Mortality risk by living arrangements for the elderly Belgian population

Abstract

RésuméObjectifs : Le risque de décéder aux âges élevés est associé avec l’état matrimonial, mais également avec la situation de ménage de la personne considérée (avec qui une personne vit). Cette étude analyse comment l’association entre situation de ménage et risque de décéder varie en fonction de l’âge et du sexe. Données et méthodes : Nous utilisons des données extraites du Registre national belge concernant la situation de ménage de plus de 3 millions de personnes âgées de 60 ans et plus, ob-servées du 1er janvier 1991 au 31 décembre 2010. Tout d’abord nous calculons et comparons les probabilités annuelles de décéder pour les personnes selon les différentes situations de ménage. Ensuite nous construisons des tables de mortalité mul-ti-états en utilisant les probabilités annuelles de transition entre différentes situations de ménage et ce, afin de reconstituer les trajectoires de situation de ménage. Résultats : Nos résultats confirment l’effet protectif associé au fait de vivre en couple marié, mais ils montrent également que vivre seul aux âges plus élevés devient favo-rable à la survie. Un croisement apparaît entre les risques de décéder de ceux vivant seuls et ceux vivant avec d’autres personnes, mais pas avec leur conjoint. Toutefois de fortes différences ressortent selon le sexe. Enfin vivre en ménage collectif est largement défavorable pour la survie par comparaison à tous les types de ménages privés et ce, pour les deux sexes. Discussion : La façon dont le risque de décéder varie selon la situation de ménage est différente selon le sexe et diminue avec l’âge de fa-çon relative. Parmi d’autres explications, le rôle sélectif de l’état de santé est majeur, tout comme le soutien du conjoint qui est, dans la plupart des cas, le premier donneur de soin. Selon cette perspective, la différence d’espérance de vie en santé entre hommes et femmes et la différence d’âges entre conjoints pourraient contribuer à expliquer les différences du risque de décéder selon la situation de ménage entre les hommes et les femmes. Nos résultats sont importants dans le cadre des politiques sociales relatives aux personnes âgées et plus particulièrement pour l’évaluation des besoins futurs de nos populations vieillissantes.AbstractObjectives: Mortality risk in old age is associated with both marital status and living arrangements (with whom a person is living). This study analyses how the association between living arrangements and mortality risk varies by age and gender. Data and methods: We use a dataset extracted from the Belgian national register for the population aged 60 years and over, from 1 January 1991 to 31 December 2010, that includes more than three million persons and describes their living arrangements. First we compute and compare single-year probabilities of death for each living arrangement. Then, in order to recompose the living arrangement trajectories, we construct multistate life tables using annual probabilities of the transitions between successive living arrangements. Results: Our results confirm the protective effect of living with a spouse, and also show that at older ages living alone becomes advantageous. A crossover occurs in the mortality risks of those living alone and those living with others (not with a spouse), but large differences appear between the genders. Institutional living arrangements are largely detrimental for survival compared with private living arrangements for both genders. Discussion: The variation of mortality risk by living arrangements is gender-specific and decreases by age in relative terms. Among possible explanations, the selective role of health is paramount, as well as the presence of a spouse, who is the primary caregiver in most cases. According to this perspective, the gender gap in healthy life expectancy and the age difference between spouses contribute to explaining the gender differences. Our findings are highly relevant to social policies and the social discourse pertaining to the future needs of the elderly within the context of population ageing.

Residential status and health in middle and late life: a population-based study with new data from Spain

“…Most approaches to mortality make use of marital status though, as shown here, the effect of living alone exists net of the effect of marriage or partner status. The results presented here closely mirror those found for Belgium,31 both with respect to the levels of excess mortality as people age and because men make the change after about 75 and women after about 65. They also suggest that this pattern may be widespread and not limited to Spain (or to Belgium).…”

“…In the case of circulatory diseases and deaths due to mental problems and accidents, the opposite is true with excess mortality higher among those living alone. This suggests that living alone may be more harmful for a person’s health when catastrophic health events occur (acute circulatory problems, suicides, accidents30 31), though with processes related to chronic disease this does not happen. In later life (65+), the picture changes substantially.…”

“…Empirical analysis has shown ambiguous results on this matter, with studies in different countries and social settings showing either no association between residential status and mortality22 or, more generally, higher mortality among those living alone 23–26. Different results have been observed for women and men27–30 and, recently, longer survival of people living alone at older ages has been documented for Belgium 31. The mechanisms behind the residential gradients in mortality rates are not clear.…”

“…There are few studies in which residential status is related specifically to the likelihood of death 24 25 31 36–40. The specific goal of this paper is to address how living alone, living with a spouse and living with others tend to condition the survival of mature adults and elderly persons in Spain.…”

Living Alone in Later Life: A Global Perspective

“…Little is known about the effects of living arrangements on health outcomes, although poorer health and higher death rates can be expected from older people living alone (Koskinen et al. ; Poulain, Dal, and Herm ). These factors notwithstanding, however, there are also strong indications that the elderly living alone tend to be a population subgroup selected for those with the best health, at least in relative terms.…”