Estimating Healthcare Expenditures After Becoming Divorced or Widowed Using Propensity Score Matching

Overview

Journal Eur J Health Econ

Specialty Health Services

Date 2022 Oct 17

PMID 36251142

Authors

Iris Meulman

Bette Loef

Niek Stadhouders

Tron Anders Moger

Albert Wong

Johan J Polder

Ellen Uiters

Affiliations

Soon will be listed here.

Abstract

Becoming divorced or widowed are stressful life events experienced by a substantial part of the population. While marital status is a significant predictor in many studies on healthcare expenditures, effects of a change in marital status, specifically becoming divorced or widowed, are less investigated. This study combines individual health claims data and registered sociodemographic characteristics from all Dutch inhabitants (about 17 million) to estimate the differences in healthcare expenditure for individuals whose marital status changed (n = 469,901) compared to individuals who remained married, using propensity score matching and generalized linear models. We found that individuals who were (long-term) divorced or widowed had 12-27% higher healthcare expenditures (RR = 1.12, 95% CI 1.11-1.14; RR = 1.27, 95% CI 1.26-1.29) than individuals who remained married. Foremost, this could be attributed to higher spending on mental healthcare and home care. Higher healthcare expenditures are observed for both divorced and widowed individuals, both recently and long-term divorced/widowed individuals, and across all age groups, income levels and educational levels.

References

Holmes T, RAHE R . The Social Readjustment Rating Scale. J Psychosom Res. 1967; 11(2):213-8. DOI: 10.1016/0022-3999(67)90010-4. View

Laditka J, Laditka S . Increased hospitalization risk for recently widowed older women and protective effects of social contacts. J Women Aging. 2003; 15(2-3):7-28. DOI: 10.1300/J074v15n02_02. View

Dabergott F . The gendered widowhood effect and social mortality gap. Popul Stud (Camb). 2021; 76(2):295-307. DOI: 10.1080/00324728.2021.1892809. View

Sasson I, Umberson D . Widowhood and depression: new light on gender differences, selection, and psychological adjustment. J Gerontol B Psychol Sci Soc Sci. 2013; 69(1):135-45. PMC: 3894126. DOI: 10.1093/geronb/gbt058. View

Strohschein L, McDonough P, Monette G, Shao Q . Marital transitions and mental health: are there gender differences in the short-term effects of marital status change?. Soc Sci Med. 2005; 61(11):2293-303. DOI: 10.1016/j.socscimed.2005.07.020. View

Moller J, Bjorkenstam E, Ljung R, Aberg Yngwe M . Widowhood and the risk of psychiatric care, psychotropic medication and all-cause mortality: a cohort study of 658,022 elderly people in Sweden. Aging Ment Health. 2010; 15(2):259-66. DOI: 10.1080/13607863.2010.513041. View

Rolden H, van Bodegom D, Westendorp R . Changes in health care expenditure after the loss of a spouse: data on 6,487 older widows and widowers in the Netherlands. PLoS One. 2014; 9(12):e115478. PMC: 4275307. DOI: 10.1371/journal.pone.0115478. View

Costa-Font J, Jimenez-Martin S, Vilaplana C . Does long-term care subsidization reduce hospital admissions and utilization?. J Health Econ. 2018; 58:43-66. DOI: 10.1016/j.jhealeco.2018.01.002. View

Lucas R . Time does not heal all wounds. Psychol Sci. 2005; 16(12):945-50. DOI: 10.1111/j.1467-9280.2005.01642.x. View

10.

Nguyen T, Collins G, Spence J, Daures J, Devereaux P, Landais P . Double-adjustment in propensity score matching analysis: choosing a threshold for considering residual imbalance. BMC Med Res Methodol. 2017; 17(1):78. PMC: 5408373. DOI: 10.1186/s12874-017-0338-0. View

11.

Blough D, Madden C, Hornbrook M . Modeling risk using generalized linear models. J Health Econ. 1999; 18(2):153-71. DOI: 10.1016/s0167-6296(98)00032-0. View

12.

Tseng F, Petrie D, Wang S, Macduff C, Stephen A . The impact of spousal bereavement on hospitalisations: Evidence from the Scottish Longitudinal Study. Health Econ. 2017; 27(2):e120-e138. DOI: 10.1002/hec.3573. View

13.

Tseng F, Petrie D, Leon-Gonzalez R . The impact of spousal bereavement on subjective wellbeing: Evidence from the Taiwanese elderly population. Econ Hum Biol. 2017; 26:1-12. DOI: 10.1016/j.ehb.2017.01.003. View

14.

Berntsen K, Kravdal O . The relationship between mortality and time since divorce, widowhood or remarriage in Norway. Soc Sci Med. 2012; 75(12):2267-74. DOI: 10.1016/j.socscimed.2012.08.028. View

15.

Maarse J, Jeurissen P . The policy and politics of the 2015 long-term care reform in the Netherlands. Health Policy. 2016; 120(3):241-5. DOI: 10.1016/j.healthpol.2016.01.014. View

16.

Arens D . Widowhood and well-being: an examination of sex differences within a causal model. Int J Aging Hum Dev. 1982; 15(1):27-40. DOI: 10.2190/v13t-0dt1-tx7d-9m9x. View

17.

Shor E, Roelfs D, Bugyi P, Schwartz J . Meta-analysis of marital dissolution and mortality: reevaluating the intersection of gender and age. Soc Sci Med. 2012; 75(1):46-59. PMC: 3881174. DOI: 10.1016/j.socscimed.2012.03.010. View

18.

Bookwala J, Marshall K, Manning S . Who needs a friend? Marital status transitions and physical health outcomes in later life. Health Psychol. 2014; 33(6):505-15. DOI: 10.1037/hea0000049. View

19.

Thomeer M, Mudrazija S, Angel J . Relationship Status and Long-Term Care Facility Use in Later Life. J Gerontol B Psychol Sci Soc Sci. 2015; 71(4):711-23. PMC: 4903036. DOI: 10.1093/geronb/gbv106. View

20.

Guldin M, Jensen A, Zachariae R, Vedsted P . Healthcare utilization of bereaved relatives of patients who died from cancer. A national population-based study. Psychooncology. 2012; 22(5):1152-8. DOI: 10.1002/pon.3120. View