Lifecourse Exposure to Work-Family Demands Predicts Mortality Patterns Among American Women

Background and purpose: Over the past half-century, American women have fundamentally changed the ways in which they fill and combine the roles of employee, spouse, and parent. These changing demographics have unknown implications for women’s life expectancy. Our study tests whether certain patterns and timing of work and family during early and middle adulthood (ages 16-50) are associated with greater mortality risk in later life. We hypothesized that prolonged exposure to work-family states characterized by high demands from both work and home, with little offsetting social support—for example, single working mothers—would be at higher risk for mortality at ages 55-75 compared with women who spent their working lives in lower-strain circumstances.

Methods: We used data from women in the US Health and Retirement Study born 1935-1956. Employment status, marital status, and presence of a child under 18 in the house, for each year of a woman’s life between ages 16 and 50, were determined using retrospective interview data. We constructed work-family histories for each woman by identifying her work-family status at each age between 16 and 50. Sequence analysis was used to identify prototypical work-family profiles (e.g., primarily married homemaker with children, primarily working married mother). Sequence analysis allows social science researchers to take a life-course perspective on exposure development, but to date it has been used primarily a tool for descriptive analyses. The method uses a modified cluster analysis (optimal matching) to identify distinct profiles or trajectories of life experiences. After identifying prototypical seven work-family profiles, we calculated age-standardized mortality rates (ASMR) and hazard ratios (HRs) for mortality at ages 55-75 as predicted by work-family profile category, adjusting for both confounding variables and potentially explanatory later-life factors.

Results: Compared with the lowest-mortality group (married women who stayed home with children for 3-5 years before reentering the labor force), and adjusting for age, race/ethnicity, and education, HRs for mortality at ages 55-75 were 2.14 (1.58, 2.90) among single non-working mothers and 1.48 (1.06,1.98) among single working mothers. Married stay-at-home mothers were also at increased mortality risk. Mortality was not significantly elevated for women in the other profiles (working women with no children; married women who took 10-15 years out of the workforce to raise children and then returned to work; married mothers who worked consistently). Effects were partially explained by later-life health behaviors (smoking, BMI) and economic factors (household wealth), but not by family formation variables such as young age at first birth or number of children.

Conclusions: Our study points to potential long-term health consequences of the growing population of US women parenting alone while working, especially in the absence of social policies that could provide offsetting support. Whereas strong social safety net policies in Europe may provide support for unmarried mothers, the lack of such policies in the United States may expose women to both work-family strain and financial difficulties.  Overall, the results suggest that mortality consequences of work-family strain may persist for years beyond active child-rearing.