Alone at Midlife – the Health Deficit

In recent decades, demographers have tracked a remarkable upturn in the fraction of Americans living alone, an upturn largely attributable to a tumbling marriage rate and a stubbornly high divorce rate. Some progressive commentators have actually celebrated this development as a manifestation of the triumph of American individualism. But a study recently published in the American Journal of Public Health makes that upturn look like a sure portent of widespread health problems.

Written by a team of researchers at University College London, this new study examines the relationship between partnership status over the life course and health in middle age. Using sophisticated twenty-first-century statistical and medical tools, these researchers confirm a very old truth: “It is not good for man to be alone” (Gen. 2:18, D-RV).

To be sure, even if they had not read the Bible recently, the authors of the new study launched their inquiry fully aware that “numerous studies have found that married people have better health and lower mortality than unmarried people, and these findings have been replicated in different countries and time periods.” But these earlier studies left unanswered questions about “the mechanisms that link marital status and health . . . [about] the operation of health-protective effects of marriage, and [about] the accumulation of benefits and risks of marital status trajectories over the life course.”

The researchers also felt a need to probe deeper into the matter of possible “health-related selection into various marital statuses.” This question of selection is critically important for determining whether marriage actually does protect men and women from ill health. The supposed protective effect of wedlock looks weak or nonexistent if careful statistical analysis reveals that poor health “selects” people into an unmarried status and good health “selects” people into marriage in the first place.

To assess the relationship between marital status and health fully, the London scholars examine social and health data for all the people born in Britain during the first week of March in 1958, a group that health authorities have tracked into adulthood. Using these data, the London scholars clearly identify a life spent alone as a life likely to turn unhealthy by middle age: “Never marrying or cohabiting,” they write, “was negatively associated [in their data] with health in midlife for both genders, but the effect was more pronounced in men.”

Gauged by using a wide range of inflammatory and hemostatic markers, the health of men who had never married or cohabited looked decidedly worse than that of peers who had married and remained married. More specifically, these men “had significantly higher levels on 3 hemostatic function biomarkers and worse respiratory function than men who were married and remained married for the duration of the observation period.” The researchers acknowledge that this clear outcome “is largely in agreement with studies using self-reported health outcomes as well as studies on mortality.”

Using the same health diagnostics and statistical tests, the researchers trace a somewhat different pattern for women. The data show that women who had married in their late 20s or early 30s and had remained married enjoyed “the best health.” The indications of superior health for these women surfaced in tests of respiratory function and fibrinogen level, tests indicating that they were significantly healthier than were women who had married in their early 20s and had remained married. But that same diagnostic measure for fibrinogen indicated that women who had married in their early 20s and had remained married were significantly healthier than peers who had never married or cohabited.

The health benefits of partnership status identified by this study are clear and significant. Nor can they be discounted as merely the artifacts of selection. To be sure, the researchers do adduce evidence that early-life socioeconomic position and early-life health tend to select favorably situated individuals into marriage, unfavorably situated individuals into lives of singleness. However, after careful statistical parsing of the data, the researchers conclude, “Our finding that partnership status is associated with midlife health implies that this effect is independent of selection.” In other words, living with a spouse genuinely does protect health; living alone genuinely does endanger it.

To be sure, it is troubling that the researchers lump together marriage and cohabitation, asserting that their data indicate that, for the most part, “men and women in cohabiting unions had midlife health outcomes similar to those in formal marriages.” However, these researchers do acknowledge that men in cohabiting unions manifested “worse respiratory functioning” than was found among married peers in this study. What is more, the researchers acknowledge that their finding of largely similar midlife health outcomes for married couples and cohabiting unions appears to “contradict earlier findings on depression and self-reported physical health in the United States,” findings indicating clear deficits for cohabiting couples.  In any case, since numerous studies have found that cohabiting unions are more fragile, more likely to break apart, than marriages, many cohabiting couples will break up before they ever realize the health benefits reported in this study.

The researchers express their hope for “a reduction in health inequalities related to marital status,” a reduction that might “shift the distribution of risk and improve population health.” But the outcomes of this study would seem to indicate that the wisest strategy for improving population health—especially among men—is to set the wedding bells ringing and silence the gavel in the divorce courts. 

(George B. Ploubidis et al., “Life-Course Partnership Status and Biomarkers in Midlife: Evidence from the 1958 British Birth Cohort,” American Journal of Public Health 105.8 [2015]: 1,596-1,603.)