An Investigation of the Consequences and Costs Associated with Bereavement: Findings from the Health and Retirement Study (2004-2014)

TitleAn Investigation of the Consequences and Costs Associated with Bereavement: Findings from the Health and Retirement Study (2004-2014)
Publication TypeThesis
Year of Publication2020
AuthorsIngels, JB
Academic DepartmentEpidemiology and Biostatistics
DegreeDoctor of Philosophy
UniversityUniversity of Georgia
CityAthens, GA
ISBN Number9798645490010
KeywordsBereavement, Loss, Mortality, Population-level health

The loss of a loved one adversely affects the bereaved. Previous research reports that loss increases the risk of mortality, physical and mental health problems, and healthcare utilization.

Using data from the 2004 to 2014 waves of the Health and Retirement Study (HRS), we estimated the risk for mortality, the number of years of healthy life lost, and the increase in medical expenditures associated with an increasing exposure to bereavement. HRS enrolls a representative sample of adults in the United States aged 50 years and older. Population sample weights are available in HRS allowing for estimates of population-level burden. The exposure to loss was defined as the total number of losses of both parents and spouses. Analyses included (1) Cox proportional hazards models (mortality risk) with an attributable fraction calculation; (2) linear regression models (years of healthy life lost) with an outcome combining survival adjusted by the self-reported measure of health combined with US Census data to estimate the annual years lost; and (3) a cost prediction model to estimate HRS respondent medical expenditures based on reported healthcare utilization, with propensity-score matching and regression models to estimate the increase in medical expenditures.

Key findings from the analyses showed a persistent increase in mortality associated with an increase in the number of losses experienced by an individual. This increase in the mortality hazard was between 33% and 49% and may account for roughly one-third of the population burden of mortality. An estimated total of 3.6 million years of healthy life are lost annually due to bereavement with the majority of the burden experienced by persons 50 to 65 years of age. Any physical activity significantly reduces the impact of bereavement, especially as the number of losses accumulates. Over a two-year period, an exposure to loss generates increased healthcare utilization estimated to be roughly $2500 per bereaved individual.

Our results add to a growing body of research concerning the impact of bereavement on health and well-being. These may be the first estimate of the population-level burden that an increasing exposure to loss places on adults in the US.

Citation Key11093