title: Marital status, widowhood duration, gender and health outcomes: a cross-sectional study among older adults in India.
abstract: Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender.
  
  
  
  Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural-urban location for men and women, separately. We then assess these associations when widowhood accounts for duration.
  
  
  
  Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0-4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5-9 years were not, compared to married women.
  
  
  
  Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India.
authors.affiliation: Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Massachusetts Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Perkins
authors.affiliation: JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea.
authors.forename: Hwa-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Jawaharlal Nehru University, New Delhi, India.
authors.forename: K S
authors.initials: KS
authors.lastname: James
authors.affiliation: JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea.
authors.forename: Juhwan
authors.initials: J
authors.lastname: Oh
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Aditi
authors.initials: A
authors.lastname: Krishna
authors.affiliation: JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea.|Public Health Joint Doctoral Program, San Diego State University & University of California, San Diego, CA, USA.
authors.forename: Jongho
authors.initials: J
authors.lastname: Heo
authors.affiliation: JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul, 110-810, Korea. docmohw@snu.ac.kr.|Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. docmohw@snu.ac.kr.
authors.forename: Jong-Koo
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D005260:Female; D005783:Gender Identity; D006262:Health; D006304:Health Status; D006801:Humans; D006973:Hypertension; D007194:India; D008297:Male; D017533:Marital Status; D008393:Marriage / Q000523:psychology; D008875:Middle Aged; D012737:Sex Factors; D013315:Stress, Psychological; D017805:Widowhood / Q000523:psychology
keywords: Aging; Chronic disease; Cognition; Gender; India; Psychological distress; Self-rated health; Widowhood