Does Marriage Really Matter to Health? Intra- and Inter-Country Evidence from China, Japan, Taiwan, and the Republic of Korea

BACKGROUND: The health benefits of marriage have been demonstrated mainly by studies on Western populations. This study aims to test whether the benefits are also valid in East Asian populations. METHODOLOGY/PRINCIPAL FINDINGS: Individuals (n = 8,538) from China, Japan, Taiwan, and the Republic of Korea were sampled from the 2006 East Asian Social Survey. The association between self-rated health status and two marriage-related independent variables was analyzed using multivariate logistic regression models. In a two-level analysis for individuals from all countries, married individuals were more likely to report very good or good health compared to their never-married counterparts [odds ratio (OR) 1.56; 95% confidence interval (95% CI) 1.16−2.10]. However, the addition of marital satisfaction disintegrated the significant association of marriage with self-rated health. Married individuals in satisfying marriages were more likely to report very good or good health compared with never-married individuals (OR 1.85; 95% CI 1.37−2.50). In contrast, married individuals in dissatisfying marriages were as likely to report very good or good health as never-married individuals (OR 0.78; 95% CI 0.50−1.24). In a one-level analysis for each country, the importance of marital satisfaction varied greatly across countries. Unlike in other countries, in Japan, married individuals in dissatisfying marriages were about half as likely to report very good or good health as never-married individuals (OR 0.51, 95% CI 0.31−0.83), thereby showing no significant benefits from marriage with regard to self-rated health. CONCLUSION/SIGNIFICANCE: The present study of East Asian countries suggests that marital satisfaction is of greater importance in determining self-rated health than marriage itself, and that the importance of marital satisfaction varies across countries. Further research is required to better understand the relationship between marital satisfaction and self-rated health in different socio-cultural settings, and to establish effective social policies aiming at improving public health.