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In sickness and in health: an examination of relationship status and health using data from the Canadian National Public Health Survey

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There is an extensive literature suggesting that marriage confers benefits to both men and women in the form of increased earnings, better health and a longer life. Yet, where the focus is on health, most of this work has centered on one or two measures of health outcomes or on certain health behaviors such as smoking or alcohol use and has often failed to include those who cohabit as a separate relationship status. In this paper, we extend the research on the links between health and relationship status in three important ways. First, we consider a wide array of health indicators including self-reported health, chronic conditions, physical limitations, a measure of mental health, body mass index (BMI), and a number of health-related behaviors. Second, we use data from eight waves of the Canadian National Public Health Survey between 1994 and 2008 which allows us to estimate the effect of relationship status on health in a setting in which health insurance is not dependent on marriage. Third, we incorporate cohabitation as a separate relationship status. After controlling for time-invariant factors related to selection into and out of marriage, we find that marriage confers health benefits in the form of improved mental health, and lower levels of alcohol use. Marriage, however, is not without its cost. Similar to studies using U.S. data, marriage results in higher BMI, greater incidence of overweight and obesity and lower probabilities of regular exercise. These benefits and costs accrue to those who marry, and often to cohabiters.

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  1. Recent empirical studies of the link between marriage and earnings using U.S. data include Averett et al., 2008; Light, 2004; Chun and Lee, 2001; Hersch and Stratton, 2000. Wilson and Oswald, 2005 and Wood 2007 provide recent reviews of this “marriage health premium” literature.

  2. For example, 59.6% of Americans received their health insurance through employers (DeNavas-Walt 2007). Lasser et al. (2006), in a comparison of health insurance and access to health care across the U.S. and Canada document that individuals in the U.S. have less access to health care. Finally, in the U.S. among working-age adults, married men and women are more likely than those who are unmarried to have health insurance (Jovanovic et al. 2003).

  3. See Crossley and Jeon (2007) for a discussion of marriage and taxation in Canada.

  4. See Kohn (2012) for further discussion of these issues and Ferraro and Farmer (1999) for a discussion of the relationship between self-assessed health and physician evaluated health.

  5. Because of the effect of pregnancy on health outcomes for women, we excluded women from the study in any year they reported being pregnant.

  6. We lose an additional 1,464 respondents who report the data necessary for our analysis in only 1 year, since individual-level fixed effects models require at least 2 years of data. Sample sizes for each of the dependent variables differ based on the frequency of missing responses, and are reported separately for each model.

  7. It is possible that the relationship between marital status and health is caused by the correlations between marriage and household income and children. For instance, one can imagine that the relationship between marriage and health, especially for women, could be influenced by the additional income that a spouse provides (Lillard and Waite 1995). The increase in family income (even per capita income) after marriage may increase access to preventive health care and investments in nutrition and fitness. It has also been suggested that the presence of young children may interfere with the time parents (particularly mothers) spend pursuing a healthy lifestyle (Berge et al. 2011). Others have found that children may result in poorer mental health for married men (Gove and Geerken 1977) but increased longevity (Umberson 1987). By controlling both for family income and the presence of children in the household the coefficients on the relationship status variables capture the effect of changes in marital status on health over and above changes in family income and the presence of children.

  8. In the sensitivity analysis section, we investigate potential bias from reverse causality by including future relationship status as a regressor.

  9. Income in the NPHS is reported only in categories. Because our study spans a 14-year period, we account for inflation by assigning an income level equal to the category midpoint and adjusting for annual inflation in Canada using national consumer price index data (Statistics Canada 2011). This method, recommended in Haut (2004), includes the formula (30% above the lower limit) for assignment of the midpoint value for the uppermost income category.

  10. To test the sensitivity of the results to the combination of various categories, we also conduct our analysis on a dichotomous indicator of poor, fair or good health and on the full ordinal scale. Results are qualitatively similar.

  11. Body mass index is measured as weight in kilograms divided by height in meters squared.

  12. Because of the complex survey design of the NPHS we run weighted regressions using bootstrap weights to estimate coefficients and standard errors using the program bswreg (see Piérard 2003 for details).

  13. Coefficients on the control variables, reported in Appendix Tables 8 and 9, are consistent with what we expect. Health largely deteriorates with age, and there is a strong positive education and income gradient with respect to health (except for drinking and BMI for men) that is consistent with the literature (Deaton 2002). Although children are generally positively related to measures of good physical and mental health, the presence of children under 12 reduces physical activity. There are also some significant provincial health differences.

  14. One can imagine that the relationship between marriage and health, especially for women, could be influenced by the additional income that a spouse provides (Lillard and Waite 1995) or the increased probability of childbearing. Estimates from models that do not include total family income and the number of children in the household leave the estimated coefficients qualitatively unchanged for women as well as men.

  15. A t test of the difference in the depression-score coefficients for married and cohabiting women yields a p value of .49.


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The authors would like to thank Inas Rashad, Deborah Roempke Graefe, and Jennifer Kohn for helpful comments.

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Correspondence to Susan L. Averett.



See Tables 8, 9 and 10.

Table 8 OLS coefficients for demographic variables on health outcomes
Table 9 OLS coefficients for demographic variables on weight and health-related behaviors
Table 10 Variation in marital status

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Averett, S.L., Argys, L.M. & Sorkin, J. In sickness and in health: an examination of relationship status and health using data from the Canadian National Public Health Survey. Rev Econ Household 11, 599–633 (2013).

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