Living arrangements, health status and mortality risk among the aged in Belgium, 2002

Anne Herm, Tallinn University and Université Catholique de Louvain
Michel Poulain, Université Catholique de Louvain and Tallinn University
Jon Anson, Ben Gurion University of the Negev

Mortality in the institutionalized aged population is generally recognized as being considerably higher than among those living in private household; whereas among the latter population, there is a greater risk of mortality among those living alone than among those living with other adults (generally with spouse and / or children). However, given that the institutionalized population is generally in poorer health compared to the independent-living population, it is unclear whether the higher mortality risk among the institutionalized population results from their poorer health, or from other causes associated with institutionalization. The Belgian Census of 2001, coupled with a near-complete follow-up of deaths over the subsequent year (2002), enables us to compute a reasonable measure of health at the time of the census and thus separate out the effects of health status and living arrangements on mortality. Taken across the entire Belgian population (Belgian nationals only) aged 65 and above at the time of the census (N = 1.64 million cases with full data), and controlling for background characteristics including education, we find that: i) men have higher mortality than women; ii) the logit of the mortality risk increases linearly with age; iii) the mortality risk declines as health status improves; iv) the mortality risk decreases as the level of education increases; v) those living in institution have a higher risk of mortality than those living in private housing, irrespective of health status. This last conclusion is prominent: even if much of the apparently higher mortality of the institutionalized aged population may be attributable to the generally poorer health of those living in institution, there is nonetheless a higher mortality risk in institution. In the discussion, we suggest the existence of a salutogenic effect of living independently in private housing, whatever the individual's health status.