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Social sequencing to determine patterns in health and work-family trajectories for U.S. women, 1968-2013.

ABSTRACT: Background:Women's social roles (partnership, parenthood, and worker status) are associated with health, with more roles being associated with lower mortality rates. Few studies have examined social roles using a lifecourse perspective to understand how changing role dynamics affect health over time. Sequence analysis is one analytic technique for examining social trajectories. Methods:Work-family trajectories were determined using social sequence analysis. We estimated mortality using age-standardized mortality rates and Poisson regression and examined the impact of personal income as a mediator. Results:We identified 5 trajectory types according to probability distributions of work/marriage/child-rearing status and descriptions in previous research: Non-working, married, later-mothers; working divorced mothers; working and non-working, never-married mothers; working, never-married non-mothers; and non-working, married earlier-mothers. Our reference group, non-working, married, later-mothers had the lowest mortality rates (1.47 per 1000 person-years). Adjusting for confounders, timing of childbearing did not impact mortality rates for married, non-working women. Working, never-married non-mothers and working and non-working, never-married mothers had the highest adjusted rates of mortality (RR = 1.81 and 1.57, respectively) these effects were attenuated slightly by the addition of household income in the model. Mortality rates for other trajectory groups were not significantly elevated in adjusted models. Conclusions:Mortality rates vary by work-family trajectories, but timing of childbearing does not meaningfully impact risk among women in this population, likely because few of the women who were married and had children also worked full-time. Household income has some mediating effect among those at highest risk of early mortality.

SUBMITTER: McKetta S

PROVIDER: S-EPMC6261835 | biostudies-other | 2018 Dec

REPOSITORIES: biostudies-other

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Social sequencing to determine patterns in health and work-family trajectories for U.S. women, 1968-2013.

McKetta Sarah S Prins Seth J SJ Platt Jonathan J Bates Lisa M LM Keyes Katherine K

SSM - population health 20181024

<h4>Background</h4>Women's social roles (partnership, parenthood, and worker status) are associated with health, with more roles being associated with lower mortality rates. Few studies have examined social roles using a lifecourse perspective to understand how changing role dynamics affect health over time. Sequence analysis is one analytic technique for examining social trajectories.<h4>Methods</h4>Work-family trajectories were determined using social sequence analysis. We estimated mortality ...[more]

PMID: 30533486

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Project description:IntroductionWork and family trajectories develop and interact over the life course in complex ways. Previous studies drew a fragmented picture of these trajectories and had limited scope. We provide the most comprehensive study of early-to-midlife work-family trajectories to date.MethodsUsing retrospective data from waves 3 and 7 of the Survey of Health, Aging and Retirement in Europe (SHARE), we reconstructed work-family trajectories from age 15 to 49 among almost 80,000 individuals born between 1908 and 1967 across 28 countries. We applied multichannel sequence and cluster analysis to identify typical trajectories and multinomial logistic regression models to uncover their social composition.ResultsThe results revealed six common trajectories. The dominant and therefore standard trajectory represents continuous full-time employment with having a partner and children. Women, the lower educated and persons from conservative and liberal welfare regimes are underrepresented in this trajectory, whereas men, higher educated people and those from social-democratic, Eastern European and Baltic welfare regimes are overrepresented. The other trajectories denote a deviation from the standard one, integrating a non-standard form of work with standard family formation or vice versa. Mothers in a stable relationship generally work part-time or not at all. When mostly in full-time employment, women are more likely to be divorced. Lower educated persons are less likely to have work-family trajectories characterized by full-time work and a non-standard family, yet more likely to be non-employed for large parts of their life with standard family formation. Younger cohorts are underrepresented in non-employment trajectories, but overrepresented in part-time employment trajectories along with a partner and children as well as full-time employment trajectories with divorce. Individuals from Southern European and liberal regimes are more likely to be non-working and self-employed partnered parents and those from social-democratic regimes are more likely to be full-time employed divorced parents. We also found pronounced gender differences in how educational level, birth cohort and welfare regime are associated with work-family trajectories from early to midlife.DiscussionOur findings highlight the socially stratified nature of earlier-life work-family trajectories in Europe. Potential implications for inequalities in later life are discussed.

Project description:Hysterectomy is among the most common surgeries performed on U.S. women. For benign conditions, minimally invasive hysterectomy is recommended, whenever permitted by clinical indication and previous surgery history. No study has examined whether the use of less invasive hysterectomy spread more slowly for Black women.We used the hysterectomy that occurs in outpatient settings as a proxy for minimally invasive hysterectomy. Using claims-based surgery data and census denominators, we calculated age-standardized rates of all hysterectomies in North Carolina from 2011 to 2013. Study participants were 41,899 women (64.6% non-Hispanic White, 28.3% non-Hispanic Black) who underwent hysterectomy for non-malignant indications. We fit Poisson models to determine whether changes in outpatient hysterectomy rates differed by Black-White race. We employed a difference-in-difference approach to control for racial differences in the severity of clinical indication. Further, we restricted to one state to minimize confounding from geographic differences in where Black and White women live.From 2011 to 2013, the overall hysterectomy rate decreased from 42.3 per 10,000 women (n = 14,648) to 37.9 per 10,000 (n = 13,241) (p < 0.0001). Most hysterectomy (67.6%) occurred in outpatient settings. The inpatient rate decreased 35.2% (p < 0.0001), to 10.3 per 10,000, while the outpatient rate increased 4.6% (p < 0.01), to 27.5 per 10,000. From 2011 to 2013, Black women's outpatient rate increased 22% (p < 0.0001): from 25.8 per 10,000 to 31.5. In contrast, among White women, outpatient rates remained stable (p = 0.79): at 28.3 per 10,000 in 2013.Rapid increases in outpatient hysterectomy among Black women compared to stable rates among White women indicate a race-specific catch-up phenomenon in the spread of minimally invasive hysterectomy. These results are consistent with the hypothesis that minimally invasive hysterectomy may have been adopted more slowly for Black women than their White counterparts after its introduction in the early 2000s. The persistently high rates of hysterectomy among young Black women and potentially slower adoption of minimally invasive procedures among these women highlight a potential racial disparity in women's healthcare.

Dataset Information

Social sequencing to determine patterns in health and work-family trajectories for U.S. women, 1968-2013.

Publications

Social sequencing to determine patterns in health and work-family trajectories for U.S. women, 1968-2013.

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