Midlife Outcomes Research Articles

Predictors of Poor Health Outcomes in Midlife and Older Adults with Diabetes in the 2018-2020 Health and Retirement Study

Predictors of Poor Health Outcomes in Midlife and Older Adults with Diabetes in the 2018-2020 Health and Retirement Study

Higher socioeconomic deprivation in areas predicts cognitive decline in New Zealanders without cognitive impairment

Previous studies identified individual-level socioeconomic factors as key determinants of cognitive health. This study investigated the effect of area-based socioeconomic deprivation on cognitive outcomes in midlife to early late-life New Zealanders without cognitive impairment at baseline. Data stemmed from a subsample of the New Zealand Health, Work and Retirement Study, a cohort study on ageing, who completed face-to-face interviews and were reassessed two years later. Cognitive functioning was measured using Addenbrooke’s Cognitive Examination–Revised, adapted for culturally acceptable use in Aotearoa New Zealand. Area-based socioeconomic deprivation was assessed using the New Zealand Deprivation Index (NZDep2006). Linear mixed-effects models analysed the association between area-based socioeconomic deprivation and cognitive outcomes. The analysis included 783 participants without cognitive impairment at baseline (54.7% female, mean age 62.7 years, 25.0% Māori, the Indigenous people of Aotearoa New Zealand). There was an association between higher area-based socioeconomic deprivation and lower cognitive functioning (B = -0.08, 95%CI: -0.15;-0.01; p = .050) and cognitive decline (B = -0.12, 95%CI: -0.20;-0.04, p = .013) over two years, while controlling for covariates. The findings emphasise the importance of considering neighbourhood characteristics and broader socioeconomic factors in strategies aimed at mitigating cognitive health disparities and reducing the impact of dementia in disadvantaged communities.

Personal views of aging in midlife and older age: the role of personality.

Personal views of aging (VoA) reflect individuals' perceptions, attitudes, and expectations regarding their aging selves. The present cross-sectional study was aimed at examining whether personality traits, as defined by the Big Five model, are associated with different VoA concepts related to both subjective age and awareness of age-related gains and losses in midlife and older age. A sample of 224 participants aged 46-85 years reported their felt age and completed the Awareness of Age-Related Change (AARC) questionnaire, assessing perceptions of age-related gains (AARC-Gains) and losses (AARC-Losses) in various functioning domains, as well as the short version of the Big Five Inventory. Linear regression models showed that Openness contributed to explain youthful subjective age. Extraversion explained higher AARC-Gains scores, whereas Emotional Stability, along with younger chronological age and perceiving better self-rated health, contributed to explaining lower AARC-Losses scores. These findings confirm the relationship between personality traits and personal VoA. They further suggest that such an association varies depending on the VoA measure considered. They underscore the importance of considering personality among those individual characteristics capable of shaping personal VoA, with implications for the development of tailored interventions and the understanding of the underlying mechanisms linking personal VoA to health and longevity outcomes in midlife and older age.

Structural inequality modifies midlife outcomes of a multisystemic early childhood program.

The role of structural inequalities in the long-term benefits of early childhood programs has not been assessed. Previous findings in the Chicago Longitudinal Study, an early childhood cohort investigation with low-income families, indicate that Child-Parent Center (CPC) participation beginning in preschool was associated with a variety of positive health behaviors. In this secondary analysis, we assessed if structural inequalities (neighborhood poverty, history of discrimination) modified the magnitude of associations between CPC and health and education outcomes (cardiovascular health, body mass index, educational attainment) 30 years later. The Chicago Longitudinal Study cohort of 1,539 children (93% Black, 7% Hispanic) grew up in high-poverty neighborhoods and attended CPCs or the usual district programs. At midlife (ages 32-37, M = 34.9 years, 2012-2017), 1,073 participants completed telephone interviews on structural inequalities, health, and education. Regression analyses were conducted with inverse propensity score weighting. After accounting for structural inequality, CPC participation was significantly associated with outcomes. Mean differences on Framingham risk scores, for example, were significant for CPC preschool at ages 3 and 4 (coefficient = -2.15, p = .004, standardized difference = -0.20). Neighborhood poverty moderated (reduced) the association between CPC and cardiovascular health. Neighborhood poverty and perceived discrimination had independent contributions with outcomes. Findings show that structural inequalities, especially poverty, directly influence and/or moderate long-term effects of CPC participation. Increasing neighborhood resources and socioeconomic status may help comprehensive programs sustain their impacts. Early childhood and sociostructural influences reflect the increasing importance of community contexts to health promotion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The link Between traumatic experiences and health in late life: challenges and opportunities for US-based longitudinal aging cohorts.

Trauma, defined as exposure to actual or threatened death, serious injury or sexual violence, is a pervasive, major public health challenge that disproportionately burdens socially disadvantaged groups and has known consequences for health outcomes in early and midlife. Despite plausible mechanisms by which trauma may also be a critically important risk factor for health outcomes in late life, there is presently a lack of literature evaluating the consequences of trauma on aging related health outcomes and inequities, such as dementia. In this commentary, we (a) discuss drivers of the paucity of epidemiological evidence on trauma and health outcomes in late life, namely a lack of available data, supported by detailed review of trauma measures, including interpersonal violence-a particularly common form of trauma-in seven established longitudinal aging cohort studies in the United States (US); (b) address four common concerns about the inclusion of trauma measures in cohort studies; and (c) suggest ways forward, including specific assessment tools to measure interpersonal violence after a structured review of the PhenX Toolkit, to facilitate critical research to understand the impact of trauma on outcomes in late life.

Trajectories in depressive symptoms and midlife brain health

Depressive symptoms may either be a risk factor or prodromal to dementia. Investigating this association in midlife may help clarify the role of depression in cognitive aging. We aimed to identify trajectories in depressive symptoms in early to mid-life and related cognitive and brain outcomes in midlife. This study includes 3944 Black and White participants (ages 26−45 years at baseline) from the Coronary Artery Risk Development in Young Adults (CARDIA) study with 20 years of follow-up. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale at five time points over 20 years. Growth mixture modeling (GMM) was used to identify depressive symptom trajectories. Participants completed a neuropsychological battery 20 years after baseline, including the Digit Symbol Substitution Test (DSST), Rey-Auditory Verbal Learning Test (RAVLT), Stroop Test, Montreal Cognitive Assessment (MoCA), and category and letter fluency tests. A sub-sample of participants (n = 662) underwent brain magnetic resonance imaging (MRI) to characterize gray matter volumes and white matter hyperintensities (WMHs). We identified four classes of depressive symptom trajectories: a “declining” class (n = 286, 7.3%) with initially high symptoms and subsequent decline, a class with consistently high symptoms (“steady high”; n = 264, 6.7%), a class with late increases in symptoms (“increasing”; n = 277, 7%), and a class with consistently low symptoms (“steady low”; n = 3117, 79.0%). The steady high and the increasing classes had poorer performance on all cognitive tests, while the declining class had poorer performance on the DSST, verbal fluency, and MoCA. Compared to the steady low symptom class, the steady high class had lower volumes in the entorhinal cortex (β: −180.80, 95% CI: −336.69 to −24.91) and the amygdala (β: −40.97, 95% CI: −74.09 to −7.85), the increasing class had more WMHs (β: 0.55, 95% CI: 0.22 to 0.89), and the declining class was not significantly different in any brain measures. Trajectories in depressive symptoms in young to mid-adulthood show distinct cognitive and brain phenotypes in midlife. Steady high depressive symptoms may represent a group that is at risk for dementia, whereas increasing symptoms in midlife may be associated with white matter damage.

Consequences of heterogeneity in aging: parental age at death predicts midlife all-cause mortality and hospitalization in a Swedish national birth cohort

BackgroundThe processes that underlie aging may advance at different rates in different individuals and an advanced biological age, relative to the chronological age, is associated with increased risk of disease and death. Here we set out to quantify the extent to which heterogeneous aging shapes health outcomes in midlife by following a Swedish birth-cohort and using parental age at death as a proxy for biological age in the offspring.MethodsWe followed a nationwide Swedish birth cohort (N = 89,688) between the ages of 39 and 66 years with respect to hospitalizations and death. Cox regressions were used to quantify the association, in the offspring, between parental age at death and all-cause mortality, as well as hospitalization for conditions belonging to the 10 most common ICD-10 chapters.ResultsLonger parental lifespan was consistently associated with reduced risks of hospitalization and all-cause mortality. Differences in risk were mostly evident from before the age of 50 and persisted throughout the follow-up. Each additional decade of parental survival decreased the risk of offspring all-cause mortality by 22% and risks of hospitalizations by 9 to 20% across the 10 diseases categories considered. The number of deaths and hospitalizations attributable to having parents not living until old age were 1500 (22%) and 11,000 (11%) respectively.ConclusionsOur findings highlight that increased parental lifespan is consistently associated with health benefits in the offspring across multiple outcomes and suggests that heterogeneous aging processes have clinical implications already in midlife.

Supplemental Material for Structural Inequality Modifies Midlife Outcomes of a Multisystemic Early Childhood Program

Supplemental Material for Structural Inequality Modifies Midlife Outcomes of a Multisystemic Early Childhood Program

Coping with Discrimination: A Longitudinal Study of Health Outcomes in Lesbian, Gay, and Bisexual and Heterosexual Midlife and Older Adults.

This study explored how coping moderates the association between discrimination and health outcomes in lesbian, gay, and bisexual (LGB) and heterosexual midlife and older adults. This study analyzed longitudinal data from 163 LGB and 326 propensity-matched heterosexual midlife and older adults over approximately 20years, using the Midlife in the United States study. Discrimination was associated with slower chronic condition accumulation over time for LGB individuals. Problem-focused and avoidance coping moderated discrimination's impact on mental health in LGB participants over time, and in heterosexual participants, they moderated the association between discrimination and chronic conditions. The results suggest a potential "steeling" effect in LGB midlife and older adults facing higher discrimination levels. Furthermore, the findings suggest that effective coping strategies for mitigating the adverse impacts of discrimination on physical and mental health may vary by sexual orientation.

The accumulation of adversity in midlife: Effects on depressive symptoms, life satisfaction, and character strengths.

Middle-aged adults are a central pillar of society because they comprise large segments of the workforce and bridge younger and older generations. Given the significant role that middle-aged adults play for the greater good of society, more research is warranted to evaluate in which ways adversity could accumulate or pile-up to impact pertinent outcomes. We used data from a sample of middle-aged adults (n = 317, age 50-65 at baseline, 55% women) who were assessed monthly for a period of 2 years to examine whether the accumulation of adversity was predictive of depressive symptoms, life satisfaction, and character strengths (generativity, gratitude, the presence of meaning, and search for meaning). Greater accumulation of adversity was associated with reporting more depressive symptoms, lower life satisfaction, and the lower presence of meaning and the effects remained for depressive symptoms when accounting for concurrent adversity. More concurrent adversity was associated with reporting more depressive symptoms and lower life satisfaction and lower levels of generativity, gratitude, and the presence of meaning. Analyses that targeted specific domains of adversity showed that the accumulation of adversity associated with close family members (i.e., spouse/partner, children, and parents), and financial, and work domains showed the strongest (negative) associations across each outcome. Our findings demonstrate that monthly adversity take its toll on pertinent midlife outcomes and points to future research targeting mechanisms underlying our findings as well as resources that promote positive outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Age of First Overweight and Obesity, COVID-19 and Long COVID in Two British Birth Cohorts

Longer exposure to obesity, and thus a longer period in an inflamed state, may increase susceptibility to infectious diseases and worsen severity. Previous cross-sectional work finds higher BMI is related to worse COVID-19 outcomes, but less is known about associations with BMI across adulthood. To examine this, we used body mass index (BMI) collected through adulthood in the 1958 National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participants were grouped by the age they were first overweight (> 25 kg/m2) and obese (> 30 kg/m2). Logistic regression was used to assess associations with COVID-19 (self-reported and serology-confirmed), severity (hospital admission and contact with health services) and long-COVID reported at ages 62 (NCDS) and 50 (BCS70). An earlier age of obesity and overweight, compared to those who never became obese or overweight, was associated with increased odds of adverse COVID-19 outcomes, but results were mixed and often underpowered. Those with early exposure to obesity were over twice as likely in NCDS (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.17–4.00) and three times as likely in BCS70 (OR 3.01, 95% CI 1.74–5.22) to have long COVID. In NCDS they were also over four times as likely to be admitted to hospital (OR 4.69, 95% CI 1.64–13.39). Most associations were somewhat explained by contemporaneous BMI or reported health, diabetes or hypertension; however, the association with hospital admission in NCDS remained. An earlier age of obesity onset is related to COVID-19 outcomes in later life, providing evidence of the long-term impact of raised BMI on infectious disease outcomes in midlife.

Adult life-course trajectories of psychological distress and economic outcomes in midlife during the COVID-19 pandemic: evidence from the 1958 and 1970 British birth cohorts

PurposeFinancial adversity in times of economic recession have been shown to have an unequal effect on individuals with prior mental health problems. This study investigated the relationship between mental health groupings across the adult life-course and change in financial situation and employment status during the COVID-19 pandemic, as well as the use of financial measures to mitigate the economic shock.MethodsUsing two nationally representative British birth cohorts, the National Child Development Study (1958) n = 17,415 and 1970 British Cohort Study n = 17,198, we identified 5 different life-course trajectories of psychological distress from adolescence to midlife which were similar but not identical across the two cohorts. We explored their relation to changes in financial and employment circumstances at different stages during the pandemic from May 2020 to March 2021, applying multinomial logistic regression and controlling for numerous early life covariates, including family socio-economic status (SES). In addition, we ran modified Poisson models with robust standard errors to identify whether different mental health trajectories were supported by government and used other methods to mitigate their financial situation.ResultsWe found that the financial circumstances of pre-pandemic trajectories of psychological distress with differential onset, severity, and chronicity across the life-course were exacerbated by the COVID-19 economic shock. The ‘stable-high’ (persistent severe symptoms) and ‘adult-onset’ (symptoms developing in 30s, but later decreasing) groups were vulnerable to job loss. Compared to pre-pandemic trajectory groupings with no, minor, or psychological distress symptoms in early adulthood, the ‘stable-high’, ‘midlife-onset’ (symptoms developing in midlife), and ‘adult-onset’ trajectory groups were more likely to seek support from the UK governments economic response package. However, trajectories with pre-pandemic psychological distress were also at greater risk of reducing consumption, dis-saving, relying on increased financial help from family and friends, and also taking payment holidays (agreements with lenders to pause mortgage, credit card or loan payments for a set period) and borrowing.ConclusionThis work highlights different trajectories of pre-pandemic psychological distress, compared to groups with no symptoms were more vulnerable to pandemic-related economic shock and job loss. By adopting unsustainable mitigating measures (borrowing and payment holidays) to support their financial circumstances during COVID-19, these mental health trajectories are at even more risk of lasting adverse impacts and future economic difficulties.

ADVERSE CHILDHOOD EXPERIENCES AND DEPRESSIVE SYMPTOMS AMONG RACIALLY/ETHNICALLY DIVERSE OLDER ADULTS IN THE US

Adverse childhood experiences (ACEs) and depression are major public health concerns. However, few studies have examined the relationship between ACEs and mid- and late-life depression among racially/ethnically diverse groups. We explore this relationship among U.S. racially/ethnically diverse community-dwelling midlife and older adults (≥50 years of age). Guided by ACEs and Minority Stress Frameworks, we used general linear models to examine this relationship with data from Wave 3 of the National Social Life, Health, and Aging Project. We created an ACEs composite ranging from 0 to 7 (e.g., violence, health, poverty) and assessed the role of individual ACEs on depressive symptoms (CES-D). Final adjusted models (n:1424) included key demographic, health (e.g., chronic disease), social (living alone, social isolation, loneliness), and minority stress factors (e.g., limited access to healthcare and treatment, perceived discrimination). Results indicated that higher composite score ACEs (particularly childhood violence and poor health) were positively associated with higher levels of depressive symptoms. We found no interactions between race/ethnicity and ACEs. Our results suggest that ACEs contribute to the presence and severity of depressive symptoms into mid- and late-life adulthood. Consistent with Minority Stress Framework, common life-course stressors for minoritized groups may explain a lack of significant interactions in our models. Future research should explore the association of ACEs and other important health outcomes in diverse midlife and older adults. Finally, research is needed to examine if and how culturally appropriate depression interventions can be adapted to address the role of ACEs in later life health.

ADVERSE CHILDHOOD EXPERIENCES AND DEPRESSIVE SYMPTOMS AMONG RACIALLY/ETHNICALLY DIVERSE OLDER ADULTS IN THE US

Abstract Adverse childhood experiences (ACEs) and depression are major public health concerns. However, few studies have examined the relationship between ACEs and mid- and late-life depression among racially/ethnically diverse groups. We explore this relationship among U.S. racially/ethnically diverse community-dwelling midlife and older adults (≥50 years of age). Guided by ACEs and Minority Stress Frameworks, we used general linear models to examine this relationship with data from Wave 3 of the National Social Life, Health, and Aging Project. We created an ACEs composite ranging from 0 to 7 (e.g., violence, health, poverty) and assessed the role of individual ACEs on depressive symptoms (CES-D). Final adjusted models (n:1424) included key demographic, health (e.g., chronic disease), social (living alone, social isolation, loneliness), and minority stress factors (e.g., limited access to healthcare and treatment, perceived discrimination). Results indicated that higher composite score ACEs (particularly childhood violence and poor health) were positively associated with higher levels of depressive symptoms. We found no interactions between race/ethnicity and ACEs. Our results suggest that ACEs contribute to the presence and severity of depressive symptoms into mid- and late-life adulthood. Consistent with Minority Stress Framework, common life-course stressors for minoritized groups may explain a lack of significant interactions in our models. Future research should explore the association of ACEs and other important health outcomes in diverse midlife and older adults. Finally, research is needed to examine if and how culturally appropriate depression interventions can be adapted to address the role of ACEs in later life health.

Is childhood or midlife socioeconomic status more predictive of brain health across race/ethnicity?

AbstractBackgroundLower lifecourse socioeconomic status (SES) is associated with worse cognition and greater risk for Alzheimer’s disease (AD). Parental level of educational attainment is one indicator of childhood SES, which predicts myriad health outcomes throughout the lifespan. It is unclear whether midlife SES moderates the impact of childhood SES on midlife outcomes, like brain health. Subgroup differences are important for future risk reduction efforts; therefore, we tested whether midlife SES modifies the influence of childhood SES similarly in White, Black, and Latinx middle‐aged adults.MethodParticipants were 569 middle‐aged older adults drawn from the Offspring study of Racial/Ethnic Disparities in AD (adult children of WHICAP participants), who received MRI (mean age = 54.5 (SD = 10.6) years; 46 non‐Latinx White, 131 non‐Latinx Black, 392 Latinx; 66% women). We used general linear models to examine the relationship of childhood SES (e.g., parental education) with MRI markers of cerebrovascular disease (e.g., white matter hyperintensity volume; WMH) and whether MSES (e.g., educational attainment) moderated this relationship, controlling for sex/gender and age.ResultWhite participants were more likely to have higher childhood SES (F(2,568) = 199.3, p<.001) and MSES (F(2,568) = 36.1, p<.001), followed by Black, then Latinx participants. In the full sample, childhood SES was not associated with WMH volume. Race/ethnicity stratified models revealed that greater childhood SES was associated with lower WMH volume, but only in White participants (B = ‐0.60, CI = ‐0.109,‐0.010). Midlife SES was not associated with WMH volume in the full sample or within each race/ethnicity group. Among White participants, midlife SES did not modify the effect of childhood SES on WMH volume. Midlife SES was unrelated to WMH volume in Black and Latinx participants.ConclusionWe found that childhood SES predicts brain health in middle aged White people. We found racial and ethnic subgroup differences in the relationship of socioeconomic indicators to brain health. However, future studies aim to further understand mechanisms of brain health disparities by considering other SES indicators than parental and offspring education, larger subgroup sample sizes, absolute versus relative SES mobility, other lived experiences, and cognitive outcomes.

Exploring the relationships between adolescent alcohol misuse and later life health outcomes.

We sought to clarify the impact of adolescent alcohol misuse on adult physical health and subjective well-being. To do so, we investigated both the direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction and the indirect effects on these outcomes attributable to subsequent alcohol problems. The sample included 2733 twin pairs (32% monozygotic; 52% female) from the FinnTwin16 study. Adolescent alcohol misuse was a composite of frequency of drunkenness, frequency of alcohol use, and alcohol problems at ages 16, 17, and 18.5. The early midlife outcomes included somatic symptoms, self-rated health, and life satisfaction at age 34. The mediators examined as part of the indirect effect analyses included alcohol problems from the Rutgers Alcohol Problem Index at ages 24 and 34. Serial mediation and co-twin comparison models were applied and included covariates from adolescence and early midlife. There were weak direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction. However, there was stronger evidence for indirect effects, whereby young adult and early midlife alcohol problems serially mediated the relationship between adolescent alcohol misuse and early midlife somatic symptoms (β=0.03, 95% CI [0.03, 0.04]), self-rated health (β=-0.02, 95% CI [-0.03, -0.01]), and life satisfaction (β=-0.03, CI [-0.04, -0.02]). These serial mediation effects were robust in co-twin comparison analyses. These results provide evidence that alcohol problems are a primary driver linking adolescent alcohol misuse and poor health outcomes across the lifespan.

Cannabis and Tobacco Use Among Young People and Labor Market Outcomes in Midlife: A 23-Year Population-Based Longitudinal Study.

Research suggests an association between cannabis use and adverse labor market outcomes, but the mechanisms are unknown. We studied the nature of this association by comparing the relative roles of cannabis and tobacco use in predicting midlife outcomes. We analyzed data from the Young in Norway Study, a 23-year longitudinal investigation (N = 2,550; 56% female). Cannabis and tobacco use, potential confounders, and mediators were assessed by self-report. We used register data on income, years Not in Education, Employment or Training (NEET), and welfare benefits. We compared cannabis users (7%) and regular tobacco users (15%) with nonusers. After confounders were controlled for, cannabis users had lower income (income decile difference = -1.31; 95% CI [-1.83, -0.80]), had more NEET years (incidence rate ratio [IRR] = 1.87; 95% CI [1.34, 2.61]), and received welfare benefits more often (odds ratio [OR] = 2.84; 95 % CI [1.56, 5.17]). Tobacco users also earned less (income decile difference = -0.51; 95% CI [-0.86, -0.17]) and received welfare benefits more often (OR = 1.74; 95 % CI [1.14, 2.66]) but did not have more NEET years (IRR = 1.22; 95% CI [0.94, 1.59]). The reduction when controlling for confounders was larger for tobacco than for cannabis. Including mediators further reduced the associations for tobacco use considerably, whereas only slight reductions were observed for cannabis. The robust associations of cannabis use with poor labor market outcomes, even after adjustments, seem to differ from how tobacco use is related to such outcomes. More knowledge is needed about causal effects of cannabis use on important life domains.

Mortality associated with nonrestorative short sleep or nonrestorative long time-in-bed in middle-aged and older adults

Associations of sleep duration with human health could differ depending on whether sleep is restorative. Using data from 5804 participants of the Sleep Heart Health Study, we examined the longitudinal association of sleep restfulness combined with polysomnography-measured total sleep time (TST) or time in bed (TIB), representing different sleeping behaviors, with all-cause mortality. Among middle-aged adults, compared with restful intermediate TST quartile, the lowest TST quartile with feeling unrested was associated with higher mortality (hazard ratio [HR], 1.54; 95% confidence interval [CI] 1.01–2.33); the highest TST quartile with feeling rested was associated with lower mortality (HR, 0.55; 95% CI 0.32–0.97). Among older adults, the highest TIB quartile with feeling unrested was associated with higher mortality, compared with restful intermediate TIB quartile (HR, 1.57; 95% CI 1.23–2.01). Results suggest a role of restorative sleep in differentiating the effects of sleep duration on health outcomes in midlife and beyond.

Social Isolation Patterns and Health Outcomes in Midlife and Later Life

Conceptualizing social isolation as a multidimensional construct encompassing social networks, social contacts, perceived support and loneliness, this research aims to: (1) identify patterns of social isolation trajectory among middle-aged and older adults in the U.S.; (2) investigate how different patterns of social isolation trajectory are related to adults’ physical, mental, cognitive, and overall health. Latent class growth modeling was used to examine social isolation trajectory patterns over nine years in a national sample of 6,457 adults aged 51+. Four patterns of social isolation trajectory were identified: severely isolated, moderately isolated, subjectively integrated, and objectively integrated. The objectively integrated group reported the best physical, mental, cognitive, and overall health, whereas the severely isolated group reported the worst. The moderately isolated and subjectively integrated groups fell in between, with the latter displaying relatively better health outcomes. Findings support a close relationship between poor health and long-term social isolation.

Early marriage and health among women at midlife: Evidence from India

AbstractObjectiveThis article links stress and cumulative disadvantage associated with early marriages with lower self‐rated health, greater functional limitations, and chronic diseases among middle‐aged women in India.BackgroundEarly marriage has been a defining feature of the marital landscape in India, but the literature is myopic in its assessment of the implications of early marriage by focusing primarily on the reproductive and sexual health outcomes of young women.MethodsThe study used the 2005 and the 2012 waves of the nationally representative India Human Development Survey (IHDS). It utilized a sample of 36,283 currently married women from the second wave and 16,474 women from the panel data. Propensity score matching was used to account for selection into early marriages.ResultsEarly marriage was found to be associated with worse self‐rated health, a higher likelihood of having functional limitations and chronic diseases among middle‐aged Indian women. Moreover, it led to the deterioration of health over the two IHDS waves, as indicated by the development of chronic diseases, functional limitations, and the worsening of self‐rated health in midlife.ConclusionEarly marriage predisposes women to chronic stress resulting in poorer health outcomes in midlife. Therefore, early marriage may set women on a path of lifelong health disadvantage.ImplicationsThe findings underscore the importance of examining the link between early marriage and women's health outcomes in later life in other contexts.