Inter-Spousal Mortality Effects
Caregiver Burden Across the
Spectrum of Disabling Disease
Nicholas A. Christakis and Paul D. Allison
The health of two people connected by a social tie may be interdependent. The impact of the death of one spouse on the risk of death of the other, known as the widow/er effect, is a classic example (Parkes and Fitzgerald 1969; Lillard and Waite 1995; Martikainen and Valkonen 1996a; and Schaefer, Quesenberry, and Soora 1995). The impact of illness in one spouse on the risk of ill health or death in the other spouse (the proband under study), is another example. This latter phenomenon, often termed caregiver burden, is typically studied as if it were unrelated to the widower effect (Clipp and George 1993; Dunkin and Anderson-Hanley 1998; Shaw et al. 1997; Schulz et al. 2003)—as if ill health in a spouse affects the morbidity, but not necessarily the mortality, of caregiving probands.
Indeed, most prior work on caregiver burden has focused on how spousal illness worsens the health of probands, but not on whether it increases their mortality, with the exception of one influential study that suggested that caregiving to dementia patients was a risk factor for death (Schulz and Beach 1999). Moreover, comparisons across different types of spousal diseases, in terms of how they may affect caregiver health, are lacking. Some studies have found that worse physical health in a spouse is
Nicholas A. Christakis is a Professor in the Departments of Health Care Policy and of So-
ciology at Harvard University, and an attending physician at Massachusetts General Hospi
tal. Paul D. Allison is a Professor in the Department of Sociology at the University of Penn-
The authors thank Laurie Meneades for the expert data programming required to build the
analytic data set and Felix Elwert for statistical programming and for comments on the man-
uscript. We also thank participants in the NBER Disability Workshop for helpful feedback.
We are grateful for financial support from the National Institute on Aging grants P30
AG12810 and R01 AG19805, and the Mary Woodard Lasker Charitable Trust and Michael
E. DeBakey Foundation.