adults: Analysis of the Behavioral Risk Factor Surveillance System. LGBT Health, 4, 62–67. https://doi.org/10.1089/lgbt.2016.0023
Grollman, E. A. (2017). Sexual orientation differences in attitudes about sexuality, race, and gender. Social Science Research, 61, 126–141. https://doi.org/10.1016/j.ssresearch.2016.05.002
Guner, N., Kulikova, Y., & Llull, J. (2018). Marriage and health: Selection, protection, and assortative mating. European Economic Review, 104, 138–166. https://doi.org/10.1016/j.euroecorev.2018.02.005
Guzzo, K. B. (2014). Trends in cohabitation outcomes: Compositional changes and engagement among never-married young adults. Journal of Marriage and Family, 76, 826–842
Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99, 2275–2281. https://doi.org/10.2105/ajph.2008.153510
Hatzenbuehler, M. L., O’Cleirigh, C., Grasso, C., Mayer, K., Safren, S., & Bradford, J. (2012). Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: A quasi-natural experiment. American Journal of Public Health, 102, 285–291
Heaton, T. B. (2002). Factors contributing to increasing marital stability in the United States. Journal of Family Issues, 23, 393–409
Holway, G. V., Umberson, D., & Donnelly, R. (2018). Health and health behavior concordance between spouses in same-sex and different-sex marriages. Social Currents, 5, 319–327
Homan, P. (2019). Structural sexism and health in the United States: A new perspective on health inequality and the gender system. American Sociological Review, 84, 486–516
Homish, G. G., & Leonard, K. E. (2007). The drinking partnership and marital satisfaction: The longitudinal influence of discrepant drinking. Journal of Consulting and Clinical Psychology, 75, 43–51
Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37. https://doi.org/10.2307/2955359
Jepsen, L. K., & Jepsen, C. A. (2002). An empirical analysis of the matching patterns of same-sex and opposite-sex couples. Demography, 39, 435–453. https://doi.org/10.1353/dem.2002.0027
Jepsen, C., & Jepsen, L. K. (2015). Labor market specialization within same-sex and different-sex couples. Industrial Relations: A Journal of Economics and Society, 54, 109–130. https://doi.org/10.1111/irel.12078
Kalmijn, M. (1998). Marriage and homogamy: Causes, patterns, trends. Annual Review of Sociology, 24, 395–421. https://doi.org/10.1146/annurev.soc.24.1.395
Klein, D. (2014). MIMRGNS: Stata Module to Run Margins after MI Estimate. Statistical Software Components S457795, Boston College Department of Economics, revised 17 Nov 2020.
Leblanc, A. J., Frost, D. M., & Wight, R. G. (2015). Minority stress and stress proliferation among same-sex and other marginalized couples. Journal of Marriage and Family, 77, 40–59. https://doi.org/10.1111/jomf.12160
Light, A. (2004). Gender differences in the marriage and cohabitation income premium. Demography, 41, 263–284. https://doi.org/10.1353/dem.2004.0016
Lillard, L. A., & Panis, C. W. A. (1996). Marital status and mortality: The role of health. Demography, 33, 313–327
Link, B. G., & Phelan, J. C. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 80–94. https://doi.org/10.1177/0022146510383498
Liu, H., Reczek, C., & Brown, D. (2013). Same-Sex cohabitors and health: The role of race-ethnicity, gender, and social status. Journal of Health and Social Behavior, 54, 25–45. https://doi.org/10.1177/0022146512468280
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697
Meyler, D., Stimpson, J. P., & Peek, M. K. (2007). Health concordance within couples: A systematic review. Social Science & Medicine, 64, 2297–2310. https://doi.org/10.1016/j.socscimed.2007.02.007
National Center for Health Statistics. (2014). Design and estimation of the National Health Interview Survey, 2006–2015. Division of Health Statistics National, National Center for Health Statistics, Centers for Disease Control, US Department of Health and Human Services.
National Center for Health Statistics. (2015). Changes to data editing procedures and the impact on identifying same-sex married couples in the 2004–2007 National Health Interview Surveys. Division of Health Statistics, National Center for Health Statistics, Centers for Disease Control, US Department of Health and Human Services.
Nugent, C. N., & Daugherty, J. (2018). A demographic, attitudinal, and behavioral profile of cohabiting adults in the United States, 2011–2015. National Center for Health Statistics, Centers for Disease Control, US Department of Health and Human Services.
Poortman, A., & Mills, M. (2012). Investment in marriage and cohabitation: The role of legal and interpersonal commitment. Journal of Marriage and Family, 74, 357–376. https://doi.org/10.1111/j.1741-3737.2011.00954.x
Raifman, J., Moscoe, E., Austin, S. B., & McConnell, M. (2017). Difference-in-difference analysis of the association between same-sex marriage policies and adolescent suicide attempts. JAMA Pediatric, 171, 350–356
Reczek, C. (2012). The promotion of unhealthy habits in gay, lesbian, and straight intimate partnerships. Social Science & Medicine, 75, 1114–1121. https://doi.org/10.1016/j.socscimed.2012.04.019
Reczek, C., Liu, H., & Spiker, R. (2017). Self-rated health at the intersection of sexual identity and union status. Social Science Research, 63, 242–252. https://doi.org/10.1016/j.ssresearch.2016.09.013
Reczek, C., & Umberson, D. (2012). Gender, health behavior, and intimate relationships: Lesbian, gay, and straight contexts. Social Science & Medicine, 74, 1783–1790
Rendall, M. S., Weden, M. M., Favreault, M. M., & Waldron, H. (2011). The protective effect of marriage for survival: A systematic review. Demography, 48, 481–506. https://doi.org/10.1007/s13524-011-0032-5
Sassler, S., & Miller, A. J. (2011). Class differences in cohabitation processes. Family Relations, 60, 163–177
Schwartz, C. R., & Graf, N. L. (2009). Assortative matching among same-sex and different-sex couples in the United States. Demographic Research, 21, 843–878. https://doi.org/10.4054/demres.2009.21.28
Simon-Pickard, A., & Knight, S. (2005). Proxy evaluation of health-related quality of life: A conceptual framework for understanding multiple proxy perspectives. Medical Care, 43, 493–499. https://doi.org/10.1097/01.mlr.0000160419.27642.a8
Smock, P. J., & Manning, W. D. (2004). Living together unmarried in the United States: Demographic perspectives and implications for family policy. Law & Policy, 26, 87–117. https://doi.org/10.1111/j.0265-8240.2004.00164.x
Spiker, R., Reczek, C., & Liu, H. (2016). Activity limitation disparities by sexual minority status, gender, and union status. In M. N. Hoque, B. Pecotte, & M. A. McGehee (Eds.), Applied Demography and Health in the 21st Century.Springer. https://doi.org/10.1007/978-3-319-43688-3_11
Springer, K. W., Hankivsky, O., & Bates, L. M. (2012). Gender and health: Relational, intersectional, and biosocial approaches. Social Science & Medicine, 74, 1661–1666. https://doi.org/10.1016/j.socscimed.2012.03.001
StataCorp. . (2017). The Stata15 user’s guide. Stata Press.
Thomeer, M. B., Reczek, C., & Umberson, D. (2015). Relationship dynamics around depression in gay and lesbian couples. Social Science and Medicine, 147, 38–46. https://doi.org/10.1016/j.socscimed.2015.10.048
Torvik, F. A., Gustavson, K., Røysamb, E., & Tambs, K. (2015). Health, health behaviors, and health dissimilarities predict divorce: Results from the HUNT Study. BMC Psychology, 3, 13. https://doi.org/10.1186/s40359-015-0072-5
Tumin, D., & Kroeger, R. A. (2020). Private health insurance coverage among same-sex couples after Obergefell v Hodges. LGBT Health, 7(5), 264–270. https://doi.org/10.1089/lgbt.2019.0323
Umberson, D. (1987). Family status and health behaviors: Social control as a dimension of social integration. Journal of Health and Social Behavior, 28, 306–319. https://doi.org/10.2307/2136848
Umberson, D. (1992). Gender, marital status, and the social control of health behavior. Social Science & Medicine, 34, 907–917. https://doi.org/10.1016/0277-9536(92)90259-s
Umberson, D., Donnelly, R., & Pollitt, A. M. (2018). Marriage, social control, and health behavior: A dyadic analysis of same-sex and different-sex couples. Journal of Health and Social Behavior, 59, 429–446
Umberson, D., & Montez, J. K. (2010). Social relationships and health: A flashpoint for health policy. Journal of Health and Social Behavior, 51, S54-66
Umberson, D., Thomeer, M. B., Reczek, C., & Donnelly, R. (2016). Physical illness in gay, lesbian, and heterosexual marriages: Gendered dyadic experiences. Journal of Health and Social Behavior, 57, 517–531. https://doi.org/10.1177/0022146516671570
Umberson, D., Thomeer, M. B., Kroeger, R. A., Reczek, C., & Donnelly, R. (2017). Instrumental- and emotion-focused care work during physical health events: Comparing gay, lesbian, and heterosexual marriages. The Journals of Gerontology Series B, 72, 498–509. https://doi.org/10.1093/geronb/gbw133
Waite, L. J. (1995). Does marriage matter? Demography, 32, 483–507. https://doi.org/10.2307/2061670
Wight, R. G., Leblanc, A. J., & Badgett, M. V. L. (2015). Same-sex legal marriage and psychological well-being: Results from the California Health Interview Survey. American Journal of Public Health, 102, 339–346. https://doi.org/10.2105/ajph.2012.301113
World Health Organization. (2002). Towards a common language for functioning, disability, and health: The international classification of functioning, disability, and health. World Health Organization.
Zajacova, A., Huzurbazar, S., & Todd, M. (2017). Gender and the structure of self-rated health across the adult lifespan. Social Science & Medicine, 187, 58–66. https://doi.org/10.1016/j.socscimed.2017.06.019
Acknowledgements
The author would like to thank Dr. Jennifer Malat, Dr. Danielle Bessett, Dr. Christopher Carpenter, and Dr. Rin Reczek for their comments and suggestions during the writing of this manuscript. Their mentorship and guidance was extremely helpful in shaping this project.
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Spiker, R. Same-Sex, Same Health? Health Concordance Among Same-Sex and Different-Sex Couples. Popul Res Policy Rev 40, 1313–1340 (2021). https://doi.org/10.1007/s11113-021-09654-7
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DOI: https://doi.org/10.1007/s11113-021-09654-7