Embed Size (px)
Citation preview
Living arrangements, health Living arrangements, health and well-being: and well-being:
A European PerspectiveA European Perspective
UPTAP MeetingUPTAP Meeting2121stst March 2007 March 2007
Harriet Young and Emily GrundyHarriet Young and Emily GrundyLondon School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical Medicine
BackgroundBackground
Demographic changes over the last Demographic changes over the last century have led to older age structures century have led to older age structures throughout Europe. throughout Europe.
Declines in the proportions of older people Declines in the proportions of older people living with children and increases in living with children and increases in proportions living alone.proportions living alone.
BackgroundBackgroundWhat are the implications for health and well-being ? What are the implications for health and well-being ?
Research to date: Research to date: Those living with spouse are the most healthyThose living with spouse are the most healthy
Contradictory evidence for those not living with Contradictory evidence for those not living with spouse: more healthy living with other relatives or spouse: more healthy living with other relatives or living alone ? living alone ? • Michael et al (2001), Grundy (2001)Michael et al (2001), Grundy (2001)
Selection effectsSelection effects
Effects vary according to cultural and socio-Effects vary according to cultural and socio-economic contexteconomic context
Research ObjectivesResearch Objectives
1 & 2: Analyse associations between living 1 & 2: Analyse associations between living arrangements, health and well-being among arrangements, health and well-being among older people older people
Across Europe, examining differences between Across Europe, examining differences between groups of countriesgroups of countries
In more detail for England / England and WalesIn more detail for England / England and Wales
3: Examine pathways to living arrangements 3: Examine pathways to living arrangements and the effect that allowing for these has on and the effect that allowing for these has on health in England and Waleshealth in England and Wales
VariablesVariables
Different outcome variablesDifferent outcome variables Scales of happiness scale, satisfaction with life & Scales of happiness scale, satisfaction with life &
lonelinessloneliness Psychological morbidity – CES-D depression scalePsychological morbidity – CES-D depression scale Self-rated health & limiting long term illnessSelf-rated health & limiting long term illness Indicators of functional capacityIndicators of functional capacity MortalityMortality
Explanatory variableExplanatory variable Living arrangements: Living arrangements:
• spouse only, spouse only, • spouse and other,spouse and other,• Children or others only,Children or others only,• Alone Alone
Dataset: European Social Survey Dataset: European Social Survey (ESS)(ESS)
Two cross-sectional rounds of data – 2002 Two cross-sectional rounds of data – 2002 and 2004and 2004
Using data from 19 countriesUsing data from 19 countries
Sample size 18,131 people aged 60+ Sample size 18,131 people aged 60+
Country groupingsCountry groupingsNorthNorth West West SouthSouth EastEast
SwedenSweden
NorwayNorway
FinlandFinland
DenmarkDenmark
GermanyGermany
BelgiumBelgium
UKUK
AustriaAustria
NetherlandsNetherlands
PortugalPortugal
GreeceGreece
SpainSpain
PolandPoland
SloveniaSlovenia
SlovakiaSlovakia
HungaryHungary
UkraineUkraine
EstoniaEstonia
Czech Czech RepublicRepublic
N=3621N=3621 N=5867N=5867 N=3857N=3857 N=4786N=4786
Dataset: English Longitudinal Study Dataset: English Longitudinal Study of Ageing (ELSA)of Ageing (ELSA)
Two waves of data in 2002 and 2004Two waves of data in 2002 and 2004
Cross-sectional dataset of population aged Cross-sectional dataset of population aged 60+ in Wave One – 7146 people60+ in Wave One – 7146 people
Longitudinal dataset of population aged Longitudinal dataset of population aged 60+ in Wave One and present at Wave 60+ in Wave One and present at Wave Two – 5443 peopleTwo – 5443 people
Dataset: Office for National Dataset: Office for National Statistics Longitudinal Study (LS)Statistics Longitudinal Study (LS)
A record linkage study of population of England A record linkage study of population of England and Wales, with 4 census points linked in, plus and Wales, with 4 census points linked in, plus census information on household members at census information on household members at each census. each census.
Dataset of population aged 60+ at 2001 Census Dataset of population aged 60+ at 2001 Census and present at all 4 census points: and present at all 4 census points: 80,937 people. 80,937 people.
Dataset of population aged 60+ at 1991 Census Dataset of population aged 60+ at 1991 Census and present 1971-1991: 91,155 peopleand present 1971-1991: 91,155 people
Psychological health and well-beingPsychological health and well-being
Associations between living arrangements Associations between living arrangements and….and…. ESS: Happiness and satisfaction with life ESS: Happiness and satisfaction with life
scales (0-10): ordinal regressionscales (0-10): ordinal regression ELSA: 8 point CES-Depression score (0-2 ELSA: 8 point CES-Depression score (0-2
compared with 3+): logistic regressioncompared with 3+): logistic regression ELSA: Loneliness scale (9 item scale from 4 ELSA: Loneliness scale (9 item scale from 4
questions): linear regressionquestions): linear regression
Odds from logistic regression of being depressed compared with those living with a
spouse only, people aged 60+ in England, ELSA 2002
0.5
1
1.5
2
2.5
Spouse & others Alone Non-spouse others
Living arrangement
Od
ds
ra
tio
This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and self-rated relatives, contact with friends, membership of social organisations and self-rated health statushealth status
ELSA
Coefficient from linear regression of loneliness compared with those living with a spouse only,
people aged 60+ in England, ELSA 2002-4
-0.5
0
0.5
1
Spouse & others Alone Non-spouse others
Living arrangement
Co
eff
icie
nt
This model controlled for gender, age, contact with relatives, contact with friends, membership of social organisations, health status at wave one, presence of depression at wave 1
ELSA
Adjusted odds ratios from ordinal regression of living Adjusted odds ratios from ordinal regression of living arrangements on happiness compared with those living arrangements on happiness compared with those living
with a spouse only, 19 European Countries, ESS 20002-4with a spouse only, 19 European Countries, ESS 20002-4(lower OR =less happy)(lower OR =less happy)
Men Men
Odds RatioOdds Ratio
Women Women
Odds RatioOdds Ratio
Spouse only Spouse only (ref group)(ref group) 1.01.0 1.01.0
Spouse and others Spouse and others 0.960.96 0.980.98
AloneAlone 0.570.57 ****** 0.540.54 ******
With non-spouse othersWith non-spouse others 0.560.56 **** 0.900.90
** P<0.01 *** P<0.001** P<0.01 *** P<0.001
Models also adjusted for region, age, income, education, feelings about income, Models also adjusted for region, age, income, education, feelings about income, social meetings and activities, current widowhood and presence of limiting long social meetings and activities, current widowhood and presence of limiting long term illness. term illness.
ESS
Table 3: Odds ratios from ordinal logistic regression of Table 3: Odds ratios from ordinal logistic regression of living arrangements & other factors on happiness for living arrangements & other factors on happiness for
non-marriednon-married women, women, 19 European countries ESS 2002-4*19 European countries ESS 2002-4*
* Model also controls for age, region, income, education, feelings about income, * Model also controls for age, region, income, education, feelings about income, indicators of social contacts, whether currently widowed, & region for Europe-indicators of social contacts, whether currently widowed, & region for Europe-wide model ** p<0.01 *** p<0.001wide model ** p<0.01 *** p<0.001
Odds RatioOdds Ratio
(lower OR= less happy)(lower OR= less happy)
Living arrangements (living with non-spouse other vv alone) Living arrangements (living with non-spouse other vv alone)
All countriesAll countries 1.71.7 ******
NordicNordic 1.21.2
WestWest 2.12.1 ******
SouthSouth 2.02.0 ****
EastEast 1.41.4
ESS
Self rated health and mortalitySelf rated health and mortality
Associations between living arrangements and:Associations between living arrangements and: Self rated health usingSelf rated health using
ELSA (binary variable: poor & fair vv excellent & v ELSA (binary variable: poor & fair vv excellent & v good & good health): logistic regressiongood & good health): logistic regression
ONS LS (binary variable: good & fair health vv poor ONS LS (binary variable: good & fair health vv poor health): logistic regressionhealth): logistic regression
ESS (6 level variable): ordinal logistic regressionESS (6 level variable): ordinal logistic regression
ONS LS: death 2001 Census to end 2004: ONS LS: death 2001 Census to end 2004: logistic regressionlogistic regression
Odds of having poor self-rated health compared with those living with a spouse only, people aged
60+ in England, ELSA 2002
0.6
0.8
1
1.2
1.4
1.6
Spouse & others Alone Non-spouse others
Living arrangement
Od
ds
ra
tio
This model controlled for gender, age, smoking, wealth, housing tenure, contact with This model controlled for gender, age, smoking, wealth, housing tenure, contact with relatives, contact with friends, membership of social organisations and self-rated relatives, contact with friends, membership of social organisations and self-rated health statushealth status
ELSA
Odds Ratios from logistic regression of poor self-rated Odds Ratios from logistic regression of poor self-rated health on living arrangement change 1991 and 2001 for health on living arrangement change 1991 and 2001 for
people aged 60+. England and Wales, ONS LS. people aged 60+. England and Wales, ONS LS.
Odds ratioOdds ratio
Living arrangement change 1991-2001 Living arrangement change 1991-2001 (ref group: (ref group: with spouse both points or moved to live with spouse)with spouse both points or moved to live with spouse)
Alone bothAlone both 0.930.93 ****
Non-spouse other bothNon-spouse other both 1.211.21 ******
To live aloneTo live alone 0.930.93 ****
To live with non-spouse To live with non-spouse othersothers
1.311.31 ******
To communal To communal establishmentestablishment
1.831.83 ******
Model also controlled for age, gender, tenure and car access score, region and Model also controlled for age, gender, tenure and car access score, region and limiting long term illness in 1991. Source: ONS Longitudinal Study, Authors limiting long term illness in 1991. Source: ONS Longitudinal Study, Authors analysis.analysis.
ONS LS
Odds Ratios from logistic regression of poor self-rated Odds Ratios from logistic regression of poor self-rated health & death on living arrangement change 1991 and health & death on living arrangement change 1991 and
2001 for people aged 60+. England and Wales, ONS LS. 2001 for people aged 60+. England and Wales, ONS LS.
Self rated health 2001Self rated health 2001
Odds ratioOdds ratio
Death 2001-2004Death 2001-2004
Odds ratioOdds ratio
Living arrangement change 1991-2001 (ref group: with spouse both Living arrangement change 1991-2001 (ref group: with spouse both points or moved to live with spouse)points or moved to live with spouse)
Alone bothAlone both 0.930.93 **** 1.101.10 ****
Non-spouse other bothNon-spouse other both 0.210.21 ****** 1.281.28 ******
To live aloneTo live alone 0.930.93 **** 1.161.16 ******
To live with non-spouse To live with non-spouse othersothers
1.311.31 ****** 1.441.44 ******
To communal To communal establishmentestablishment
1.831.83 ****** 5.695.69 ******
ONS LS
Model also controlled for age, gender, tenure and car access score, region and Model also controlled for age, gender, tenure and car access score, region and limiting long term illness in 1991. Source: ONS Longitudinal Study, Authors limiting long term illness in 1991. Source: ONS Longitudinal Study, Authors analysis.analysis.
Self rated health and living Self rated health and living arrangements: ESS dataarrangements: ESS data
No significant associations between self-No significant associations between self-rated health and living arrangements for all rated health and living arrangements for all regions combined.regions combined.
However, living alone was associated with However, living alone was associated with poorer health than those living with a poorer health than those living with a spouse for women in Northern countries spouse for women in Northern countries and men in Western countries.and men in Western countries.
ESS
LimitationsLimitations
Comparability of variables between datasets Comparability of variables between datasets
Proportion of population in institutions differs Proportion of population in institutions differs throughout Europe – exclusion of this group may throughout Europe – exclusion of this group may have biased ESS results. have biased ESS results.
Longitudinal analysis: 10 yearly interval for Longitudinal analysis: 10 yearly interval for change in living arrangements using ONS LS.change in living arrangements using ONS LS.
ConclusionsConclusions
Clear association between living alone and Clear association between living alone and higher levels of depression, loneliness and higher levels of depression, loneliness and unhappiness (ESS & ELSA).unhappiness (ESS & ELSA).
Contradictory findings on self-rated health. Contradictory findings on self-rated health.
Differing findings depending on health Differing findings depending on health indicator usedindicator used
