Non-Spousal Support,Marital Status,and Mortality Risk

Abstract

Objective

To investigate whether the association between non-spousal support and mortality risk differs by marital status.

Methods

Using data from the National Social Life, Health, and Aging Project (N = 2460), we estimate a series of logistic regression models to assess how non-spousal support moderates the relationship between marital status and mortality across a 5-year period.

Results

Never married respondents who had minimal perceived access to non-spousal support had a greater probability of death compared to married respondents with similar levels of non-spousal support. The disparity in mortality risk between these two groups disappeared when non-spousal support was high.

Discussion

Although family and friends play an important role in mortality risk in later life, these findings suggest that never married older adults exhibit a heightened dependence on support from non-spousal sources. Future research and policies should explore ways in which never married older adults can be integrated into a supportive social environment.

Keywords

social support marital status mortality

Introduction

A large literature highlights the protective nature of social support against disease and illness (Berkman & Glass, 2000; Thoits, 1995; Umberson et al., 2010). Numerous empirical studies spanning multiple decades consistently find that individuals with supportive social relationships enjoy healthier and longer lives than those who lack such positive social environments (Cobb, 1976; Cohen & Wills, 1985; Song et al., 2011). Although social support proves beneficial across the life course, it becomes especially important in later life as this represents a period typically characterized by health declines and an increased desire for emotionally rewarding social relationships (Bengtson & Settersten, 2016; Charles & Carstensen, 2010). Yet, older adults are not uniformly embedded within equally supportive social environments (Carr, 2019; Roth, 2020b). Opportunities to provide and receive support depend on multiple sociodemographic factors, including marital status.

Married older adults routinely exchange various forms of support with their spouse. Indeed, spousal support has been identified as a central martial resource that enhances health and longevity (Carr & Springer, 2010; Thoits, 1995; Umberson & Thomeer, 2020). Unmarried older adults, meanwhile, lack a spouse with whom they can readily exchange support. They must rely instead on alternative sources to fulfill their instrumental and emotional needs (Sarkisian & Gerstel, 2016). Consequently, unmarried older adults are expected to draw support from extended family and friends to help compensate for their lack of a spouse (Barrett, 1999; Shanas, 1979; Stokes & Moorman, 2017). It remains unclear, however, whether support from these non-spousal sources can successfully compensate for the lack of a spouse to provide unmarried older adults with similar protection against mortality as compared to their married counterparts.

Using nationally representative data from the National Social Life, Health, and Aging Project, the present study investigates whether non-spousal support moderates mortality disparities between married and unmarried older adults. Although we examine all forms of singlehood (i.e., divorce, widowhood, and never married), we pay primary attention to never married older adults relative to their married peers. Never married individuals are likely to have unconventional support structures, especially into later life, as they never had a spouse from whom they could derive support (Rubinstein, 1987; Sarkisian & Gerstel, 2016). Therefore, we anticipate that non-spousal support will play a crucial role in the lives of never married older adults.

Social Support and Marital Status

Conceptual models of aging consistently highlight the value of leading a healthy social life (Bengtson & Settersten, 2016; Charles & Carstensen, 2010; Rowe & Kahn, 1997). Beyond simply maintaining a set of active social relationships, it is important for older adults to feel that they can derive adequate support from their family and friends when needed. Therefore, it is essential to consider the qualities of one’s social relationships when assessing health and well-being (Berkman & Glass, 2000). Social support, which refers to “the functions performed for the individual by significant others” (Thoits, 2011, p. 146), has been linked with numerous health outcomes, including hypertension (York Cornwell & Waite, 2012), depression (Fiori & Denckla, 2012), and cognitive function (Harling et al., 2020). Such findings have led scholars to deem social support (or the lack thereof) as a potential driver of mortality, particularly in later life (Holt-Lunstad et al., 2010; Lyyra & Heikkinen, 2006; Song et al., 2011).

Although support is exchanged across numerous types of social relationships, spouses constitute the primary source of support in later life (Cantor, 1979). Spouses provide each other with various forms of support, including routine daily functions (e.g., talking through problems and coordinating household chores) as well as caregiving during illness (Freedman et al., 2014; Idler et al., 2012). Marriage also provides older adults with an important social control function in which spouses regulate each other’s health behaviors (Umberson, 1992). Collectively, the social advantages of marriage contribute to the well-established mortality disparities between married and unmarried older adults (Liu, 2009; Manzoli et al., 2007).

By contrast, unmarried older adults are a heterogenous group whose divergent pathways to singlehood uniquely influence their health and social lives (Hughes & Waite, 2009; Lin & Brown, 2012; Pudrovska et al., 2006). Divorce and widowhood signal a departure from marriage, albeit with the former representing an unanticipated life transition and the latter representing an anticipated life transition (Exley & Letherby, 2001; Matthews, 1991). The marital crisis model holds that marital dissolution initiates an emotional crisis that overshadows the previous benefits of marriage (Amato, 2000; Williams & Umberson, 2004). Indeed, the transition out of marriage marks the loss of central confidant and a restructuring of one’s social life (Cornwell, 2015; Donnelly & Hinterlong, 2009; Utz et al., 2002; Zettel & Rook, 2004). Consequently, formerly married individuals have been shown to exhibit increased signs of depression, risky behaviors, and elevated mortality risk (Bulanda et al., 2016; Stroebe et al., 2007; Waite et al., 2009).

Unlike their unmarried peers, never married older adults are unique in that they have not experienced the exogenous shock of marital dissolution nor any of the corresponding discontinuities in their daily routines. Therefore, the latter group is more likely to enjoy uninterrupted social lives that have been established during a lifetime of singlehood (Barrett, 1999; Pudrovska et al., 2006). The continuity of long-lasting close social relationships established during this time should carry over and ease the exchange of support into later life (Blieszner et al., 2019; Wellman & Wortley, 1990). Consequently, we expect that some never married older adults can effectively rely on non-spousal support to protect themselves against disease and illness. Conversely, some never married individuals select out of marriage based on either health conditions or personalities that prohibit them from cultivating close relationships. Given the heterogenous support structure of never married individuals, we formalize the following hypothesis: The expected mortality differences between never married and married older adults will decrease when non-spousal support is high.

Despite the theoretical appeal of testing the non-spousal support hypothesis for never married older adults, there are several reasons not to extend this hypothesis to divorce and widowhood. First, marital dissolution often leads to an initial spike in support from family and friends (Ha, 2008; Miller et al., 1998). At the same time, marital dissolution—especially widowhood—is also correlated with increased mortality risk due to the stressors associated with losing a spouse (Amato, 2000; Williams & Umberson, 2004). Therefore, any observed relationship between non-spousal support and mortality among divorced and widowed individuals may be reflective of the fact that they experienced an external shock (i.e., marital dissolution). Second, formerly married older adults must cultivate new relationships and or redefine existing relationships if they wish to remain socially connected in the wake of marital dissolution. The new dynamics of these relationships may impede the flow of support (Blieszner & Adams, 1992; Rook, 2009; Wellman et al., 1997). Because the stressors of marital dissolution alter older adults’ social and emotional needs (Zettel & Rook, 2004), even well-established social relationships may be unable to provide functionally specific forms of support to meet these changing needs (Arbuckle & De Vries, 1995; Perry & Pescosolido, 2015). For these reasons, we focus primarily on never married older adults—who are more likely to maintain continuity in their social lives—and their comparison to married older adults.

Data and Methods

The present study uses data from the National Social Life, Health, and Aging Project (NSHAP). The NSHAP is a nationally representative panel study of older Americans. Starting in 2005–2006, the NSHAP used a multistage probability sampling design to survey 3005 noninstitutionalized older adults between the ages of 57 and 85 years (O’Muircheartaigh et al., 2009). In 2010–2011, respondents were recontacted to participate in Wave 2 (W2). A total of 2261 of the original 3005 respondents participated in the W2 interview. Meanwhile, 430 of the 744 nonparticipating respondents were reported deceased at the time of contact.¹ Because mortality status is the only variable to be used from W2, all the original respondents are retained in the analyses excluding respondents whose mortality status was unknown as well as those missing key independent variables (e.g., social support).

Dependent Variable

Mortality status at W2 (0 = Alive, 1 = Deceased) was confirmed through proxy interviews with family members/friends or a public record search. The cause of death was not asked due to the sensitivity of the topic. Therefore, we rely on a dichotomous measure of all-cause mortality as the dependent variable in the main set of analyses.²

Marital Status

Marital status was self-reported as either “married,” “partnered (but not married),” “divorced/separated,” “widowed,” or “never married.” Given that recoupling after divorce does not guarantee immediate health returns (Lorenz et al., 2006), we separated married respondents into two categories: “married (once)” and “married (multiple times).” Although we are primarily interested in comparing never married respondents against married respondents, we retained formerly married respondents as well unmarried respondents in romantic relationships to determine whether the non-spousal support hypothesis is relevant only to never married respondents or whether it applies to all unmarried respondents.

Non-Spousal Support

Non-spousal support was measured using four items asking about the amount of support respondents felt they could draw from their social relationships. Respondents were asked the extent to which they felt they could (a) “open up to” and (b) “rely upon” family members other than their spouse (two items) and their friends (two items). Possible answers included “Hardly ever/never” (=1), “Some of the time” (=2), and “Often” (=3). Responses to these four items were averaged and summed to create a non-spousal support index (α = .64). The index was standardized for final analyses. We also conducted a parallel set of analyses in which we decomposed the support index into family support (α = .64) and friendship support (α = .63).

Covariates

Because they have been shown to influence access to social support and mortality risk, we adjust for the following covariates: age (in years), gender (0 = man, 1 = woman), education (<HS, HS, some college, college), race/ethnicity (white, black, Hispanic, other), number of living children,³ number of close relatives (0, 1, 2–3, 4–9, 10–20, >20), number of friends (0, 1, 2–3, 4–9, 10–20, >20), and comorbidities. The latter covariate is measured using the NSHAP comorbidity index (Williams et al., 2009)—a count variable of whether the respondent has ever had any of the following chronic conditions: heart attack, arthritis, ulcers, emphysema, asthma, stoke, hypertension, diabetes, Alzheimer’s disease, cirrhosis, leukemia, lymphoma, skin cancer, cancer, poor kidney function, thyroid problems, and enlarged prostate (men only).

Missing Data

The survey items used to construct the non-spousal support index as well as the items pertaining to children, close relatives, and friends were administered through a leave-behind questionnaire that respondents were asked to return after the in-person interview. Consequently, a total of 545 respondents (18.14%) did not provide responses for one or more of the following variables: number of children (n = 223); number of close relatives (n = 209); number of friends (n = 197); and non-spousal support (n = 187). Three of these 545 respondents also refused to provide their race/ethnicity. Ten respondents had an unconfirmed mortality status at W2. After dropping these observations, the sample size is 2460 for the main analysis. Issues of selection bias are discussed in the following section.

Analytic Strategy

We start by providing the descriptive statistics for the sample. Next, we estimate logistic regression models to assess the odds of all-cause mortality at W2. Model 1 assesses the associations between marital status, non-spousal support, and mortality for all respondents. Model 2 introduces an interaction term between marital status and non-spousal support. Models 3 and 4 substitute the non-spousal support index with family support and friendship support, respectively. Because the coefficient on the interaction term is not a valid test of interaction in categorical regression models, all interactions are tested via second differences using Stata’s margins command (Ai & Norton, 2003). Marginal effects are plotted to help visualize these findings. The delta method was used to provide accurate confidence intervals for group comparisons (Xu & Long, 2005). All models use the NSHAP-supplied person weights to adjust for the probability being included in the sample. These weights account for selection bias at W1. To account for omitted respondents, the person weights are readjusted by estimating a logit model using W1 sociodemographic and health variables as predictors. The inverse probabilities from this model are multiplied by the NSHAP person weight and used in the final models (Austin, 2011).

Results

Descriptive Statistics

Table 1 presents the descriptive statistics for all variables for the full sample. The mean age was 68.6 years (SD = 7.70), a slight majority were women (52%), and most respondents were white (74%). Thirteen percent of respondents (n = 329) were reported deceased by W2. The majority of respondents were married (67%)—46% were on their first marriage and 21% had been married multiple times—followed by those who were widowed (16%) and divorced (9%). Six percent of the sample (n = 168) were partnered, and 3% had never been married (n = 72). This latter percent—although small—is only slightly lower than a previous national estimate of 4% (Tamborini, 2007). Table 2 presents the mean levels of social support broken down by marital status. As anticipated by theory, the respondent who had experienced marital dissolution (i.e., divorce or widowhood) reported the highest levels of perceived support. Divorced respondents had more support from friends (+.15 SD), whereas widowed respondents had more support from family members (+.11 SD). Never married respondents exhibited the lowest mean levels of non-spousal support (−.23 SD). Despite these low levels, they were not significantly different than married respondents as there was considerable variation in non-spousal support for never married.

Table 1.

Descriptive Statistics (N = 2460).

	Mean/prop (SD)	Min–Max
Mortality status
Deceased	.13
Age	68.61 (7.70)	[57, 85]
Gender
Woman	.52
Education
<HS	.27
HS	.25
Some college	.27
College	.21
Race/ethnicity
White	.74
Black	.14
Hispanic	.09
Other	.03
Comorbidity index	2.32 (1.56)	[0, 9]
Marital status
Married (once)	.46
Married (multiple times)	.21
Partnered	.06
Divorced	.08
Widowed	.16
Never married	.03
Children	3.09 (2.10)	[0, 22]
Close relatives
None	.02
1	.05
2–3	.25
4–9	.44
10–20	.18
>20	.08
Friends
None	.01
1	.03
2–3	.19
4–9	.32
10–20	.24
>20	.22
Non-spousal support	.00 (1.00)	[-2.70, 1.42]
Family support	.00 (1.00)	[-2.54, .94]
Friendship support	.00 (1.00)	[-1.88, 1.38]

Note. All statistics are weighted using NSHAP person weights and adjusted using propensity scores.

Table 2.

Social Support by Marital Status (N = 2460).

	Married (once)	Married (multiple)	Partnered	Divorced	Widowed	Never married
Non-spousal support	−.02	−.12	−.09	.12	.09	−.23
Family support	.00	−.16*	−.04	.02	.11*	−.36*
Friendship support	−.05	−.07	−.13	.15*	.02	−.06
N	1047	480	168	225	468	72

Note. Estimated means are reported using the National Social Life, Health, and Aging Project person weights and adjusted using propensity score weighting. Significance tests for married (multiple), partnered, divorced, widowed, and never married are in relation to married (once). *p < .05 **p < .01 ***p < .001.

Multivariate Analyses

Table 3 provides the odds ratios from the logistic regression models predicting all-cause mortality at W2. Model 1 shows that divorced (OR = 1.82, SE = .48), widowed (OR = 1.90, SE = .37), and never married (OR = 2.17, SE = .80) respondents all had significantly greater odds of death compared to married respondents, adjusting for comorbidities, sociodemographic, and social support variables. Model 2 builds on the previous model by introducing the interaction terms for non-spousal support and marital status to assess the moderating role of non-spousal support for never married respondents. The significant interaction term between non-spousal support and never married (OR = .43, SE = .14, p = .013) suggests that never married respondents exhibit a stronger association between non-spousal support and mortality risk compared to married respondents.

Table 3.

Logistic Regression Models Predicting All-Cause Mortality (n = 2460).

	Model 1		Model 2		Model 3		Model 4
Marital status (ref: Married once)
Married (multiple times)	1.02	(.18)	1.01	(.19)	1.04	(.19)	1.00	(.19)
Partnered	1.06	(.31)	1.06	(.32)	1.05	(.31)	1.06	(.31)
Divorced	1.82*	(.48)	1.69	(.45)	1.81*	(.48)	1.68	(.44)
Widowed	1.90**	(.37)	1.92**	(.38)	1.94**	(.38)	1.91**	(.37)
Never married	2.17*	(.80)	1.59	(.72)	1.47	(.59)	2.14	(.83)
Non-spousal support	1.04	(.08)	1.14	(.11)
Family support					1.21	(.12)	1.05	(.06)
Friendship support					.99	(.08)	1.01	(.12)
Age (decade)	1.73***	(.18)	1.74***	(.18)	1.74***	(.18)	1.72***	(.18)
Education (ref: <HS)
HS	.81	(.17)	.80	(.16)	.81	(.17)	.80	(.16)
Some college	.48**	(.11)	.48**	(.11)	.48**	(.11)	.47**	(.11)
College	.40***	(.10)	.41***	(.10)	.40***	(.10)	.40***	(.10)
Race/ethnicity (ref: White)
Black	1.05	(.21)	1.09	(.22)	1.11	(.22)	1.04	(.20)
Hispanic	.63	(.18)	.64	(.18)	.63	(.18)	.61	(.17)
Other	1.30	(.57)	1.25	(.57)	1.26	(.59)	1.28	(.56)
Gender (ref: Man)
Woman	.56**	(.11)	.54**	(.10)	.55**	(.10)	.55**	(.11)
Close relatives (ref: none)
One	.20***	(.09)	.24**	(.12)	.29*	(.16)	.20**	(.10)
2–3	.41*	(.16)	.51	(.22)	.61	(.30)	.41	(.18)
4–9	.34**	(.13)	.42*	(.17)	.49	(.23)	.34*	(.15)
10–20	.33*	(.14)	.40*	(.17)	.48	(.24)	.33*	(.15)
>20	.31*	(.15)	.38	(.19)	.45	(.26)	.31*	(.17)
Friends (ref: none)
One	.85	(.75)	.95	(.93)	.94	(.90)	.94	(.90)
2–3	.76	(.64)	.88	(.80)	.84	(.75)	.85	(.77)
4–9	.62	(.48)	.70	(.60)	.68	(.57)	.68	(.58)
10–20	.58	(.46)	.67	(.58)	.65	(.56)	.64	(.55)
>20	.41	(.34)	.47	(.43)	.47	(.42)	.46	(.42)
Number of children	.92	(.05)	.92	(.05)	.91	(.05)	.92	(.05)
Comorbidities	1.27***	(.07)	1.27***	(.07)	1.28***	(.07)	1.27***	(.07)
Marital status*non-spousal support
Married (multiple)*non-spousal support			.89	(.24)
Partnered*non-spousal support			.96	(.25)
Divorced*non-spousal support			1.40	(.37)
Widowed*non-spousal support			.79	(.11)
Never married*non-spousal support			.43*	(.14)
Marital status*family support
Married (multiple)*family support					.90	(.21)
Partnered*family support					.93	(.21)
Divorced*family support					.99	(.26)
Widowed*family support					.73	(.11)
Never married*family support					.38**	(.13)
Marital status*friendship support
Married (multiple)*friendship support							.91	(.24)
Partnered*friendship support							1.00	(.28)
Divorced*friendship support							1.64	(.40)
Widowed*friendship support							.90	(.15)
Never married*friendship support							.85	(.22)
F statistic	7.85*** (26, 25)		8.07*** (31, 20)		5.49*** (32, 19)		5.84*** (32, 19)

Note. Odds ratios are displayed (standard errors in parentheses). *p < .05 **p < .01 ***p < .001.

Models 3 and 4 breakdown the non-spousal support variable into family and friendship domains. As seen in Model 3, the interaction term between family support and never married is statistically significant (OR = .38, SE = .13, p = .005). Friendship support, however, does not appear to offer any protection against mortality for respondents, regardless of marital status. As shown in Model 4, the odds ratio between never married and friendship support is .85 (SE = .22, p = .547. Because odds ratios are an inappropriate metric to interpret interactions, we turn to the predicted probabilities to further interpret the significant findings from Model 3.

Figure 1 plots the marginal effects of family support on mortality separated by marital status. There were no significant differences in the probability of death for partnered, divorced, nor widowed respondents compared to married respondents across all levels of support. However, never married respondents who reported the lowest observed levels of family support (−2.5 SD) had a significantly higher probability of death compared to married respondents with equal levels of family support. Never married respondents with the lowest levels of family support had a .47 probability of dying between waves compared to respondents on their first marriage whose probability was .07 (Δ prob = .40, p = .015).

Figure 2 plots the differences in probabilities of mortality between never married and married respondents. Although the mortality disparity between never married and married respondents shrank as family support increased, Figure 2 shows that never married respondents maintained a significantly higher probability of death until their level of perceived support reached .70 SDs below the mean. In other words, it is only when never married respondents reported perceived family support that was well below the mean (i.e., −.70 SD or less) that they had a significantly higher probability of death compared to their married peers. Never married respondents with average to high levels of family support were neither more nor less probable to die between waves than married respondents with the same levels of family support. In substantive terms, never married respondents with the highest observed levels of family support (+.94 SD) had a .08 probability of death, whereas married respondents with similar levels of family support had a .12 probability of death (Δ prob = .04, p = .303).

Discussion

The present study contributes to the literature on social support and health by highlighting the importance of non-spousal support for never married older adults. Never married individuals are unique because they have (a) been shown to have a higher risk of mortality compared to their married peers (Liu, 2009) and (b) experienced a lifetime without a spouse—the traditional main source of support in later life (Cantor, 1979). Given these unique attributes, we hypothesized that expected mortality differences between never married and married older adults would decrease when access to non-spousal support was plentiful. Divorced and widowed older adults, meanwhile, have experienced a marital shock that has been suggested to alter both their access to social support (Ha, 2008; Williams & Umberson, 2004) as well as increase their likelihood of death. Given these potential issues with these latter subgroups, it is perhaps not surprising that we failed to detect any significant relationship between non-spousal support and mortality for divorced or widowed respondents.

In line with our hypothesis, we found that never married older adults were especially sensitive to non-spousal support. More specifically, they were sensitive to the absence of support. Indeed, never married respondents who reported high levels of non-spousal support exhibited neither a higher nor lower probability of death compared to married respondents who had similar levels of support. Yet, when non-spousal support was low, never married respondents had a significantly higher probability of death after adjusting for covariates. Upon decomposing non-spousal support into family and friendship domains, we found that this initial association was driven largely by family support. In other words, the ability to derive support from family—not friends—appeared to serve as a protective factor for never married respondents against mortality risk. These latter findings align with past studies that show that family members are fundamental in protecting the physical well-being of older adults, whereas friendships tend to enhance immediate psychological well-being (Amati et al., 2018; Larson et al., 1986). Family members—who tend to have an obligatory commitment to one another—are likely to provide caregiving assistance in times of need (Antonucci & Akiyama, 1995; Cantor, 1979). Since the present study focuses on mortality—not life satisfaction—it makes sense that family support plays a larger role than friendship support.

From a life course perspective, never married older adults are more likely than their married and previously married peers to have lived uninterrupted social lives (Barrett, 1999; Pudrovska et al., 2006). This consistency of social life—alongside the absence of marital dissolution—may help explain how never married older adults with high levels of non-spousal support exhibit low mortality risk despite their lack of a spouse. Yet, social support is not ubiquitous among never married older adults. As portrayed in previous qualitative and quantitative accounts, some never married older adults lead lives largely devoid of close social relationships, including interactions with family (Band-Winterstein & Manchik-Rimon, 2014; Rubinstein, 1987; Seccombe & Ishii-Kuntz, 1994; Wenger, 2001). Given that supportive relationships protect against disease and illness (Berkman & Glass, 2000) as well as serve as caregiving sources in the presence of poor health (Cantor, 1979; Freedman et al., 2014), we expected that never married older adults who had neither a spouse nor any other supportive relationships would be likely to experience a health decline and not recover, thereby elevating their mortality risk. This expectation was supported by our analyses.

Although the latter portrayal of never married older adults leading lives devoid of supportive relationships helps explain the detrimental impact of the absence of non-spousal support, prior research suggests that this scenario is far more likely to occur among men than women (Koropeckyj-Cox, 2005; Wenger, 2001). Men of the current older cohort are often considered ill-suited for lifelong singlehood as their selection out of marriage tends to be based on negative attributes (e.g., limited socioeconomic resources and poor health earlier in life) (Carr & Utz, 2020). Men are also less likely than women to actively seek support when needed (Taylor, 2011; Thoits, 1995), thus further adding to the vulnerability of never married men who live in unsupportive social environments. Women of the current older cohort, meanwhile, have traditionally been considered well-prepared for a lifetime of singlehood (Carr, 2019; Koropeckyj-Cox, 2005). These women tended to positively select out of marriage on the basis of financial and educational privilege (Carr & Springer, 2010). Contemporary depictions of never married older women as “self-reliant” and “independent” (Wenger, 2001) suggest that never married women should be less sensitive to the absence of non-spousal support compared to never married men. While there is clear theoretical justification for considering the role of gender, we did not have sufficient statistical power to test a three-way interaction between gender, marital status, and support. Future research using samples that oversample for never married older adults should look to address the gendered aspect of marital status and social support.

Limitations and Future Directions

This study has several limitations. First, similar with the gender issue, we did not have sufficient statistical power to investigate how the link between non-spousal support and mortality may differ across race/ethnicity. This is an important omission, given that social support—particularly from family members—offers varying levels of protection depending on one’s race/ethnicity (Roth, 2020a; Sheffler & Sachs-Ericsson, 2016; Uchino et al., 2016). Second, the NSHAP does not provide information on nonmarital romantic history. We do not know if never married respondents were previously in long-term relationships or if they have been perpetually single all their adult life. Nor do we know about the timing and nature of divorced and widowed respondents’ martial dissolutions. Respondents who lost a spouse immediately prior to data collection likely answered questions about social support differently than respondents who were unmarried for a long time. Third, there may be issues of selection bias. Because the NSHAP interviewed respondents who were 57–85 years old at baseline, vulnerable and unhealthy individuals may have already died prior to the first wave.³ Moreover, prior research suggests that never married individuals—especially men—often negatively select out of marriage due to poor health earlier in life (Carr & Utz, 2020) or perhaps personalities that make it difficult for them to form close personal relationships. Although we attempted to account for these latter concerns by controlling for baseline comorbidities and number of friends in our models, this does not rule out the possibility of selection bias. Finally, we were limited to studying all-cause mortality as the NSHAP did not provide information on the cause of death. Future studies that incorporate the cause of death will provide better insight into the specific pathways through which social support influences how individuals die.

Conclusion

This study offered new insight into the intersection of social support and marital status among older adults. Although a wide literature emphasizes the value of social support in later life, this is—to our knowledge—the first empirical investigation of non-spousal support as a driving mechanism of mortality disparities between married and never married older adults. Specifically, we explored whether marital status moderated the relationship between non-spousal support and mortality. We found that never married older adults who had minimal access to family support had a greater probability of all-cause mortality compared to married older adults with similar levels of family support. These findings are especially relevant in light of decreasing marriage rates in recent years (Wang & Parker, 2014). Whereas the decline of marriage in the United States has been highlighted in the media and political sphere (Luscombe, 2018; Sterbenz, 2014; Zagorsky, 2016), our study suggests that there are alternative social situations to marriage that prove equally protective of mortality risk in later life. Given the fatal consequences of social isolation among this group, future research and policies should explore ways in which never married older adults can be integrated into a supportive social environment.

Supplemental Material

sj-pdf-1-jah-10.1177_08982643211025381 – Supplemental Material for Non-Spousal Support, Marital Status, and Mortality Risk

Supplemental Material, sj-pdf-1-jah-10.1177_08982643211025381 for Non-Spousal Support, Marital Status, and Mortality Risk by Adam R. Roth and Siyun Peng in Journal of Aging and Health

Footnotes

Acknowledgments

We thank Brea Perry, Meltem Odabaş, Max Coleman, Emily Ekl, Elizabeth Anderson, Caroline Brooks, and Nicholas Smith for their feedback on an earlier draft of this paper.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a National Institute on Aging R01 grant (5R01AG057739-02, PI: Brea Perry).

ORCID iD

Adam R. Roth

Supplementary Material

Supplemental material for this article is available online.

Notes

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