Demography

, Volume 31, Issue 3, pp 487–507

Double jeopardy: Interaction effects of marital and poverty status on the risk of mortality

  • Ken R. Smith
  • Norman J. Waitzman
Mortality, Race, and the Family

Abstract

The purpose of this paper is to examine the hypothesis that marital and poverty status interact in their effects on mortality risks beyond their main effects. This study examines the epidemiological bases for applying an additive rather than a multiplicative specification when testing for interaction between two discrete risk factors. We specifically predict that risks associated with being nonmarried and with being poor .interact to produce mortality risks that are greater than each risk acting independently. The analysis is based on men and women who were ages 25–74 during the 1971–1975 National Health and Nutrition Examination Survey I (NHANES I) and who were traced successfully in the NHANES I Epidemiologic Follow-Up Study in 1982–1984. Overall, being both poor and nonmarried places nonelderly (ages 25–64) men, but not women, at risk of mortality greater than that expected from the main effects. This study shows that for all-cause mortality, marital and poverty status interact for men but less so for women; these findings exist when interaction is assessed with either a multiplicative or an additive standard. This difference is most pronounced for poor, widowed men and (to a lesser degree) poor, divorced men. For violent/accidental deaths among men, the interaction effects are large on the basis of an additive model. Weak main and interaction effects were detected for the elderly (age 65 +).

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References

  1. Aiken, L. S. and S. G. West. 1991. Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage.Google Scholar
  2. Antonovsky, A. 1967. “Social Class, Life Expectancy, and Overall Mortality.” Milbank Memorial Fund Quarterly 45:31–74.CrossRefGoogle Scholar
  3. — 1987. Unraveling the Mystery of Health: How People Manage Stress and Stay Well. San Francisco: Jossey-Bass.Google Scholar
  4. Black, D., P. Townsend, and N. Davidson. 1982. Inequalities in Health: The Black Report. Harmondsworth, UK: Penguin.Google Scholar
  5. Carter, H. and P. C. Glick. 1976. Marriage and Divorce: A Social and Economic Study. Cambridge, MA: Harvard University Press.Google Scholar
  6. Catalano, R. 1991. “The Health Effects of Economic Insecurity.” American Journal of Public Health 81:1148–52.CrossRefGoogle Scholar
  7. Duleep, H. O. 1986a. “Measuring the Effect of Income on Adult Mortality Using Longitudinal Administrative Record Data.” Journal of Human Resources 21:238–51.CrossRefGoogle Scholar
  8. — 1986b. “Incorporating Longitudinal Aspects into Mortality Research Using Social Security Administrative Record Data.” Journal of Economic and Social Measurement (Winter): 126–29.Google Scholar
  9. Duncan, G. J. 1984. Years of Poverty, Years of Plenty. Ann Arbor: Institute for Social Research, University of Michigan.Google Scholar
  10. Feldman, J. J., D. M. Makuc, J. C. Kleinman, and J. Coroni-Huntley. 1989. “National Trends in Educational Differentials in Mortality.” American Journal of Epidemiology 129:919–33.Google Scholar
  11. Gerstel, N., C. Riessman, and S. Rosenfield. 1985. “Explaining the Symptomatology of Separated and Divorced Women and Men: The Role of Material Conditions and Social Networks.” Social Forces 64:84–101.CrossRefGoogle Scholar
  12. Goldman, N. 1993. “Marriage Selection and Mortality Patterns: Inferences and FaiIacies.” Demography 30:189–208.CrossRefGoogle Scholar
  13. Gove, W. R. 1973. “Sex, Marital Status, and Mortality.” American Journal of Sociology 79:45–67.CrossRefGoogle Scholar
  14. Gove, W. R., M. Hughes, and C. B. Style. 1983. “Does Marriage Have Positive Effects on the Psychological Well-Being of the Individual?” Journal of Health and Social Behavior 24:122–31.CrossRefGoogle Scholar
  15. Haan M., G. A. Kaplan, and T. Camacho. 1987. “Poverty and Health: Prospective Evidence from the Alameda County Study.” American Journal of Epidemiology 125:989–98.Google Scholar
  16. House, J. S., R. C. Kessler, R. Herzog, R. P. Mero, A. M. Kinney, and M. J. Breslow. 1990. “Age, Socioeconomic Status, and Health.” Milbank Memorial Fund Quarterly 68:383–411.Google Scholar
  17. House, J. S., K. R. Landis, and D. Umberson. 1988. “Social Relationships and Health.” Science 241:540–45.CrossRefGoogle Scholar
  18. Kaprio, J., M. Koskenvuo, and H. Rita. 1987. “Mortality after Bereavement: A Prospective Study of 95,647 Widowed Persons.” American Journal of Public Health 77:283–87.CrossRefGoogle Scholar
  19. Kasl, S. V. and J.A. Wells. 1985. “Social Support and Health in the Middle Years: Work and the Family.” pp. 170–98 in Social Support and Health, edited by S. Cohen and L. Syme. New York: Academic Press.Google Scholar
  20. Kitagawa, E. M. and P. M. Hauser. 1973. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology. Cambridge, MA: Harvard University Press.Google Scholar
  21. Koopman, J. S. 1981. “Interaction between Discrete Causes.” American Journal of Epidemiology 113:716–24.Google Scholar
  22. Koopman, J. S. and D. L. Weed. 1990. “Epigenesis Theory: A Mathematical Model Relating Causal Concepts of Pathogenesis in Individuals to Disease Patterns in Populations.” American Journal of Epidemiology 132:366–90.Google Scholar
  23. Koskenvuo, M., J. Kaprio, A. Kesaniemi, and S. Sarna. 1980. “Differences in Mortality from Ischemic Heart Disease by Marital Status and Social Class.” Journal of Chronic Diseases 33:95–106.CrossRefGoogle Scholar
  24. Kotler, P. and D. Wingard. 1989. “The Effect of Occupational, Marital, and Parental Roles on Mortality: The Alameda County Study.” American Journal of Public Health 79:607–12.CrossRefGoogle Scholar
  25. Litwak, E, and P. Messeri. 1989. “Organizational Theory, Social Supports, and Mortality Rates: A Theoretical Convergence.” American Sociological Review 54:49–66.CrossRefGoogle Scholar
  26. Makuc, D. M. and J. C. Kleinman. 1986. “Survival Analysis Using Complex Survey Data: Examples from the National Health and Nutrition Survey Epidemiologic Follow-Up Study.” Paper presented at the annual meetings of the American Statistical Association, Chicago.Google Scholar
  27. Marmot, M. G., M. Kogevinas, and M.A. Elston. 1987. “Social/Economic Status and Disease.” Pp, 111–35 in Annual Review of Public Health, edited by L. Breslow, J. E. Fielding, and L. B. Lave. Palo Alto: Annual Reviews, Inc.Google Scholar
  28. National Center for Health Statistics. 1987. Plan and Operation of the NHANES I Epidemiologic Follow-Up Study 1982–84. Washington, DC: GPO.Google Scholar
  29. Pearlin, L. 1985. “Social Structure and Processes of Social Support.” Pp. 43–60 in Social Support and Health, edited by S. Cohen and S. L. Syme. Orlando: Academic Press.Google Scholar
  30. — 1989. “The Sociological Study of Stress.” Journal of Health and Social Behavior 30:241–56.CrossRefGoogle Scholar
  31. Pearlin, L. and H. A. Turner. 1987. “The Family as a Context of the Stress Process.” pp. 143–65 in Stress and Health: Issues in Research Methodology, edited by S. V. Kasl and C. L. Cooper. New York: Wiley.Google Scholar
  32. Rosen, S. and P. Taubman. 1982. “Healthiness, Education, and Marital Status.” Pp. 20–40 in Economic Aspects of Health, edited by V. R. Fuchs. Chicago: University of Chicago Press.Google Scholar
  33. Ross, C. E., J. Mirowsky, and K. Goldsteen. 1990. “The Impact of the Family on Health.” Journal of Marriage and the Family 52:1059–78.CrossRefGoogle Scholar
  34. Rothman, K. 1976. “The Estimation of Synergy or Antagonism.” American Journal of Epidemiology 103:506–11.Google Scholar
  35. — 1986. Modern Epidemiology. Boston: Little Brown.Google Scholar
  36. Smith, J. C., J. A. Mercy, and J. M. Conn. 1988. “Marital Status and Suicide.” American Journal of Public Health 78:78–80.CrossRefGoogle Scholar
  37. Syme, S. L. and L. F. Berkman. 1976. “Social Class, Susceptibility, and Sickness.” American Journal of Epidemiology 104:1–9.Google Scholar
  38. Thoits, P. A. 1982. “Conceptual, Methodological, and Theoretical Problems in Studying Social Support as a Buffer against Life Stress.” Journal of Health and Social Behavior 23:145–59.CrossRefGoogle Scholar
  39. Umberson, D. 1987. “Family Status and Health Behaviors: Social Control as a Dimension of Social Integration.” Journal of Health and Social Behavior 28:306–19.CrossRefGoogle Scholar
  40. Venters, M.H. 1986. “Family Life and Cardiovascular Risk: Implications for the Prevention of Chronic Disease.” Social Science and Medicine 22:1067–74.CrossRefGoogle Scholar
  41. Verbrugge, L. 1979. “Marital Status and Health.” Journal of Marriage and the Family 31:267–85.CrossRefGoogle Scholar
  42. Waitzman, N. J. 1988. “The Occupational Determinants of Health: A Labor Market Segmentation Analysis.” Doctoral dissertation, American University.Google Scholar
  43. Weed, D. L., M. Selmon, and T. Sinks. 1988. “Links between Categories of Interaction.” American Journal of Epidemiology 127:17–27.Google Scholar
  44. Zick, C. D. and K. R. Smith. 1991a. “Marital Transitions, Poverty, and Gender Differences in Mortality.” Journal of Marriage and the Family 53:327–36.CrossRefGoogle Scholar
  45. — 1991b. “Changes in Economic Status Surrounding the Death of a Spouse.” Journals of Gerontology: Social Sciences 46:S310–20.Google Scholar

Copyright information

© Population Association of America 1994

Authors and Affiliations

  • Ken R. Smith
    • 1
  • Norman J. Waitzman
    • 2
  1. 1.Department of Family and Consumer StudiesUniversity of UtahSalt Lake City
  2. 2.Department of EconomicsUniversity of UtahSalt Lake City

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