摘要：Objectives. We examined the association between trajectories of partnership status over the life course and objectively measured health indicators in midlife. Methods. We used data from 4 waves (1981, 1991, 2000, and 2002–2004) of the British National Child Development Study (NCDS), a prospective cohort study that includes all people born in Britain during 1 week in March 1958 (n = 18 558). Results. After controlling for selection attributable to early-life and early-adulthood characteristics, we found that life-course trajectories of partnership status were associated with hemostatic and inflammatory markers, the prevalence of metabolic syndrome and respiratory function in midlife. Never marrying or cohabiting was negatively associated with health in midlife for both genders, but the effect was more pronounced in men. Women who had married in their late 20s or early 30s and remained married had the best health in midlife. Men and women in cohabiting unions had midlife health outcomes similar to those in formal marriages. Conclusions. Partnership status over the life course has a cumulative effect on a wide range of objectively measured health indicators in midlife. Numerous studies have found that married people have better health and lower mortality than unmarried people, and these findings have been replicated in different countries and time periods. 1–18 A reduction in health inequalities related to marital status therefore has the potential to shift the distribution of risk and improve population health. 19 However, to do so, further understanding of the mechanisms that link marital status and health is needed, including further consideration of health-related selection into various marital statuses, the operation of health-protective effects of marriage, and the accumulation of benefits and risks of marital status trajectories over the life course. With a few exceptions, 20 studies of marital status and health have considered only current marital status or transitions over relatively short periods, 15 and only a few studies have considered the association between nonmarital cohabitation and health, 12,21 a topic of increasing importance given that cohabitation is becoming more common in the United Kingdom. 22 Furthermore, of those studies that have used measures of health, rather than mortality, as an outcome, 23 most have used self-reported measures. In the few studies in which objective health indicators were used, sample sizes were relatively small. 24,25 In this study, we used data from a population-based birth cohort to summarize longitudinal patterns of partnership status that distinguish marital status and nonmarital cohabitation. We used a model-based approach that allowed us to capture stability as well as transitions in partnership status over a 21-year period (ages 23–44 years) and used this to investigate the effects that 21-year trajectories of partnership status have on a wide range of biomarkers in midlife. Our objective was to investigate the association of different trajectories of partnership status over the life course and objectively measured health indicators in midlife.
