Aging
‘Til death do us part? Marital status and excess mortality among older adults during the COVID-19 pandemic Michelle A DeVost* Michelle DeVost Yea-Hung Chen Marie-Laure Charpignon Whitney M Wells M Maria Glymour Ruijia Chen
Background
Despite extensive research on social factors affecting health outcomes during the COVID-19 pandemic, the role of marital status in influencing older adults’ mortality remains underexplored. This study aimed to fill this gap by examining the relationship between marital status and excess mortality among older Californians during the pandemic, assessing potential heterogeneity by place of death.
Methods
Using California death records for decedents aged 65+, we estimated the expected number of deaths during the pandemic (Mar. 2020–Jul. 2023) based on pre-pandemic trends (Jan. 2015–Feb. 2020). ARIMA time series models stratified by marital status (married, widowed, divorced, never married) and place of death (home, hospital, nursing home/long-term care, other) yielded monthly and cumulative estimates of absolute pandemic-era excess mortality overall and by subgroup, per 100,000 using American Community Survey population data.
Results
Among California decedents aged 65+ (n=1,595,862), married individuals had lower excess mortality overall and across age, sex, and education groups. In nursing homes, married individuals had a relative mortality risk ratio of 0.69 (0.65, 0.73), 31% lower than expected based on pre-pandemic trends. Never-married individuals had a ratio of 0.86 (0.83, 0.89), 14% lower than expected. The difference (0.17) between the relative risk ratios of married vs. never-married in nursing homes was nearly twice as large as that observed for home deaths (1.15 vs. 1.24) and six times larger than for hospital deaths (1.22 vs. 1.25).
Conclusions
Marriage was associated with lower excess all-cause mortality among older adults during the COVID-19 pandemic, particularly in nursing homes. These findings suggest that marital status–possibly through mechanisms such as social support and advocacy–may play a critical role in mitigating mortality risk during public health crises, especially in institutional care settings.