Better alone? The impact of living arrangements on mortality of Costa Rican older adults

Vazquez-Castillo, Paola

doi:10.20947/S0102-3098a0236

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Estudos de População

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. bras. estud. popul. 40 • 2023 • https://doi.org/10.20947/S0102-3098a0236 copy

Better alone? The impact of living arrangements on mortality of Costa Rican older adults

Melhor sozinho? O impacto de arranjos domiciliares na mortalidade de idosos costarriquenhos

¿Mejor solo? El impacto de los arreglos de vivienda en la mortalidad de las personas adultas mayores costarricenses

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Previous research has shown differentiated effects of living arrangement types on mortality. However, little is known about this phenomenon in Latin America and its multigenerational households. This study measures the relationship between older adults’ living arrangement types and subsequent mortality. Gompertz event history models were performed to estimate mortality differences across living arrangements. We used the Costa Rica Longevity and Aging Study (CRELES) pre-1945 cohort in the 2005, 2007, and 2009 waves. The results show that older adults who live with a partner have the highest survival rates among the categories tested. When controlling for sex and age in the model, the effect of living alone is not different from partnered living. When controlling for socioeconomic and health factors as well, older adults living with their children or others show an increased risk of death by at least 40% (p-value<0.05). The study demonstrates an association between living arrangements and older adult mortality in Costa Rica. Results show that the highest survival chances rely on being partnered and suggest that support exchanges with other family members are not equally effective. Including this variable type in mortality studies is crucial to better understanding how household conditions relate to health and mortality outcomes.

Keywords:
Living arrangements; Old-age mortality; Costa Rica

Variables / living arrangements	Total	Alone	With partner (with/ without others)	With children (with/without others except partners)	Other arrangements
	100	9.77	59.51	20.05	10.66
Demographic
Sex ***
Female	52.69	55.63	39.52	80.26	71.53
Male	47.31	44.37	60.48	19.74	28.47
Age***
<75 years	72.20	56.91	80.85	56.80	66.99
75+ years	27.80	43.09	19.15	43.20	33.01
Socioeconomic
Household wealth***
Low	11.71	26.48	9.66	10.85	11.24
Mid	64.47	61.46	62.84	69.44	67.01
High	23.81	12.06	27.50	19.71	21.75
Educational Attainment ***
None	13.50	15.20	11.86	16.55	15.34
Primary	64.97	63.53	64.68	68.63	61.01
Secondary or higher	21.53	21.28	23.45	14.82	23.65
Type of area***
Urban	62.47	63.85	59.37	66.73	70.44
Rural	37.53	36.15	40.63	33.27	29.56
Health variables
Hypertension
Yes	48.37	50.29	46.61	54.71	44.46
No	51.63	49.71	53.39	45.29	55.54
Diabetes*
Yes	20.75	14.85	21.95	20.93	19.19
No	79.25	85.15	78.05	79.07	80.81
Multimorbidity**
Yes	11.59	10.26	10.64	13.66	14.22
No	88.41	89.74	89.36	86.34	85.78
Self-rated health
Good	52.64	51.42	52.48	53.03	53.94
Fair or bad	47.36	48.58	47.52	46.97	46.06
ADLs & IADLs***
Healthy	81.23	83.15	86.28	69.92	72.56
Disabled	18.77	16.85	13.72	30.08	27.44
Health-related behaviors
Smoked ***
Yes	42.77	46.69	47.20	30.48	37.58
No	57.23	53.31	52.80	69.52	62.42
Exercise***
Yes	31.95	30.86	36.16	22.11	28.00
No	68.05	69.14	63.84	77.89	72.00
Obesity
Yes	29.35	31.02	29.39	29.25	27.72
No	70.65	68.98	70.61	70.75	72.28

	Model 1	Model 2	Model 3	Model 4
Variables	RR [CI]	RR [CI]	RR [CI]	RR [CI]
Living arrangements
With partner (with/without others) ref.	1	1	1	1
Alone	0.93 [0.66, 1.30]	0.94 [0.67, 1.32]	1.15 [0.82, 1.62]	1.17 [0.83, 1.65]
With children (with/ without others except partner)	1.50** [1.18, 1.92]	1.51 ** [1.18, 1.93]	1.44 ** [1.12, 1.84]	1.44 ** [1.13, 1.84]
Other arrangements	1.35 * [0.99, 1.85]	1.36 * [0.99, 1.86]	1.39 ** [1.02, 1.91]	1.41 ** [1.03, 1.93]
Sex
Male ref.	1	1	1	1
Female	0.75 ** [0.62, 0.92]	0.75 ** [0.61, 0.91]	0.65 ** [0.53, 0.80]	0.60 *** [0.48, 0.75]
Age (cont.)	1.08 *** [1.07, 1.09]	1.08 *** [1.07, 1.09]	1.06 *** [1.05, 1.07]	1.06 *** [1.05, 1.07]
Household wealth
Low ref.		1	1	1
Mid		1.03 [0.79, 1.36]	1.10 [0.84, 1.45]	1.10 [0.84, 1.45]
High		1.05 [0.74, 1.48]	1.13 [0.80, 1.60]	1.13 [0.80, 1.60]
Educational attainment
Primary ref.		1	1	1
None		0.90 [0.72, 1.13]	0.85 [0.68, 1.07]	0.85 [0.67, 1.06]
More than primary		0.91 [0.65, 1.28]	1.07 [0.77, 1.51]	1.08 [0.77, 1.52]
Type of area
Rural ref.		1	1	1
Urban		0.99 [0.80, 1.21]	1.00 [0.82, 1.23]	1.00 [0.82, 1.22]
Hypertension
No ref			1	1
Yes			0.91 [0.75, 1.11]	0.89 [0.74, 1.09]
Diabetes
No ref			1	1
Yes			1.44 *** [1.14, 1.82]	1.41 ** [1.11, 1.79]
Multimorbidity
No ref			1	1
Yes			1.26 * [1.00, 1.58]	1.25* [0.99, 1.57]
Self-rated health
Good ref.			1	1
Fair or bad			1.26 ** [1.03, 1.54]	1.24** [1.01, 1.52]
ADL & IADLs
Healthy ref.			1	1
Disabled			3.00*** [2.35,3.83]	2.78 *** [2.17, 3.56]
Smoked
No ref				1
Yes				0.91 [0.74, 1.12]
Exercise
No ref				1
Yes				0.62 ** [0.44, 0.87]
Obesity
No ref				1
Yes				1.18 [0.93, 1.50]
Constant	0.00 *** [0.00, 0.00]	0.00 *** [0.00, 0.00]	0.00 *** [0.00, 0.00]	0.00 *** [0.00, 0.00]
Gamma	0.00 ** [0.00, 0.00]	0.00 ** [0.00, 0.00]	0.00 *** [0.00, 0.00]	0.00 *** [0.00, 0.00]

	Model 4	Model 4 W/O Proxy answers
Variables	RR [CI]	RR[CI]
Living arrangement
With partner (with/without others) ref.	1	1
Alone	1.17	1.12
Alone	[0.83, 1.65]	[0.70, 1.79]
With children (with/ without others except partner)	1.44 **	1.52**
With children (with/ without others except partner)	[1.13, 1.84]	[1.04,2.20]
Other arrangements	1.41 **	1.26
Other arrangements	[1.03, 1.93]	[0.76, 2.09]
Sex
Male ref.	1	1
Female	0.60 ***	0.57 **
Female	[0.48, 0.75]	[0.40, 0.82]
Age (cont.)	1.06 ***	1.06 ***
Age (cont.)	[1.05, 1.07]	[1.04, 1.08]
Household wealth
Low ref.	1	1
Mid	1.1	1.07
Mid	[0.84, 1.45]	[0.67, 1.70]
High	1.13	1.07
High	[0.80, 1.60]	[0.61, 1.87]
Educational attainment
Primary ref.	1	1
None	0.85	0.81
None	[0.67, 1.06]	[0.52, 1.25]
More than primary	1.08	1.09
More than primary	[0.77, 1.52]	[0.69, 1.71]
Type of area
Rural ref.	1	1
Urban	1	1
Urban	[0.82, 1.22]	[0.72, 1.38]
Hypertension
No ref	1	1
Yes	0.89	0.83
Yes	[0.74, 1.09]	[0.62, 1.12]
Diabetes
No ref	1	1
Yes	1.41 **	1.64 **
Yes	[1.11, 1.79]	[1.17, 2.30]
Multimorbidity
No ref	1	1
Yes	1.25*	1.23
Yes	[0.99, 1.57]	[0.84, 1.79]
Self-rated health
Good ref.	1	1
Fair or bad	1.24**	1.31 *
Fair or bad	[1.01, 1.52]	[0.97, 1.79]
ADL & IADLs
Healthy ref.	1	1
Disabled	2.78 ***	1.76 **
Disabled	[2.17, 3.56]	[1.24, 2.51]
Smoked
No ref	1	1
Yes	0.91	0.96
Yes	[0.74, 1.12]	[0.69, 1.33]
Exercise
No ref	1	1
Yes	0.62 **	0.65 **
Yes	[0.44, 0.87]	[0.43, 0.97]
Obesity
No ref	1	1
Yes	1.18	1.37 *
Yes	[0.93, 1.50]	[0.98, 1.92]
Constant	0.00 ***	0.00 ***
Constant	[0.00, 0.00]	[0.00, 0.00]
Gamma	0.00 ***	0.00 **
Gamma	[0.00, 0.00]	[0.00, 0.00]

Model	Observations	ll(null)	ll(model)	DF	AIC	BIC
1	2,593	-1616.93	-1574.44	5	3158.89	3188.19
2	2,593	-1616.93	-1416.71	7	2847.42	2888.45
3	2,593	-1616.93	-1416.17	12	2856.33	2926.66
4	2,593	-1616.93	-1352.93	17	2739.87	2839.5
5	2,593	-1616.93	-1347.49	20	2734.99	2852.20

Wave	Alone	With partner (with/ without others)	With children (with / without others except partner)	Other arrangements
1	18	96	32	29
2	40	115	52	40
Total	58	221	84	69

Associação Brasileira de Estudos Populacionais Rua André Cavalcanti, 106, sala 502., CEP 20231-050, Fone: 55 31 3409 7166 - Rio de Janeiro - RJ - Brazil
E-mail: editor@rebep.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Contact address
Interdisciplinary Centre on Population Dynamics at the University of Southern Denmark Campusvej 55 5230 − Odense M, Denmark