1. Single motherhood was associated with increased risk of Activities of Daily Living (ADL) limitations and poor Self-Reported Health (SRH) in late adulthood in the USA, England, and many other European countries that increased with duration of single-motherhood.
2. While in some countries, controlling for per capita income and wealth reduced or obviated significant differences in health of single mothers, other countries had very little change in ADL limitation or poor SRH.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Many lines of evidence have shown that single mothers have poorer health and higher risk of certain diseases in early or mid-life, but few studies have looked at the long-term impact of single-motherhood on women in later life (>50yo). In addition, family structure and social expectations make the experience of single-motherhood different across countries. In this study, three longitudinal surveys from the USA, England, and 13 European countries assessed the health of married and single-mothers at age 50 or older. The rate of ADL limitations and poor SRH was significantly increased in the USA, England, and Scandanavia but not Western, Southern, or Eastern Europe. In addition, when controlling for per capita income, ADL limitation associations were no longer significant in the USA and poor SRH risk was greatly reduced. Scandanavia and England had only moderate reductions in these two outcomes by comparison, and there was a significant difference between the health risks of single-motherhood when comparing England to any of the other countries surveyed. Further, those who had a longer duration of single-motherhood had increased ADL limitations and poor SRH.
This is a strong meta-analysis that suggests that single-motherhood may have long-term impact on the health of mothers later in life, especially when single-motherhood is sustained for many years. The differences in significance after controlling for per capita income, however, may suggest different societal support for single mothers or be a reflection of different socioeconomic demographics of single mothers. The lack of association between poorer health and single motherhood in the European cohorts, however, could be due to lower response rates than in the other two surveys. Despite these limitations, the findings provide an impetus for increased support for single mothers and identification of the circumstance as a risk factor.
In-Depth [meta-analysis]: 3 harmonized longitudinal surveys or retrospective cohorts on health and aging (US Health and Retirement Study; English Longitudinal Study of Aging; Survey of Health, Aging, and Retirement in Europe) were used to gather data on three primary outcomes: ADL limitations, instrumental ADL limitations, and poor SRH. Participants were polled biennially, and response rates ranged from 75.3% to 91.4% in the US survey, 69% to 81%in the English survey, and 46% to 61% in the European survey. Covariates considered for Relative Risk (RR) prediction were year of assessment, age, educational attainment, number of children, and current marital status at time of survey. Within the USA, single mothers had an increased RR of 1.27 (CI95 1.14 to 1.40) for ADL limitations and 1.32 (CI95 1.22 to 1.42) for poor SRH. Within England, the RR of ADL limitations was 1.51 (CI95 1.29 to 1.77) and 1.61 (CI95 1.43 to 1.81) for poor SRH. Within Scandinavia the RR of ADL limitations was 1.50 (CI95 1.10 to 2.05) and 1.20 (CI95 1.01 to 1.44) for poor SRH. When controlling for per capita income, the ADL limitation in the USA were no longer significant while the RR of poor SRH was attenuated considerably to 1.16 (CI95 1.09 to 1.25). By contrast, little attenuation was seen in the English or Scandinavian RR of ADL limitations or poor SRH. No significant differences in RR were seen in Western, Eastern, or Southern Europe. A “dose-dependence” of duration of single-motherhood was associated with increasing RR of ADL limitations (RR = 1.01 at 1-3 years vs RR = 1.71 at 14+ years; p<0.05) and poor SRH (RR = 1.15 at 1-3years vs 1.43 at 14+ years; p<0.05).
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