title: Marital status, labour force activity and mortality: a study in the USA and six European countries.
abstract: OBJECTIVE
  Labour force activity and marriage share some pathways through which they potentially influence health. In this paper, we examine whether marriage and labour force participation interact in the way they influence mortality in the USA and six European countries.
  
  
  METHODS
  We used data from the US National Health Interview Survey linked to the National Death Index, and national mortality registry data for Austria, England/Wales, Finland, Hungary, Norway and Spain (specifically, the Basque country) during 1999-2007, for men and women aged 30-59 years at baseline. We used Poisson regression to estimate both the additive (relative excess risk due to interaction) and multiplicative interactions between marriage and labour force activity on mortality.
  
  
  RESULTS
  Labour force inactivity was associated with higher mortality, but this association was stronger for unmarried, rather than married, individuals. Likewise, being unmarried was associated with higher mortality, but this association was stronger for inactive than for active individuals. To illustrate, among US women out of the labour force, being unmarried was associated with a 3.98 times (95%CI 3.28-4.82) higher risk of dying than being married; whereas the relative risk (RR) was 2.49 (95%CI 2.10-2.94), for women who were active in the labour market. Although this interaction between marriage and labour force activity was only significant for women on a multiplicative scale, there was a significant additive interaction for both men and women. The pattern was similar across all countries.
  
  
  CONCLUSIONS
  Marriage attenuated the increased mortality risk associated with labour force inactivity; while labour force activity attenuated the mortality risk associated with being unmarried. Our study emphasizes the importance of public health and social policies that improve the health and well-being of unmarried and inactive men and women.
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Karen
authors: K
authors: Van Hedel
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands f.vanlenthe@erasmusmc.nl.
authors: Frank J
authors: FJ
authors: Van Lenthe
authors: LSE Health and Social Care, London School of Economics and Political Science, London, UK Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
authors: Mauricio
authors: M
authors: Avendano
authors: Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors: Matthias
authors: M
authors: Bopp
authors: Department of Public Health, Basque Government, Vitoria, Spain.
authors: Santiago
authors: S
authors: Esnaola
authors: Demographic Research Institute of the Central Statistical Office, Budapest, Hungary.
authors: Katalin
authors: K
authors: Kovács
authors: Department of Social Research, University of Helsinki, Helsinki, Finland.
authors: Pekka
authors: P
authors: Martikainen
authors: Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.
authors: Enrique
authors: E
authors: Regidor
authors: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Johan P
authors: JP
authors: Mackenbach
mesh_terms: D000328:Adult; D004651:Employment / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D014481:United States / Q000453:epidemiology
keywords: Comparative study; employment status; marital status; mortality; public health; risk factors; unemployment