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


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.

This is a preview of subscription content, access via your institution.


  1. 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. 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. 3.

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

  4. 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. 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. 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. 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. 8.

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

  9. 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. 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. 11.

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

  12. 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. 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. 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. 15.

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


  1. Ali, M., & Ajilore, O. (2011). Can marriage reduce risky health behavior for African-Americans? Journal of Family and Economic Issues, 32(2), 191–203.

    Google Scholar 

  2. Alm, J. R., & Whittington, L. (1999). For love or money? The Impact of Income Taxes on Marriage Economica, 66(4), 297–316.

  3. Averett, S. L., Sikora, J., & Argys, L. M. (2008). For better or worse: Relationship status and body mass index. Economics and Human Biology, 6(2), 330–349.

    Article  Google Scholar 

  4. Berge, J. M., Larson, N., Bauer, K. W., & Neumark-Sztainer, D. (2011). Are parents of young children practicing healthy nutrition and physical activity behaviors? Pediatrics, 127(5), 881–887.

    Article  Google Scholar 

  5. Chun, H., & Lee, I. (2001). Why do married men earn more: Productivity or marriage selection? Economic Inquiry, 39, 307–319.

    Google Scholar 

  6. Crossley, T. F., & Jeon, S. (2007). Joint taxation and the labour supply of married women: Evidence from the Canadian tax reform of 1988. Fiscal Studies. Institute for Fiscal Studies, 28(3), 343–365.

    Article  Google Scholar 

  7. Deaton, A. (2002). Policy implications of the gradient of health and wealth. Health Affairs, 21(2), 13–30.

    Article  Google Scholar 

  8. DeNavas-Walt, C., Proctor, B., & Smith, J. (2007). U.S. Census Bureau, Current Population Reports, P60-233. Income, Poverty, and Health Insurance Coverage in the United States: 2006. U.S. Government Printing Office, Washington, DC.

  9. Duncan, G. J., Wilkerson, B., & England, P. (2006). Cleaning up their act: The effects of marriage and cohabitation on licit and illicit drug use. Demography, 43(4), 691–710.

    Article  Google Scholar 

  10. Ferraro, K. F., & Farmer, M. M. (1999). Utility of health data from social surveys: Is there a gold standard for measuring morbidity? American Sociological Review, 64(2), 303–315.

    Article  Google Scholar 

  11. Gardner, J. & Oswald, A. (2002). Is it marriage or money that keeps people alive? mimeo.

  12. Goodwin, P. Y., Mosher, W. D., & Chandra, A. (2010). Marriage and cohabitation in the United States: A statistical portrait based on cycle 6 (2002) of the National Survey of Family Growth. National Center for Health Statistics, Vital Health Statistics, 23(28). February

  13. Gove, W. R., & Geerken, M. R. (1977). The effect of children and employment on the mental health of married men and women. Social Forces, 56(1), 66–76.

    Google Scholar 

  14. Grossman, M. (1972). On the concept of health capital and the demand for health. The Journal of Political Economy, 80(2), 223–255.

    Article  Google Scholar 

  15. Haut, M. (2004). Getting the most out of the GSS income measures. GSS Methodological Report # 101, 1–15.

  16. Hersch, J., & Stratton, L. S. (2000). Household specialization and the male marriage wage premium. Industrial and Labor Relations Review, 54, 78–94.

    Article  Google Scholar 

  17. Horwitz, A. V., White, H. R., & Howell White, S. (1996). Becoming married and mental health: A longitudinal study of a cohort of young adults. Journal of Marriage and the Family, 58, 895–907.

    Article  Google Scholar 

  18. Hughes, M. E., & Waite, L. J. (2009). Marital biography and health at mid-life. Journal of Health and Social Behavior, 50, 344–358.

    Article  Google Scholar 

  19. Institute of Marriage and Family Canada. (2009). Cohabitation statistics. January 7.

  20. Jovanovic, Z., Lin, C. J., & Chang, C. H. (2003). Uninsured vs. insured population; variations among nonelderly Americans. Journal of Health & Social Policy, 14, 71–85.

    Google Scholar 

  21. Kerr, D., Moyser, M., & Beaujot, R. (2006). Tying the knot or just living together: Demographic and socioeconomic characteristics. PSC Discussion Papers Series, 20(2), Article 2. Available at:

  22. Kessler, R. C. P., Barker, L., Colpe, J., Epstein, J., Gfroerer, E., Hiripi, M., et al. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189.

    Article  Google Scholar 

  23. Kiecolt-Glaser, J. K., & Newton, T. L. (2001). Marriage and health: his and hers. Psychological Bulletin, 127, 472–503.

    Article  Google Scholar 

  24. Kim, H. K., & McKenry, P. (2002). The relationship between marriage and psychology well-being. Journal of Family Issues, 23(8), 885–911.

    Article  Google Scholar 

  25. Kohn, J. (2012). What is health? A multiple correspondence health index. Eastern Economic Journal, 38(1), 223–250.

    Article  Google Scholar 

  26. Lamb, K. A., Lee, G. R., & DeMaris, A. (2003). Union formation and depression: Selection and relationship effects. Journal of Marriage and Family, 65, 953–962.

    Article  Google Scholar 

  27. Lasser, K., Himmelstein, D., & Woolhandler, S. (2006). Access to care, health status, and health disparities in the United States and Canada: Results of a cross-national population-based survey. American Journal of Public Health, 96(7), 1300–1307.

    Article  Google Scholar 

  28. Le Bourdais, C., & Lapierre-Adamcyk, É. (2004). Changes in conjugal life in Canada: Is cohabitation progressively replacing marriage? Journal of Marriage and Family, 66(4), 929–942.

    Article  Google Scholar 

  29. Lee, S., Cho, E., Grodstein, F., Kawachi, I., Hu, F. B., & Colditz, G. A. (2005). Effects of marital transitions on changes in dietary and other health behaviors in U.S. Women. International Journal of Epidemiology, 34, 69–78.

    Article  Google Scholar 

  30. Light, A. (2004). Gender differences in the marriage and cohabitation income premium. Demography, 41, 263–284.

    Article  Google Scholar 

  31. Lillard, L. A., & Panis, C. W. A. (1996). Marital status and mortality: The role of health. Demography, 33(3), 313–327.

    Article  Google Scholar 

  32. Lillard, L. A., & Waite, L. J. (1995). Till death do us part: Marital disruption and mortality. American Journal of Sociology, 100, 1131–1156.

    Article  Google Scholar 

  33. Lorenz, F. O., Wichrama, K. A. S., Conger, R. D., & Elder, G. H., Jr. (2006). The short-term and decade-long effects of divorce on women’s midlife health. Journal of Health and Social Behavior, 47(2), 111–125.

    Article  Google Scholar 

  34. Lundborg, P., Nystedt, P., & Lindgren, B. (2006). Getting ready for the marriage market? The association between divorce risks and investments in attractive body mass among married Europeans. Journal of Biosocial Science, 39, 531–544.

    Article  Google Scholar 

  35. McDonough, P., Walters, V., & Strohschein, L. (2003). Chronic stress and social patterning on women’s heath in Canada. Social Science and Medicine, 54(5), 767–782.

    Google Scholar 

  36. Meyer, M. H., & Pavalko, E. K. (1996). Family, work, and access to health insurance among mature women. Journal of Health and Social Behavior, 47, 311–325.

    Article  Google Scholar 

  37. Molloy, G., Stamatakis, E., Randall, G., & Hamer, M. (2009). Marital status, gender and cardiovascular mortality: Behavioural, psychological distress and metabolic explanations. Social Science and Medicine, 69(2), 223–228.

    Article  Google Scholar 

  38., (2007). Two-thirds of Canadian marriages successful. Last accessed June 15, 2008.

  39. Piérard, E., Buckle, N., & Chowhan, J. (2003). Bootstrapping made easy: A Stata Ado File. Statistics Canada, available at (last accessed 10/27/2011).

  40. Rindfuss, R. R., & VandenHeuvel, A. (1990). Cohabitation: A precursor to marriage or an alternative to being single. Population and Development Review, 16(4), 703–726.

    Article  Google Scholar 

  41. Simon, R. W. (2002). Revisiting the relationships among gender, marital status and mental health. American Journal of Sociology, 107, 1065–1096.

    Article  Google Scholar 

  42. Sobal, J., Rauschenbach, B., & Frongillo, E. A. (2003). Marital status changes and body weight changes: A US longitudinal analysis. Social Science and Medicine, 56(7), 1543–1555.

    Article  Google Scholar 

  43. Statistical Abstract of the U.S. (2007). Accessed September 15, 2009.

  44. Statistics Canada. (2009). Website, Accessed September 27, 2009.

  45. Statistics Canada. (2011). Consumer Price Index, Historical Summary, Accessed May 11, 2011.

  46. Thompson, M. E. (1994). Uses of NPHS in examining health behavior changes, with particular references to smoking cessation. Waterloo: University of Waterloo, Southwestern Ontario Research Data Center.

    Google Scholar 

  47. 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.

    Article  Google Scholar 

  48. Waite, L., & Gallagher, M. (2000). The case for marriage: Why married people are happier, healthier, and better off financially. New York: Doubleday.

    Google Scholar 

  49. Williams, K., & Umberson, D. (2004). Marital status, marital transitions, and health: A gendered life course perspective. Journal of Health and Social Behavior, 45, 81–98.

    Article  Google Scholar 

  50. Wilson, C., & Oswald, A. (2005). How does marriage affect physical and pyschological health? A survey of the longitudinal evidence. IZA discussion paper # 1619.

  51. Winkler, A. (1997). Economic decision making by cohabitors: Findings regard income-pooling. Applied Economics, 29(8), 1079–1090.

    Article  Google Scholar 

  52. Wood, R. G., Goesling, B., & Avellar, S. (2007). The Effects of Marriage on Health: A Synthesis of Recent Research Evidence. Mathematica Policy Research, Inc.

  53. Wu, Z., & Hart, R. (2002). The effects of marital and nonmarital union transitions on health. Journal of Marriage and Family, 64, 420–432.

    Article  Google Scholar 

  54. Zimmer, D. (2007). Asymmetric effects of marital separation on health insurance among men and women. Contemporary Economic Policy, 25(1), 92–106.

    Article  Google Scholar 

Download references


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

Author information



Corresponding author

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

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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).

Download citation


  • Marriage
  • Mental health
  • Obesity
  • Physical health
  • Protection
  • Selection

JEL Classification

  • J12
  • I12