Purpose To examine the impact of marital status on stage at diagnosis, use of definitive therapy, and cancer-specific mortality among each of the 10 leading causes of cancer-related death in the United States. Methods We used the Surveillance, Epidemiology and End Results program to identify 1,260,898 patients diagnosed in 2004 through 2008 with lung, colorectal, breast, pancreatic, prostate, liver/intrahepatic bile duct, non-Hodgkin lymphoma, head/neck, ovarian, or esophageal cancer. We used multivariable logistic and Cox regression to analyze the 734,889 patients who had clinical and follow-up information available. Results Married patients were less likely to present with metastatic disease (adjusted odds ratio [OR], 0.83; 95% CI, 0.82 to 0.84; P .001), more likely to receive definitive therapy (adjusted OR, 1.53; 95% CI, 1.51 to 1.56; P .001), and less likely to die as a result of their cancer after adjusting for demographics, stage, and treatment (adjusted hazard ratio, 0.80; 95% CI, 0.79 to 0.81; P .001) than unmarried patients. These associations remained significant when each individual cancer was analyzed (P .05 for all end points for each malignancy). The benefit associated with marriage was greater in males than females for all outcome measures analyzed (P .001 in all cases). For prostate, breast, colorectal, esophageal, and head/neck cancers, the survival benefit associated with marriage was larger than the published survival benefit of chemotherapy. Conclusion Even after adjusting for known confounders, unmarried patients are at significantly higher risk of presentation with metastatic cancer, undertreatment, and death resulting from their cancer. This study highlights the potentially significant impact that social support can have on cancer detection, treatment, and survival.

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Marital Status and Survival in Patients With Cancer

The Case for Marriage: Why Married People are Happier, Healthier, and Better Off Financially. Linda J. Waite & Maggie Gallagher. New York: Doubleday. 2000. 260 pp. ISBN 0-38550085-8. $24.95 cloth. Marriage, our second oldest institution, has been controversial during most of its existence. In The Bankruptcy of Marriage, Calverton (1928) observed, "It is marriage as we know it... the marriage of modern monogamy, of the bindingcontract variety, our system of marriage, in other words, that has broken down, and to-day is bankrupt" (p. 62). Given its age and its undisputed importance, marriage has long been challenged and defended. The Case for Marriage offers a spirited and well-documented but flawed example of such a defense. First, its use of language is far from neutral. Its tone oozes with disrespect for those who deviate from lifelong marriage. Marriage throughout the text is referred to as a "bargain," a superior investment benefiting both those who participate and society at large. Cohabitation, on the other hand, is a "deal," something one picks up at a flea market. Cohabiting partners, regardless of their age, are referred to as "live-in" boy- or girlfriends and are described as "couples living together without commitment" (p. 190). Adult singles are treated as a residual category. As constructionists remind us, the use of language is not just a descriptive but a creative and frequently assertive activity. My second concern is conceptual. Marriage institutionalizes the legitimacy of offspring in human societies. Children born in it, regardless of its form, are considered "legitimate" and belong to a kinship network. The marriage institution, then, has a clear stake in its procreative consequences, as is exemplified by its sole universal rule, the "incest taboo." Its main "enemy" is promiscuous reproduction. Its "allies" are those other forms of "living together" that, regardless of their duration, counter random mating. "Family," the oldest human institution, traditionally is responsible for "caring" for the very young, and nowadays also for the aged. It seems impossible to imagine humanity's pilgrimage without these two institutions. It is quite possible, however, to imagine each one taking on a variety of forms. The core units of the marriage and family institutions are, respectively, married couples and family networks. The bulk of Waite's and Gallagher's book is not about the institutions of marriage and family, but rather about individuals who choose to participate in marital and familial units. They conceptualize marriage as more than a "private emotional relationship" and specify a "lifelong commitment to form a new family" (p. 187) as its raison d'etre. They use the words marriage and family interchangeably. This is confusing. For example, are voluntarily childless married couples to be considered deviants? Uncommitted? What about one-parent families? Are they a different legitimate family form or, as the authors seem to imply, simply an outcome of unwed motherhood, marital failure, or early spousal death? I agree with the authors that marriage's "larger public role must be acknowledged and supported by the larger society and its institutions" (p. 187). All social arrangements, whether sacred or profane, to use Durkheim's terminology, that combat reproductive promiscuity or inadequate family care deserve support from "society and its institutions." The authors' treatment of cohabitation is equally troublesome to me. Analytically, cohabitation, in its many manifestations, should not be contrasted or compared with marriage but rather with the equally diverse category of singlehood. I have no problem with the multitude of quantitative data amassed by the authors to show that enduring marriages and families, on the average, offer some distinct advantages over cohabitation. …

The Case for Marriage: Why Married People Are Happier, Healthier, and Better off Financially

https://link.springer.com/content/pdf/10.2307%2F3342422.pdf

Inequalities in Health: The Black Report

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Disability in America: Toward a National Agenda for Prevention

What determines whether children grow up to be rich or poor? Arguing that parental actions are some of the most important sources of wealth inequality, Casey B. Mulligan investigates the transmission of economic status from one generation to the next by constructing an economic model of parental preferences. In Mulligan's model, parents determine the degree of their altruistic concern for their children and spend time with and resources on them accordingly—just as they might make choices about how they spend money. Mulligan tests his model against both old and new evidence on the intergenerational transmission of consumption, earnings, and wealth, including models that emphasize "financial constraints." One major prediction of Mulligan's model confirmed by the evidence is that children of wealthy parents typically spend more than they earn. Mulligan's innovative approach can also help explain other important behavior, such as charitable giving and "corporate loyalty," and will appeal to a wide range of quantitatively oriented social scientists and sociobiologists.

Parental Priorities and Economic Inequality

The theory that marriage has protective effects for survival has itself lived for more than 100 years since Durkheim’s groundbreaking study of suicide (Durkheim 1951 [1897]). Investigations of differences in this protective effect by gender, by age, and in contrast to different unmarried statuses, however, have yielded inconsistent conclusions. These investigations typically either use data in which marital status and other covariates are observed in cross-sectional surveys up to 10 years before mortality exposure, or use data from panel surveys with much smaller sample sizes. Their conclusions are usually not based on formal statistical tests of contrasts between men and women or between never-married, divorced/separated, and widowed statuses. Using large-scale pooled panel survey data linked to death registrations and earnings histories for U.S. men and women aged 25 and older, and with appropriate contrast tests, we find a consistent survival advantage for married over unmarried men and women, and an additional survival “premium” for married men. We find little evidence of mortality differences between never-married, divorced/separated, and widowed statuses.

/pdf/the-protective-effect-of-marriage-for-survival-a-review-and-ejqxxu5fcf.pdf

The protective effect of marriage for survival: a review and update.

Husbands and wives often coordinate retirement decisions, as many married workers withdraw from the labor force at about the same time as their spouses. However, joint retirement behavior may differ for couples in which one spouse retires with health problems. In those cases, the able-bodied spouse may delay retirement to compensate for the earnings lost by the disabled spouse. This paper examines the retirement decisions of husbands and wives and how they interact with spousal health and employment, using data from the 1992-1998 waves of the Health and Retirement Study. The results indicate that both men and women are more likely to retire if their spouses have already retired than if they are still working. However, they are less likely to retire if their spouses appear to have left the labor force because of health problems, especially when spouses are not yet eligible for Social Security retirement benefits. There is no evidence that spousal caregiving demands affect retirement rates.

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Retiring together or working alone: The impact of spousal employment and disability on retirement decisions

Social security faces a major long-term funding crisis. A 38 or greater percentage increase in the system's tax rate is needed to meet benefit payments on an ongoing basis. Tax increases of this magnitude or comparable benefit cuts would significantly worsen social security's treatment of postwar Americans. This paper uses CORSIM (a dynamic micro simulation model) and SOCSIM (a detailed social security benefit calculator) to study this treatment. The study finds that Americans born in the postwar period will, under current law, lose roughly 5 cents of every dollar they earn to the OASI program in taxes net of benefits. Measured as a proportion of their lifetime labor incomes, the middle class are the biggest losers, surrendering about 7 cents per dollar earned. But measured in absolute dollars, the rich lose the most. Out of every dollar that postwar Americans contribute to the OASI system, 67 cents represent a pure tax. The system treats women better than men, whites better than non-whites, and the colle...

https://www.nber.org/system/files/working_papers/w6603/w6603.pdf

Social Security's Treatment of Postwar Americans

This research was funded by the Social Security Administration, Office of Research, Evaluation, and Statistics, Division of Policy Evaluation (Contract No.: 0600-01-60123). We gratefully acknowledge programming assistance from Barbara Butrica, Joshua Goldwyn and Joyce Morton and helpful advice from Gary Burtless. We remain solely responsible for all errors and omissions. The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

Modeling Income in the Near Term 4

About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance's role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

Melissa M. Favreault

Papers

The protective effect of marriage for survival: a review and update.

Retiring together or working alone: The impact of spousal employment and disability on retirement decisions

Social Security's Treatment of Postwar Americans

Modeling Income in the Near Term 4

Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending