Lone parenting, socioeconomic conditions and severe ill-health : longitudinal register-based studies

Sammanfattning: The general aims of this dissertation are to analyse how family situation, and especially lone parenting, influence health and life chances in Sweden and the extent to which possible relations are influenced by socioeconomic circumstances and health selection. In two population-based cohort studies we analysed overall and cause-specific mortality (1991-95), and also severe morbidity (1991-94) from different causes among lone mothers in comparison with mothers with partners. Information on the mothers was obtained from the Swedish Population and Housing censuses of 1985 and 1990. The outcomes considered were death or utilisation of (overnight) hospital care, with data taken from population-based national health registers. In the analyses we adjusted for socioeconomic and demographic circumstances, such as socioeconomic status, country of birth, receipt of social-welfare benefit, and housing situation. To take health-selection effects into account, we adjusted for previous inpatient history (1987-90). Our findings suggest that lone motherhood entails health disadvantages with regard to mortality, severe morbidity and injury. Socioeconomic circumstances were found to play a major role in accounting for increased risks, but the risks are partly independent of both socioeconomic conditions and health selection into lone motherhood. In two further studies we analysed mortality (1991-98), severe morbidity and injury (1991-99), and also educational achievement (in 1998 at ages 24-25 of offspring), of children who had lived in lone-parent families in comparison with children in two-parent families. We mainly used data from the Swedish censuses and national health-data registers. Living in a lone parent family was found to be associated with increased risks of a variety of unfavourable outcomes: psychiatric disease, suicide/suicide attempt, injury, addiction, and low educational attainment. Relatively poor educational performance and also health disadvantages are explicable to a large extent by socioeconomic conditions, especially a lack of economic resources (as measured here by receipt of social-welfare benefit and having rented accommodation). Educational achievement among children varies with cause of lone parenthood, with the best prospects found among the children of widows/widowers. In a fifth study we analysed mortality from different causes (1991-2000) among lone fathers (fathers with and without custody of their children) and childless men (with and without partners) in comparison with cohabiting fathers with children in the household. For this purpose we linked information from the Swedish censuses of 1985 and 1990 to Sweden’s Multi-Generation Register (which contains information about all known biological relations between children and parents). Lone non-custodial fathers and lone childless men suffer from the most pronounced elevated risks, especially of death from injury or addiction, but also from all-cause mortality and death from ischaemic heart disease. Being a lone custodial father also seems to entail an increased mortality risk, although generally to a much lesser degree, and not for all outcomes studied. The elevated risks for all subgroups fell when variables assumed to control health selection and socioeconomic circumstances were introduced into the initial regression model employed. However, even following adjustments, significantly increased risks, albeit greatly attenuated, remained in all the subgroups investigated. Key Words: Single parent, single mother, single father, children, risk factor, socio-economic status, mortality, morbidity, injury, psychiatric disease, education, epidemiology, longitudinal