Relationship Status-Based Health Disparities during the COVID-19 Pandemic

Abstract

Previous research finds that marriage is a privileged family form with health benefits. These health advantages may have shifted during the pandemic, as more time was spent at home and resources strained. This study compares differences in three health outcomes across relationship statuses between April and December 2020 using a nationally-representative US survey, the Household Pulse Survey (N = 1,422,733). As the pandemic progressed, larger differences emerged when comparing married and never married respondents' probabilities of fair or poor health, depression, and anxiety as never married people had the steepest decline in health, even adjusting for pandemic-related stressors (e.g., food insufficiency). Yet, widowed and divorced/separated respondents' greater probabilities of these three health outcomes compared to married respondents' narrowed over this same period. During the pandemic, relationship status and self-rated health patterns were similar for men and women, but for mental health there was evidence that the growing advantage of marriage relative to never being married was more pronounced for men, whereas the shrinking advantage of marriage relative to being previously married was more pronounced for women. This study identifies the unique health needs for never married adults during the pandemic, demonstrating that social conditions around the pandemic likely exacerbated health disparities by relationship status.

Keywords: gender; health and illness; mental health; relationship status; stressors.

Figure 1.

Hypotheses for differences in association between relationship statuses and health outcomes between April–December 2020.

Figure 2.

Proportion of Respondents with Fair or Poor Health, Depression, and Anxiety Across COVID-19 Pandemic Waves (Household Pulse Survey; April- December 2020). N = 1,422,733 for fair/poor health, N = 1,417,604 for depression, N = 1,418,450 for anxiety. Between Waves 1 and 2: April 23-June 16; Wave 2: June 18-July 21; Between Waves 2 and 3: August 19-October 26; Wave 3: October 28-December 21. Unweighted.

Figure 3.

Estimated Trends in Reporting Fair or Poor Health by Relationship Status, Household. Pulse Survey, April-December 2020; N = 1,422,733. Weighted using sampling and replicate weights. Post-estimation values were calculated using parameter estimates from logistic regression models adjusting for gender, age, age-squared, race/ethnicity, educational attainment, household income, coresidence with minor child, week of survey, loss of income, food insufficiency, delaying medical care, and housing payment issues (Model 1) in Table 2. Covariates held at their means.

Figure 4.

Estimated Trends in Depression by Relationship Status, Household Pulse Survey, April-December 2020; N = 1,417,604. Weighted using sampling and replicate weights. Post-estimation values were calculated using parameter estimates from logistic regression models adjusting for gender, age, age-squared, race/ethnicity, educational attainment, household income, coresidence with minor child, week of survey, loss of income, food insufficiency, delaying medical care, and housing payment issues (Model 2) in Table 2. Covariates held at their means.

Figure 5.

Estimated Trends in Anxiety by Relationship Status, Household Pulse Survey, April–December 2020; N = 1,418,450. Weighted using sampling and replicate weights. Post-estimation values were calculated using parameter estimates from logistic regression models adjusting for gender, age, age-squared, race/ethnicity, educational attainment, household income, coresidence with minor child, week of survey, loss of income, loss of income, food insufficiency, delaying medical care, and housing payment issues (Model 3) in Table 2. Covariates held at their means.