Marital biography and chronic disease progression in mid- and late life

In light of lengthening life expectancy with chronic disease and increasingly diverse marital experiences over the life course among older adults in the US, this dissertation investigates how marital biography is linked to chronic disease progression among older adults aged 50 years old and over in the US. I use three papers to address this overarching research question. The data are from the Health and Retirement Study (HRS), 1994--2012, a national panel sample representative of noninstitutionalized civilian adults aged at least 50 years old in the US. My first paper evaluates how current marital status and current marriage duration are associated with the development of functional limitations among older adults diagnosed with diabetes, using multilevel growth curve models. The findings show that remarried, cohabiting and divorced/separated older adults with diabetes report significantly more functional limitations at age 50 than their peers who stay in their first marriage. Although widowed older adults with diabetes report significantly fewer functional limitations than the first-time married at age 50, they show a faster decline in their functional health over time. The never-married show a similar functional health trajectory as the first-time married. The second paper assesses the link between marital quality and functional limitations among older adults diagnosed with cardiovascular disease. Multilevel models are used to estimate the associations between marital quality and functional health and control for household-level clustering effects. My analyses show that while negative dimensions of marital quality are significantly associated with worse functional health subsequently in two years for both older men and women with cardiovascular disease, positive dimensions of marital quality are significantly linked to better functional health only for men. Additionally, improvements in positive marital quality over a four-year period are significantly associated with better functional health four years later. The third paper examines differential mortality risk by marital trajectories among older adults with cardiovascular disease, focusing on their lifetime exposure to marital losses with Cox regression models. The analyses show that among the remarried, only those who are one-time widowed exhibit a significantly higher mortality risk than the first-time married. Both the currently divorced/separated and widowed experience significant mortality disadvantage compared to their peers in their first marriage. Additionally, older cohabitors with cardiovascular disease also show a heightened mortality risk. The never-married, however, show comparable mortality risk to that of the first-time married. Overall, the findings from this dissertation point to the significance of marriage for maintaining physical functioning for older adults while they manage major chronic illnesses such as diabetes and cardiovascular disease. However, the benefits of marriage for chronic disease management are also contingent upon past marital experience and relationship quality. I expect the findings to have important implications for healthcare professionals working with chronic disease patients and public policies regarding chronic disease management.