Demographic Differences in Life Dissatisfaction Among Adults

National Health Statistics Reports

Number 192  November 2, 2023

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Demographic Differences in Life Dissatisfaction

Among Adults: United States, 2021

by Amanda E. Ng, M.P.H., Dzifa Adjaye-Gbewonyo, Ph.D., and Kristen Cibelli Hibben, Ph.D.

Abstract

Objective—Previous work has established life satisfaction as an important

indicator of overall health and well-being. This report describes differences in life

dissatisfaction by selected characteristics, grouped by family income.

Methods—Data from the 2021 National Health Interview Survey were used

to examine the percentage of adults that were dissatisfied with life by selected

demographic characteristics (age, sex, race and Hispanic origin, and nativity status

[born in the United States or U.S. territory]), grouped by family income.

Results—In 2021, 4.8% of adults were dissatisfied with life. In general, analyses

showed significant differences by all selected demographic characteristics among

adults with incomes of less than 200% of the federal poverty level. Among this group,

men, adults ages 45–64, White non-Hispanic adults, Black non-Hispanic adults, and

adults born in the United States were more likely to be dissatisfied with life compared

with their counterparts. No significant differences in life dissatisfaction by selected

demographic characteristics among adults with incomes greater than 200% of the

federal poverty level were observed.

Conclusion—This report presents estimates of life dissatisfaction among adults

by demographic subgroups and family income. These results highlight the importance

of monitoring life dissatisfaction among detailed subgroups grouped by income, in

addition to the overall national estimate.

Keywords: life satisfaction • quality of life • subjective well-being • social

determinants of health • National Health Interview Survey (NHIS)

Introduction

Subjective well-being is a concept

that captures how people feel about and

evaluate or assess their overall lives, and

it reflects various elements, including

personal health as well as other factors

(such as life events, social interactions

and relationships, employment, and social

and economic conditions) (1). Improving

subjective well-being has been identified

as a national priority by Healthy People

2030 (2,3), a federal initiative that sets

data-driven objectives to improve health

over the current decade. Well-being is

central to the Healthy People 2030 vision,

and an indicator is included as a summary

outcome measure to evaluate progress

toward achieving Healthy People

objectives.

A key measure of subjective

well-being is satisfaction with life, as

defined by one’s view or experience (1).

In 2021, the U.S. Department of Health

and Human Services added a question

on life satisfaction to the National Health

Interview Survey (NHIS) to assess well-

being in the United States and monitor

change over time for the Healthy People

initiative. Life satisfaction was last

included in NHIS in 2001. Single-item

measures have been found to provide

a broad and reliable assessment of life

satisfaction (4) and have been used in

major surveys around the world (5).

Previous work suggests demographic

differences in overall life satisfaction,

although many such studies use data

collected over 10 years ago. Higher

levels of life satisfaction are reported

by women compared with men (6),

White non-Hispanic (subsequently,

White) adults compared with Black

non-Hispanic (subsequently, Black) and

Hispanic adults (7), and among older

immigrants compared with native-born

people (8,9). Recent data from NHIS

may provide additional understanding of

the distribution of life satisfaction levels

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.

Page 2 National Health Statistics Reports  Number 192  November 2, 2023

among these demographic groups, as well

as potential patterns by age group.

Research has demonstrated links

between satisfaction with life and

physical health, morbidity, and mortality

(9–12), especially among adults of low

socioeconomic status (10). Studies have

shown a positive association between

income and life satisfaction (13,14); that

is, people with higher incomes generally

rate their satisfaction with life to be

higher, while those with lower incomes

generally rate their satisfaction to be

lower (15–17). This often-replicated

and robust finding has been observed

particularly for evaluative well-being

measures that look at general satisfaction

with life as a whole—when people pause

and reflect, as in a health survey—and

recent research suggests higher life

satisfaction is also evident at higher

incomes for experienced well-being

measures examining people’s feelings in

the moment (14,18).

Given the potential demographic

variation in life satisfaction and the

existing link between income and

life satisfaction, increased reporting

of dissatisfaction with life in recent

decades (19), and racial inequities in

the prevalence of factors associated

with dissatisfaction with life (17),

it is important to understand the

association of income with demographic

differences in both life satisfaction

and dissatisfaction. In addition, given

that poor life satisfaction is linked to

negative health outcomes, understanding

the characteristics of those who are

dissatisfied with their life can help to

identify populations potentially at risk.

This report examines the percentage

of adults ages 18 and older who report

being dissatisfied or very dissatisfied

with life by selected demographic

characteristics, based on data from the

2021 NHIS. Because of the relationship

between income and life satisfaction, the

analyses of demographic differences are

grouped by family income as a percentage

of the federal poverty level (FPL).

Methods

Data source

Data from the 2021 NHIS were used

for this analysis. NHIS is a nationally

representative household survey of

the civilian noninstitutionalized U.S.

population. It is conducted continuously

throughout the year by the National

Center for Health Statistics (NCHS).

Interviews are typically conducted in

respondents’ homes, but follow-ups to

complete interviews may be conducted

over the telephone. Because of the

COVID-19 pandemic, interviewing

procedures were disrupted, and during

2021, 62.8% of the Sample Adult

interviews were conducted at least

partially by telephone (20). For more

information about NHIS, visit

https://www.cdc.gov/nchs/nhis.htm.

Measures

Dissatisfaction with life

Dissatisfaction with life was based

on responses to the question, “In general,

how satisfied are you with your life?

Would you say very satisfied, satisfied,

dissatisfied, or very dissatisfied?”

Selected sociodemographic

characteristics

Family income as a percentage

of FPL—Based on FPL, which was

calculated from family income in the

previous calendar year and family size

using the U.S. Census Bureau’s poverty

thresholds (21). Family income was

imputed when missing (22). A cut point

of 200% FPL was used, which was about

$55,000 for a family of four in 2021.

Nativity status—Based on a “yes”

response to the question, “Were you born

in the United States or a U.S. territory?”

Race and Hispanic origin—

Respondents were grouped into

four categories: Asian non-Hispanic

(subsequently, Asian), Black, White, and

Hispanic. These categories were based on

responses to two survey questions asking

about race and Hispanic origin, where

those characterized as Hispanic or Latino

could be of any race or combination of

races. People who reported unknown

race or ethnicity or multiple races were

not reported due to small sample size but

were included in the overall analysis and

other sociodemographic subanalyses.

Estimates for non-Hispanic adults of

races other than White only, Black only,

or Asian only, and those of multiple

races, are not shown but are included in

total estimates. Analyses were limited to

the race and Hispanic-origin groups for

which data were reliable and sufficiently

powered to make group comparisons.

Statistical analyses

Percentages of life dissatisfaction

were calculated by selected

sociodemographic characteristics,

grouped by family income. These

estimates excluded unknown values

from the denominators, and differences

between percentages were assessed with

two-sided pairwise tests at the 0.05 alpha

level. Linear and quadratic trends by age

group were evaluated using orthogonal

polynomials.

All estimates were weighted and

calculated using SAS-callable SUDAAN

software (23) to account for the complex

sample design of NHIS. Ninety-five

percent confidence intervals were

generated using the Korn–Graubard

method for complex surveys. All estimates

meet NCHS data presentation standards

for proportions (24).

Results

In 2021, 4.8% of all adults were

dissatisfied or very dissatisfied with life,

including 3.7% (confidence interval

[CI]: 3.5–4.0) who were dissatisfied and

1.1% (CI: 1.0–1.2) who were very

dissatisfied. In contrast, 95.2% of all

adults were satisfied or very satisfied

with life, including 46.6% (CI: 45.8–47.3)

who were satisfied and 48.6%

(CI: 47.8–49.4) who were very satisfied

(Figure 1).

Among all adults, 5.1% (CI: 4.7–5.6)

of men and 4.6% (CI: 4.2–5.0) of women

were dissatisfied or very dissatisfied with

life (Table). The percentage of adults

that were dissatisfied or very dissatisfied

with life varied by age group, from 4.4%

(CI: 3.9–4.8) among adults ages 18–44

to 5.5% (CI: 5.0–6.0) among adults ages

45–64 and 4.8% (CI: 4.3–5.3) among

adults ages 65 and older. Asian adults

National Health Statistics Reports  Number 192  November 2, 2023 Page 3

Figure 1. Percent distribution of life satisfaction among adults ages 18 and older:

United States, 2021

(3.1%, CI: 2.2–4.2) were less likely to

be dissatisfied with life compared with

Black (6.0%, CI: 5.0–7.0) and White

(4.9%, CI: 4.5–5.3) adults. Black adults

were also more likely to be dissatisfied

than Hispanic (4.1%, CI: 3.4–4.9)

and White adults. Adults born in the

United States (5.0%, CI: 4.7–5.4) were

more likely to be dissatisfied with life

compared with adults born outside the

United States (3.7%, CI: 3.1–4.4).

When grouped by income, feeling

dissatisfied or very dissatisfied with life

was consistently more likely among

adults with family incomes of less than

200% FPL. In 2021, 8.1% of adults with

family incomes of less than 200% FPL,

and 3.6% of adults with family incomes

of 200% or more FPL were dissatisfied or

very dissatisfied with life (Figure 2).

Among adults with family incomes of

less than 200% FPL, men were more

likely to be dissatisfied or very

dissatisfied with life (9.3%) compared

with women (7.2%). Among adults with

family incomes of 200% or more FPL,

this percentage was similar for men

(3.8%) and women (3.4%).

NOTE: Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.

Percent

100

Very dissatisfied

Dissatisfied

Satisfied

Very satisfied48.6

46.6

3.7

1.1

Table. Percentage of adults ages 18 and older who were dissatised or very dissatised with life, by selected sociodemographic

characteristics overall and by family income: United States, 2021

Characteristic Overall Less than 200% FPL 200% or more FPL

Percent (95% condence interval)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 (4.5–5.1) 8.1 (7.4–8.9) 3.6 (3.3–3.9)

Sex

Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 (4.7–5.6)

9.3 (8.1–10.6) 3.8 (3.3–4.2)

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.6 (4.2–5.0) 7.2 (6.3–8.1) 3.4 (3.0–3.9)

Age group

18–44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.4 (3.9–4.8)

6.8 (5.8–8.0) 3.3 (2.8–3.8)

45–64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 (5.0–6.0) 11.1 (9.6–12.7) 3.8 (3.3–4.4)

65 and older . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.8 (4.3–5.3) 7.2 (6.1–8.5) 3.9 (3.3–4.5)

Race and Hispanic origin

Asian, non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,4

3.1 (2.2–4.2)

3,4

4.7 (2.5–7.9) 2.6 (1.6–4.0)

Black, non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,5

6.0 (5.0–7.0) 9.0 (7.2–11.0) 3.8 ( 2.7–5.1)

White, non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.9 (4.5–5.3) 9.7 (8.6–10.8) 3.7 (3.4–4.1)

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.1 (3.4–4.9)

3,4

5.0 (3.9–6.3) 3.4 (2.5–4.4)

Nativity status

U.S.-born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.0 (4.7–5.4)

9.2 (8.4–10.2) 3.6 (3.3–4.0)

Born outside United States. . . . . . . . . . . . . . . . . . . . . . 3.7 (3.1–4.4) 4.7 (3.5–6.0) 3.2 (2.4–4.0)

Signicantly different from women (p < 0.05).

Signicant quadratic trend by age group (p < 0.05).

Signicantly different from White non-Hispanic adults (p < 0.05).

Signicantly different from Black non-Hispanic adults (p < 0.05).

Signicantly different from Hispanic adults (p < 0.05).

Signicantly different from adults born outside the United States (p < 0.05).

NOTES: FPL is federal poverty level. Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population. Chi-squared tests show signicant differences

between adults that were dissatised or very dissatised with life who had family incomes of less than 200% FPL and 200% or more FPL (p < 0.05).

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.

Page 4 National Health Statistics Reports  Number 192  November 2, 2023

Among adults with family incomes

of less than 200% FPL, the percentage

of adults who were dissatisfied or very

dissatisfied with life varied by age, from

6.8% among adults ages 18–44, to 11.1%

for ages 45–64, and 7.2% for ages 65

and older (Figure 3). In contrast, among

adults with family incomes of 200% or

more FPL, the percentage of adults that

were dissatisfied or very dissatisfied with

life was similar by age (3.3% for ages

18–44, 3.8% for ages 45–64, and 3.9%

for ages 65 and older).

Life dissatisfaction among adults

with family incomes of less than 200%

FPL was higher among White (9.7%)

and Black (9.0%) adults compared

with Hispanic (5.0%) or Asian (4.7%)

adults (Figure 4). Among adults with

family incomes of 200% or more FPL,

the percentage of adults who were

dissatisfied or very dissatisfied with life

was similar by race and Hispanic origin.

Among adults with family incomes

of less than 200% FPL, the percentage

of adults who were dissatisfied or very

dissatisfied with life was higher among

U.S.-born adults (9.2%) compared with

adults born outside the United States

(4.7%) (Figure 5). Among adults with

family incomes of 200% or more FPL,

the percentage of adults who were

dissatisfied or very dissatisfied with life

was similar by nativity status (3.6% for

those born in the United States and 3.2%

for those born outside the United States).

Summary

In 2021, 4.8% of adults were

dissatisfied or very dissatisfied with

life. Adults with family incomes of less

than 200% FPL were more likely to be

dissatisfied or very dissatisfied with

life compared with adults with family

incomes greater than 200% or more FPL.

Among adults with family incomes of less

than 200% FPL, additional differences

were observed by sex, age group, race

and Hispanic origin, and nativity status.

Men, adults ages 45–64, White adults,

Black adults, and adults born in the

United States were more likely to report

being dissatisfied or very dissatisfied with

life compared with their counterparts.

No differences were observed among

adults with family incomes of 200% or

more FPL. This suggests that the overall

differences in life dissatisfaction by these

demographic characteristics are largely

driven by people with lower incomes.

This report aligns with previous

research noting associations between

life dissatisfaction and socioeconomic

disadvantage (14,25). It is also consistent

with recent research that found a lower

likelihood of dissatisfaction with life

among Hispanic and Asian adults

(26). Results by nativity status are also

consistent with prior studies, which

examined life satisfaction among non-

U.S.-born Hispanic adults and immigrants

from other racial and ethnic backgrounds

compared with native-born adults (8,9).

The findings in this report also confirm

previous research, which has found a

greater likelihood of dissatisfaction with

life among Black adults compared with

White adults (7,26).

This report demonstrates the

importance of stratifying by income when

examining life satisfaction as a national

indicator of well-being. Although the

percentage of life dissatisfaction is

Figure 2. Percentage of adults ages 18 and older who were dissatised or very dissatised with life, by sex and family income:

United States, 2021

Percent

Significantly different from adults with family incomes of 200% or more of the federal poverty level (FPL) (p < 0.05).

Significantly different from men (p < 0.05).

NOTE: Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.

WomenMenTotal

Less than 200% FPL

Overall

200% or more FPL

4.8

8.1

9.3

1,2

7.2

3.6

3.8

3.4

National Health Statistics Reports  Number 192  November 2, 2023 Page 5

Figure 4. Percentage of adults ages 18 and older who were dissatised or very dissatised with life, by race and Hispanic origin and family

income: United States, 2021

Figure 3. Percentage of adults ages 18 and older who were dissatised or very dissatised with life, by age group and family income:

United States, 2021

Significantly different from adults with family incomes of 200% or more of the federal poverty level (FPL) (p < 0.05).

Significant quadratic trend by age (p < 0.05).

NOTE: Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.

65 and older45–6418–44

200% or more FPLLess than 200% FPL

Percent

1,2

6.8

11.1

7.2

3.3

3.8

3.9

3.4

3.7

2,3

5.0

9.7

White, non-Hispanic HispanicBlack, non-HispanicAsian, non-Hispanic

200% or more FPLLess than 200% FPL

Percent

Significantly different from Black non-Hispanic adults (p < 0.05).

Significantly different from White non-Hispanic adults (p < 0.05).

Significantly different from adults with family incomes of 200% or more of the federal poverty level (FPL) (p < 0.05).

Significantly different from Hispanic adults (p < 0.05).

NOTE: Estimates are based on household interviews of a sample of the U.S. civilian noninstitutionalized population.

SOURCE: National Center for Health Statistics, National Health Interview Survey, 2021.

1–3

4.7

2–4

9.0

2.6

3.8

Page 6 National Health Statistics Reports  Number 192  November 2, 2023

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relatively low among the total adult

population (4.8%), these results suggest

that the prevalence of life dissatisfaction

is higher among certain demographic

subgroups of adults with lower incomes.

For example, 11% of adults ages 45–64

with family incomes of less than 200%

FPL were dissatisfied or very dissatisfied

with life compared with 3% of adults of

this age group with family incomes of

200% or more FPL. The inclusion of life

satisfaction on the 2021 NHIS provides

a population baseline of well-being,

and its continued inclusion will allow

documentation of progress toward the

Healthy People 2030 goals of improving

overall well-being and reducing

disparities in well-being.

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Figure 5. Percentage of adults ages 18 and older who were dissatised or very dissatised with life, by nativity status and family income:

United States, 2021

Percent

Significantly different from adults with family incomes of 200% or more of the federal poverty level (FPL) (p < 0.05).

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3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

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Suggested citation

Ng AE, Adjaye-Gbewonyo D, Cibelli Hibben K.

Demographic differences in life dissatisfaction

among adults: United States, 2021. National

Health Statistics Reports; no 192. Hyattsville,

MD: National Center for Health Statistics. 2023.

DOI: https://dx.doi.org/10.15620/cdc:133057.

All material appearing in this report is in

the public domain and may be reproduced

or copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Brian C. Moyer, Ph.D., Director

Amy M. Branum, Ph.D., Associate Director for

Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Director

Anjel Vahratian, Ph.D., M.P.H., Associate

Director for Science

Division of Research and Methodology

Jennifer D. Parker, Ph.D., Director

John Pleis, Ph.D., Associate Director for

Science