Mortality among lone mothers in Sweden: a population study

doi:10.1016/S0140-6736(00)02087-0

The Lancet

Volume 355, Issue 9211, 8 April 2000, Pages 1215-1219

https://doi.org/10.1016/S0140-6736(00)02087-0 Get rights and content

Summary

Background

An increasing number of lone mothers are experiencing financial and health disadvantages. Our aim was to assess mortality among lone mothers compared with mothers with partners.

Methods

In this population-based study, overall and cause-specific mortality, between 1991 and 1995, was estimated for 90 111 lone mothers and 622 368 mothers with partners from data collected in the Swedish Population and Housing Census 1990. We estimated relative risks by Poisson regression, adjusted for socioeconomic status, and, to handle health-selection effects, we adjusted for previous inpatient history from 1987 to 1990.

Findings

Lone mothers showed an almost 70% higher premature risk of death than mothers with partners. The excess risk remained significantly increased (relative risk 1·2 [95% CI 1·1–1·4]) after adjustments for socioeconomic status and previous severe somatic and psychiatric inpatient history. Increased mortality was especially pronounced for suicides (2·2 [1·5–3·1]), violence (3·0 [0·9–10·6]), and alcohol-related mortality (2·4 [1·4–4·1]) among mothers who were without a partner in 1985 and in 1990.

Interpretation

The increase of lone mothers in society shows financial, social, and health disadvantages. Nevertheless, the increased mortality risk of lone mothers seems to be partly independent of socioeconomic status and health selection into lone motherhood. For long-term lone mothers the risks may be underestimated when adjusting for selection bias by taking hospital discharge history into account, since these events may be part of the consequences of the stress of lone motherhood.

Introduction

During the past few decades the proportion of lone-parent families has increased substantially in Western countries. In Sweden, lone parents now constitute about 20% of all families with children.¹ Most lone parents are women. Although studies show that Swedish lone mothers have an economically more favourable situation than their counterparts in other countries, many findings show that their situation is disadvantageous.1, 2, 3, 4 Relying on only one income, lone-parent families are to a larger extent dependent on public subsidy. Social welfare and housing allowance are far more common for lone-parent families than for other families.¹ The proportion of lone mothers who had difficulties in paying their household expenses increased from about 30% in 1979, to more than 50% in 1995. For couples, proportions were 12% in 1979, and 20% in 1995.³

There is a well-established link between socioeconomic status and health.5, 6, 7, 8, 9 Furthermore, the relation between marital status, parenthood, and health is well known.10, 11 White-collar workers and high-income groups have better health than blue-collar workers, unemployed people, and those in low-income strata. Married people live longer and report better health conditions than unmarried and divorced people. Given the circumstances of lone mothers, it is not surprising that studies have found a high proportion of lone parents with poor health.4, 12, 13, 14, 15, 16 In a comparison of self-perceived health among lone mothers and mothers with partners, in Great Britain and Sweden,¹⁷ the increased relative risk for lone mothers was of the same size in both countries despite a more favourable social policy in Sweden. There are few studies on mortality, although in some analyses of the effect of occupational, marital, and parental roles on mortality, lone mothers were found to have an increased risk of premature death.18, 19

The explanations offered for these health disadvantages are mainly divided between theories of social causation and health selection. Social causation suggests that the psychological stress, stigma, and financial difficulties associated with lone parenthood have adverse health consequences. For previously married people the stress suffered during marital breakdown also contributes. The health-selection argument suggests that the “healthy state of marriage” is due to a lower probability for unhealthy people to get married, stay married, or remarry. Previous studies have mainly focused on elucidating the processes of social causation.¹⁴ Studies that examine health-selection mechanisms are rare, probably because of the scarcity of the data required for this kind of research.

We analysed the mortality of lone mothers in Sweden compared with mothers with partners on the assumption that the poor socioeconomic status of lone mothers contributes to higher mortality. We adjusted for previous inpatient history to handle health-selection factors. This was done for overall and cause-specific mortality. In addition, we assessed the modifying effects of social position, social welfare, and number of children on the association between mortality and lone motherhood.

Section snippets

Participants and methods

The population was generated from the Swedish Population and Housing Census 1990. In Sweden, it is mandatory for every household to answer and return a census questionnaire (from 1960 to 1990, the census was every 5 years). The drop-out rate in the 1990 census was 2·5%.²⁰ We selected women aged 29–54 years, living alone or with a partner, and with children aged 0–15 years, by using a variable about household type. We combined this variable with information about marriage or consensual union.

Results

We studied 90 111 lone mothers and 622 368 mothers who had partners. The socioeconomic status of lone mothers in comparison to mothers with partners is shown in table 1. A slightly higher proportion of lone mothers than mothers with partners were manual workers or high and medium non-manual workers, and were more likely to lack information about occupation. We also analysed the level of education (data not shown), and found a lower degree of higher education (ie, >12 years in school) among lone

Discussion

Our study of more than 90 000 lone mothers showed an increased premature death risk for lone mothers compared with mothers living with partners. The highest risks were for suicide, violence, and alcohol-related mortality, although absolute numbers of violent deaths were small.

Some of the mortality differences in the multivariate analyses were accounted for by differences in socioeconomic status. To some extent we have controlled for health selection by inclusion of previous psychiatric and

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Lone-parent families tend to have poorer health, greater poverty, and lower employment than do two-parent families.1–3
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Stringent conditions for receiving welfare benefits are increasingly common in high-income countries. Our results suggest that requiring lone parents with school-age children toseek work as a condition of receiving welfare benefits adversely affects their mental health.
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ArticlesMortality among lone mothers in Sweden: a population study

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Participants and methods

Results

Discussion

Lancet

Lancet

Lancet

Soc Sci Med

Soc Sci Med

Soc Sci Med

Soc Sci Med

Soc Sci Med

Soc Sci Med

An economic analysis of lone motherhood in Sweden (doctoral thesis)

Economic problems. Living conditions and inequality 1975–1995 (in Swedish with English summary)

Levnadsförhållanden, rapport no 91

Articles
Mortality among lone mothers in Sweden: a population study