摘要：Objectives. To investigate whether less-healthy work–family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women. Methods. We used sequence analysis to identify distinct work–family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992–2006) and the Survey of Health, Aging, and Retirement in Europe (2004–2009). Results. Work–family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work–family trajectories as European women. Conclusions. Combining work and lone motherhood was more common in the United States, but differences in work–family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women. Life expectancy is shorter in the United States than in many Western European countries. Older Americans are also more likely to report poorer health and to suffer chronic conditions, particularly American women. 1,2 Explanations for this so-called US health disadvantage include differences in the prevalence of smoking and other behavioral risk factors, rates of disease and injury, financial barriers to health care access, and psychosocial stress. 2–6 Although higher smoking prevalence histories among older women in the United States is one of the driving explanations, 3 none of these factors fully accounts for the female US health disadvantage. Lives of American women changed substantially in the second half of the previous century. Female labor force participation increased more in the United States than in many European countries, 7 and marriage rates decreased more rapidly for US women as a result of a higher fraction of American women never marrying as well as higher divorce rates. 8,9 By contrast, although fertility rates declined in all countries, 10 they declined less in the United States than in many European countries, leaving more American women facing the prospect of combining work and family roles, often in the context of lone motherhood. Women who are married, employed, and have children are generally healthier than their unmarried, nonemployed, and childless counterparts. 11,12 Whereas the role accumulation theory suggests that combining family and work roles is beneficial for women’s health, the multiple role theory poses that combining these roles may increase levels of stress, which has a negative impact on health. 13 These negative impacts may, however, depend on the availability of supportive policies that enable parents to combine work with family roles. We hypothesized that work–family trajectories may be differentially related to cardiovascular health in the United States than in Europe, as a result of the different work–family policy environment in the United States and Europe. If combining family and work roles is beneficial for a woman’s health, women experiencing a more family-friendly policy environment such as that in Europe may benefit more from role accumulation, resulting in better cardiovascular health. If combining roles is detrimental for a woman’s health, American women may experience more strain from work–family stress than European women as a result of a less supportive policy environment in the United States. The aim of this study was to assess whether less-healthy work–family life histories among American women have contributed to their cardiovascular health disadvantage in older age relative to women in 13 European countries. We used unique retrospective data for 13 European countries and the United States to construct full life histories and work–family trajectories, and linked them to stroke and heart disease outcomes in older ages. We examined the association between work–family trajectories and late-life cardiovascular outcomes and assessed whether the distribution and risks associated with these work–family trajectories explain why older American women have higher stroke and heart disease prevalence than older women in Europe.
