Illness and the feminine role: a theoretical review

Sex disparities in health of older adults in India: assessing the morbidity-mortality paradox through disability-free life expectancy

Background

Older adults face substantial sex gaps in health. In many contexts, females live longer than males, but their time spent with disability is also higher. Our study assesses (i) the sex gap (female-male) in health through life expectancy and healthy life expectancy and (ii) the morbidity-mortality paradox among older adults aged 60 and above in India and its states.

Methods

We utilized data on age-specific death rates obtained from the Sample Registration System and age-specific disability prevalence from the Longitudinal Ageing Survey (LASI) in India. We estimated abridged life tables between age groups 60-64 to 85 + using Greville's method. We then combined the disability data obtained from LASI with the constructed life tables using Sullivan's method to estimate disability-free life expectancy (DFLE) and life expectancy with disability (DLE). Finally, we decomposed the sex gap in DFLE and DLE into mortality and disability components using a stepwise replacement decomposition method.

Results

At the national level, life expectancy at age 60 for males were 17.4 years and for females 19.2 years, indicating a female mortality advantage of 1.8 years. At the state level, the sex gap ranged between 5.1 years in Jammu & Kashmir and -1.1 years in Jharkhand. The disability prevalence was higher among females compared to males at the national level and in all states. The decomposition result indicates that 98% of the mortality advantage of females at the national level was spent in disability. The disability disadvantage of females over their mortality advantage was highest in Uttar Pradesh; 93% of additional years of life were spent with disability. The disability disadvantage of females over their mortality advantage was lowest in Rajasthan where only 9% of additional years were spent in disability. Stepwise replacement decomposition of the sex gap in DFLE by age groups shows that as age increases, the contribution of mortality effects decreases, whereas disability effects increase.

Conclusions

We find evidence of a morbidity-mortality paradox in India nationally and sub-nationally. As the sex gap in health and its implications vary across the states of India, policies to address these inequities must also vary across the states.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41118-025-00247-2.

Inequalities in successful aging among the older adults in China: A decomposition study based on a gender perspective

Studies have shown that gender is associated with inequalities in successful aging. However, little is known about the trends in gender gaps in successful aging and the factors contributing to these disparities. This study aims to provide evidence of gender inequalities in successful aging and to identify the contributing factors to inform targeted policy development. Using the data of China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, a total of 21,718 older adults (60+) were enrolled in this study. Successful aging was assessed by successful aging index covering absence of disease, physical functioning, psychological functioning, activity of daily living, physical activity functioning, cognitive functioning, and interpersonal social engagement. We employed Shapley decomposition to examine factors contributing to successful aging inequalities and further analyzed gender-specific disparities using Oaxaca-Blinder decomposition. Results indicate an upward trend in successful aging inequalities. The most significant contributors to such inequalities are gender, education, age, residential area, drinking, and smoking, which span across the dimensions of personal characteristics, family characteristics, regional factors, and lifestyle. Under the gender perspective, education emerged as the most influential factor, while other characteristics like smoking, drinking, age, marital status, and residential area also matter. Over time, the contribution of education is more stable, whereas the influence of smoking and drinking increased. Gender inequalities in successful aging in China are generally increasing, with a continuous expansion over time. To mitigate these disparities, gender-specific geriatric care policies are needed to ensure equitable and inclusive aging opportunities for both men and women.

Chronic morbidity levels and associated factors among older adults in western Nepal: A cross-sectional study

Objective

The growing prevalence of chronic morbidity among Nepali older adults reflects the need for studies exploring the patterns and determinants for evidence-based public health strategies. This study evaluated chronic morbidity levels and the associated factors.

Methods

A cross-sectional study recruited 612 participants (≥ 60 years) from all three ecological regions in Gandaki province, Nepal. Chronic morbidity level was derived as the cumulated presence of eight chronic conditions: coronary heart disease, hypertension, stroke, diabetes, cancer, respiratory issues, musculoskeletal conditions, and depression, and then creating three groups: no morbidity, single morbidity and multimorbidity. Ordinal logistic regression analyzed factors associated with morbidity levels, and findings are presented in adjusted odds ratio (OR) and 95% confidence interval (CI). All ethical standards were properly followed.

Findings

About 40% of total participants reported having single morbidity, while 25% had multimorbidity. Participants above 70 years (OR: 1.68, CI: 1.18-2.38) and older women (OR: 2.34, CI: 1.53-3.58) reported odds of being in a higher morbidity category than their counterparts. Older adults without healthcare visits within a year had 90% lower odds (OR: 0.10, CI: 0.06-0.15) of being in a higher morbidity category.

Interpretation

This study underlines the importance of regular healthcare visits, recommending that older adults undergo timely screenings for early diagnosis and effective management. It also emphasizes the need for increased public awareness and health promotion initiatives focused on chronic disease prevention activities within the older population. Additionally, investigating gender-specific factors may provide deeper insight into effective public health interventions.

Gender differentials in cognitive frailty among older adults in India: a multivariate decomposition approach

There has been an increasing focus on the interplay between physical frailty and cognitive impairment, as both conditions pose significant risks for life-threatening health complications and are receiving considerable attention in global geriatric health initiatives. A recent consensus introduces "cognitive frailty," denoting the co-existence of physical frailty and cognitive impairment without dementia. This study aims to ascertain the prevalence of cognitive frailty and investigate the factors contributing to gender differentials of cognitive frailty among older adults in India. This study has used the data from the nationally representative survey Longitudinal Ageing Study in India 2017-18. This study included a sample of 13,946 males and 14,989 females aged 60 and above. Descriptive and bivariate analyses were conducted. A proportion test was employed to assess gender disparities and determine the statistical significance of risk factors. Furthermore, multivariate decomposition analysis was performed to identify the extent to which various covariates contribute to explaining the gender differences observed in cognitive frailty. The overall prevalence of cognitive frailty was 4.4%. There was a significant gender difference in cognitive frailty among older adults in India (Difference: 4.3%; p-value < 0.001] with 2.1% (95% CI: 1.8-2.3) older males and 6.4% (95% CI: 6.0-6.8) older females suffering from cognitive frailty. The considerable gender gap in cognitive frailty would be reduced if women had similar levels of education (37% reduction) than men. Results highlight that increasing age, being a woman (AOR: 1.61; 95% CI: 1.33-1.95), out-of-wedlock, less education and non-working status (AOR:2.19; 95% CI: 1.71-2.80) were significantly associated with cognitive frailty. Poor nutritional status, and depression are also prone among the cognitively frail participants. Gender sensitive interventions improving education access for women are crucial. Developing countries like India urgently require a multidimensional approach to ensure appropriate and comprehensive healthcare for the elderly population.

Invalidated and 'salty': an auto/biographical and theoretical review of the lived experiences of individuals with PoTS

Postural orthostatic Tachycardia Syndrome (PoTS), sometimes also written as 'POTS', is a form of dysautonomia (dysfunction of the autonomic nervous system) and orthostatic intolerance (which causes symptoms to be worsened when standing). This paper explores the extant literature on the lived experiences of those living with PoTS in relation to interactions between patients and healthcare providers as well as interactions at the level of the individual between PoTSies and those around them. My title contains the word 'salty' because it can be used to describe the feeling of being frustrated, while also reflecting a specific dietary change recommended to many (but not all) PoTS patients when they are told to consume additional sodium to minimise symptoms. COVID-19 is thought to have led to an increased prevalence of PoTS so this topic is particularly relevant to contemporary discussions and debates. In this sociological article, I refer not only to existing research on the lived experiences of having PoTS but also that of other chronic illnesses when relevant. The following themes are explored through auto/biographical and theoretical analysis: Undiagnosed and Invalidated; (In)Visible; Impacts of Diagnosis; Recovery and Expectations; Community. Reflecting auto/biographically, I have included analysis of interactions related to my lived experiences of presyncope, COVID-19 and dysautonomia, as I have been diagnosed with PoTS myself, which is thought to have been significantly exacerbated by the COVID-19 virus. This research is sociological, rather than medical or psychological, and conclusions are drawn about what is known so far about the lived experiences of living with PoTS, as well as discussion about what remains unknown, as there is currently a paucity of research on the lived experiences of individuals with PoTS and its comorbidities.

Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia

Background Urgent care clinics (UCCs) provide services for patients without the need to book an appointment in advance to treat acute diseases and injuries that do not need ED service and provide care for chronic conditions. This study aimed to assess the patients's level of awareness regarding UCCs in the Al-Ahsa region and provide information contributing to decision-makers' support about the urgent care services and their patterns of use within primary healthcare. Methods A descriptive cross-sectional study was conducted in the Al-Ahsa region from August 2023 to December 2023. A validated questionnaire was used. Cluster sampling was used to select three primary healthcare centers from four health sectors (southern cluster, middle cluster, northern cluster, and eastern cluster), and then simple random sampling was used to select participants. sample size calculated by Cochran's sample size formula, which estimated 377 participants. However, to accommodate a non-response rate of 10.0% and stronger statistical power and effect size, the final sample size was 469 participants. Data were analyzed by SPSS Statistics version 28 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.). Both descriptive and inferential statistics were used. A p-value ≤0.05 is considered statistically significant. Results Of the 469 participants in the study, more than half (54.8%) were aged between 18 and 38 years old, and more than half (54.8%) were male. More than half (67.4%) reported having no chronic diseases, whereas the most common chronic diseases reported were diabetes mellitus (11.9%) and hypertension (14.3%). Most of the participants (84.9%) weren't aware of UCCs. Among the participants who were aware of UCCs (n=71), 53.5% of them had visited a UCC in the last three months. The most common reasons for their visits were the common cold (40.8%), headaches (5.6%), and abdominal pain (5.6%). More than one-third of participants (38.6%) believed that UCCs provide services like those of the emergency center. According to patients' sex, there was a significant (0.031) difference in the awareness level; the highest was among females at 20.1% vs. 12.6%. Conclusion The study revealed that the majority of the participants were unaware of UCCs. Increasing patients' awareness of UCCs is necessary through different media to improve access to healthcare services and reduce overcrowding in the ED that is caused by non-urgent problems.

Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China

Introduction

In the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures.

Methods

Using data from the China Health and Retirement Longitudinal Survey (CHARLS) and the China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders.

Results

We find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, as well as the total, out-of-pocket and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control in LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; both healthcare and spiritual consolation services have significant negative effects, while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables.

Conclusion

This study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure among disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, pay more attention to the accessibility and affordability of HCBS for fragile groups, and diversify and optimize the development of the health service and the spiritual consolation service.

CRP, but not fibrinogen, is associated with gait speed as early as middle age, in females but not males

Low grade systemic inflammation and age-related gait speed decline are known to be related in older adults, but their relations in the early stages of the aging process are yet to be fully described. The aim of this study was to examine the relationship between gait speed and two inflammation markers-c-reactive protein (CRP) and fibrinogen-in a cohort of middle-aged adults in Israel. 326 healthy, middle-aged, Muslim-Arabs from three villages in northern Israel participated in this cross-sectional study. Serum CRP and fibrinogen were measured via blood tests, and gait speed was assessed with the 6-min walk test (6MWT). After adjusting for sex, age, height, BMI, systolic blood pressure, fasting blood glucose and triglycerides, executive function, smoking status and aerobic physical activity, gait speed was negatively and significantly associated with CRP (b = - 0.01, p = 0.029). When stratifying by gender, this link remained significant only among females (b = - 0.012, p = 0.041), such as that an increase of one SD unit of CRP was associated with a 0.047 m/s decrease in gait speed. No significant link was found between fibrinogen levels and gait speed. Blood CRP levels are associated with a slower walking speed already in middle age, independent of age, executive function and cardio-metabolic factors, among female Arab-Muslims in Israel. Future studies should examine this relationship longitudinally and investigate a broader array of inflammation markers. Systemic inflammation may serve as an early marker for people at risk of decreased walking or accelerated aging; Early identification and intervention among at-risk individuals may help prevent or slow gait speed decline, and promote healthier aging.

Analysis of the prescription trends of potentially inappropriate medications in Korean older outpatients by sex: A retrospective study using data from the health insurance review and assessment service

This study aimed to determine the policy implications for drug management by identifying the prescription trends of potentially inappropriate medications (PIMs) in older outpatients. Considering the Drug Utilization Review and Korean version of the standards for PIMs based on the Beers Criteria, 141 ingredients were selected that spanned over 7 years of health insurance claims data analysis. During the study period, the number of patients and claims related to PIMs increased. Although the number of health insurance claims decreased in 2020 owing to coronavirus disease (COVID-19), it increased again in 2021. Tamsulosin was the most frequently prescribed drug for male patients, followed by alprazolam and zolpidem. For female patients, eperisone was the most frequently prescribed drug, followed by alprazolam, zolpidem, and etizolam. In Korea, health insurance claims for PIMs decreased in 2020 owing to the COVID-19 pandemic. However, an overall increasing trend was observed from 2015 to 2021. Moreover, during this period, the prescription trend of benzodiazepine-type drugs and zolpidem increased in both male and female patients. Therefore, management policies regarding PIMs and drug ingredients, such as benzodiazepines and zolpidem, are required.

Factors Associated with the Use of Complementary and Alternative Medicine/Therapy among United States Adults with Asthma

This article examined the sociodemographic and health-related factors associated with the use of complementary and alternative medicine/therapy (CAM) among adults with current asthma in the United States. We used data from 76,802 adults aged 18 years and above from the 2012-2019 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS) cycles. Weighted binary and multinomial logistic regression was used to examine the association of these factors with ever CAM use and the number of CAM use. We found that approximately 45.2% of US adults with asthma ever used CAM. Among adults with asthma, 25.3% and 19.9% endorsed using one CAM and ≥2 CAMs, respectively. CAM use was significantly associated with adults ≤ 35 years, female gender, multiple/other race/ethnicity, higher cost barriers, adults with two or more disease comorbidities, and those with poorly controlled asthma in both binary and multinomial models. CAM use was not associated with insurance and income status. Understanding factors associated with CAM use can provide asthma care professionals valuable insights into the underlying drivers of CAM use behavior in this population, enabling them to offer more informed and effective medical advice and guidance.

Trends in the Use of Complementary and Alternative Therapies among US Adults with Current Asthma

Complementary and Alternative Medicines/Therapies (CAM) are commonly used by US asthma adults, yet little is known about recent trends in their use. Our aim was to report trends in CAM use among US adults with current asthma. We conducted a serial cross-sectional study using nationally representative data from the BRFSS Asthma Call-Back Survey (ACBS) collected between 2008 and 2019 (sample size per cycle, 8222 to 14,227). The exposure was calendar time, as represented by ACBS cycle, while the main outcomes were use of at least one CAM and eleven alternative therapies. We analyzed CAM use overall and by population subgroups based on age, gender, race/ethnicity, income, and daytime and night-time asthma symptoms. Our findings show that there was an increase in the use of at least one CAM from 41.3% in 2008 to 47.9% in 2019 (p-trend < 0.001) and an upward trend in the use of herbs, aromatherapy, yoga, breathing exercises, homeopathy, and naturopathy (p-trend < 0.05). However, the use of vitamins, acupuncture, acupressure, reflexology, and other CAM therapies remained stable (p-trend > 0.05). These trends varied according to population characteristics (age, sex, race, income) and asthma symptoms. In conclusion, our study suggests that CAM use among US adults with current asthma is either increasing or stable, and further studies are needed to explore the factors influencing these trends.

Multivariate decomposition of gender differentials in successful aging among older adults in India

BACKGROUND

Rowe and Kahn define successful aging as a high physical, psychological, and social functioning in old age without major diseases. It is considered a viable solution to the burdens placed on healthcare systems and financial and social security in societies with aging population. The present study aimed to determine the prevalence of successful aging and explore the factors contributing to gender differentials in successful aging among older adults in India.

METHODS

This study utilized data from the nationally representative Longitudinal Ageing Study in India, conducted in 2017-18. The study is based on a sample of 15,098 older men and 16,366 older women aged 60 years and above. The outcome variable was a dichotomous measure of successful aging with six components including absence of chronic diseases, free from disability, high cognitive ability, free from depressive symptoms, active social engagement in life and free from obesity. Older adults satisfying all these conditions were considered aging successfully. Descriptive and bivariate analyses were carried out. Proportion test was used to evaluate the gender differentials and reflect the statistical significance in the associated factors. Multivariate decomposition analysis was conducted to identify covariates' contribution in explaining the gender differences in successful aging.

RESULTS

There was a significant gender difference in successful aging among older adults in India (Difference: 8.7%; p-value < 0.001] with 34.3% older men and 25.6% older women experiencing successful aging. A proportion of 88% of gender difference in successful aging was explained by the differences in the distribution of characteristics (Coef: 0.082; p-value < 0.05). Considerable gender gap in successful aging would be reduced if women had similar levels of work status (28% reduction) to their male counterparts. Bringing the level of frequent physical activity in women to the same levels observed in men would reduce the gender gap by 9%.

CONCLUSIONS

The findings suggest that women had a lower score in successful aging, which is attributed to several socioeconomic and behavioural factors including not working status and physical inactivity. More studies must be done to explore the reasons for such differences and what particular factors in low-income countries create differences among older men and women in achieving successful aging.

Heterogeneous effects of retirement on the biomedical risk factors for cardiovascular and metabolic diseases: New evidence based on the physical examination database in Shanghai, China

Retirement has a heterogeneous impact depending on gender and occupation. This study aimed to analyze and evaluate the heterogeneity and potential mechanism of retirement on the biomedical risk factors for cardiovascular and metabolic diseases. Physical examination data from 2017 to 2020 were extracted from a hospital database in Shanghai. The fluctuation tendency of biomedical risk factor indicators for cardiovascular and metabolic diseases was evaluated by gender and occupation shortly after retirement using fuzzy regression discontinuity design and was analyzed for internal mechanism. Retirement had a significantly negative influence on body weight (β = -3.943), body mass index (β = -2.152), and diastolic blood pressure (β = -5.180) in women working in public institutions or state-owned enterprises, but a positive influence on their blood glucose level (β = 0.696). Retirement had a significantly positive effect on high-density lipoprotein in men (β = 0.138), particularly those employed in private enterprises (β = 0.339). The internal influencing mechanism of retirement showed that the health attention effect after retirement among women in government or public institutions on diastolic blood pressure reduction was better than that before retirement. The body weight, body mass index, and diastolic blood pressure of women in public institutions or state-owned enterprises were reduced at retirement; however, they were exposed to higher risks of elevated blood glucose level. Conversely, high-density lipoprotein level, which is protective against cardiovascular disease, was increased in men at retirement. Retirement has a heterogeneous effect on cardiovascular and metabolic health among people of different genders or occupational experiences. Retirees with low health awareness should be targeted for behavioral interventions and monitored conscientiously by health providers during retirement adaptation.

Gendered health consequences of unemployment in Norway 2000-2017: a register-based study of hospital admissions, health-related benefit utilisation, and mortality

BACKGROUND

The existing literature indicates that unemployment leads to deteriorated mental and somatic health, poorer self-assessed health, and higher mortality. However, it is not clear whether and to what extent the health consequences of unemployment differ between men and women. According to social role theory, women can alternate between several roles (mother, wife, friend, etc.) that make it easier to deal with unemployment, whereas the worker role is more important for men, and unemployment could therefore be more harmful to them. Thus, gender differences in the health consequences of unemployment should decrease as society grows more gender equal. Accordingly, this study examines changes over time in the gendered health consequences of unemployment in Norway.  METHODS: Linked Norwegian administrative register data, covering the period from 2000 to 2017, were analysed by means of linear probability models and logistic regression. Four health outcomes were investigated: hospitalisation, receiving sick pay, disability benefit utilisation, and the likelihood of mortality. Two statistical models were estimated: adjusted for (1) age, and (2) additional sociodemographic covariates. All analyses were run split by gender. Three different unemployment cohorts (2000, 2006, and 2011) that experienced similar economic conditions were followed longitudinally until 2017.

RESULTS

The empirical findings show, first, that hospital admission is somewhat more common among unemployed males than among unemployed females. Second, receiving sick pay is much more common post-unemployment for men than for women. Third, excess mortality is higher among unemployed males than among unemployed females. Fourth, there is no gender component in disability benefit utilisation. There is a remarkable pattern of similarity when comparing the results for the three different unemployment cohorts (2000; 2006; 2011). Thus, the gendered health consequences of unemployment have hardly changed since the turn of the century.

CONCLUSION

This paper demonstrates that the health consequences of unemployment are serious, gendered, and enduring in Norway.

Differences in All-Cause Mortality Among Transgender and Non-Transgender People Enrolled in Private Insurance

Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% randomly selected non-trans cohort. Overall, we found that trans people were nearly twice as likely to die over the period as their non-trans counterparts. When stratifying by gender, we found key disparities within trans populations, with people on the trans feminine to nonbinary spectrum being at the greatest risk of mortality compared to non-trans males and females. While we found that people on the trans masculine to nonbinary spectrum were at a similar risk of overall mortality compared to non-trans females, their overall mortality rate was statistically smaller than that of non-trans males. These findings provide evidence that some trans and non-trans populations experience substantially different mortality conditions across the life course and necessitate further study.

Gender differences in the association of depression trajectories with executive and memory functions: Evidence from the longitudinal study of the Survey of Health, Ageing and Retirement in Europe (2004-2017)

Gender differences in depression trajectories and their effects on cognitive function are poorly understood. This article aims to identify depression trajectories in both genders and further explore the association of depression trajectories with executive and memory functions by gender. A total 3990 participants aged 50 years or older with repeated measurements from waves 1 to 7 (wave 3 excluded) of the Study of the Survey of Health, Ageing and Retirement in Europe (SHARE) were included. Group-based trajectory modeling (GBTM) was conducted to identify the optimal number of depression trajectories. Generalized estimating equation (GEE) models were used to examine the relation of depression trajectories to cognitive function after stratification by gender. Three distinct depression trajectories were identified in both genders, but the patterns of trajectories among genders were nonidentical. The trajectories of depression in males were characterized by non-low, moderate, persistent-depressive symptoms but with an unstable trend, while in females, they were characterized by non-low, moderate, persistent-depressive symptoms and with a worsening trend. The prevalence of persistent high depression in women (20.08%) was higher than that in men (3.13%). Moderate and persistent high depression trajectories were negatively associated with episodic memory (β = -0.53 and -0.72, respectively, p < 0.001) and verbal fluency in females (β = -0.96 and -1.47, p=0.01 and < 0.001, respectively). Older women had a greater frequency of developing depression than older men. Gender differences in depression trajectories existed. Moderate and persistent high depression trajectories exerted a negative effect on some domains of cognitive impairment only in females.

A Study on the Factors Influencing Overall Fatigue and Musculoskeletal Pains in Automobile Manufacturing Production Workers

In South Korea, the automobile sector is a key industry that occupies a very large proportion of production, employment, and exports in the national economy. However, production workers in the automobile industry are still exposed to a wide range of risk factors. This study aims to investigate the relationships between personal characteristics or occupational hazard exposure and subjective overall fatigue or musculoskeletal pains in the automobile manufacturing industry. We extracted 446 automobile manufacturing production workers as subjects from the data of the 5th Korean Working Conditions Survey. The χ2 test is performed to test whether there are differences in the distribution of complaints of musculoskeletal pains or overall fatigue in view of personal characteristics and exposure to working environment hazards and logistic regression analysis was used to analyze the relationships between them. Results showed that the proportions of the overall fatigue and musculoskeletal pains of the complaining group increase as the hazard exposure time increases. Longer exposure to tobacco smoke shows higher rates of complaints of overall fatigue and musculoskeletal pain. Results of logistic regression show that gender, longer exposure to fumes and dust, manual heavy loads handling, and to repetitive motion were the risk factors for overall fatigue and that gender, work experience, longer working hours, longer exposure to noise, fumes and dust, awkward posture, and high temperature were risk factors for musculoskeletal pains. The results show that there are close relationships between personal characteristics, working environment hazards, overall fatigue, and musculoskeletal pains.

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016

As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.

Sex differences in the trajectories to diagnosis of patients presenting with common somatic symptoms in primary care: an observational cohort study

OBJECTIVE

Little insight exists into sex differences in diagnostic trajectories for common somatic symptoms. This study aims to quantify sex differences in the provided primary care diagnostic interventions for common somatic symptoms, as well as the consequences hereof for final diagnoses.

METHODS

In this observational cohort study, we used real-world clinical data from the Dutch Family Medicine Network (N = 34,268 episodes of care related to common somatic symptoms; 61,4% female). The association between patients' sex on the one hand, and diagnostic interventions and disease diagnoses on the other hand, were assessed using multilevel multiple logistic regression analyses. Structural equation modelling was used to estimate a mediation model with multiple parallel mediators to assess whether the fewer disease diagnoses given to female patients were mediated by the fewer diagnostic interventions female patients receive, compared to male patients.

RESULTS

Women received fewer physical examinations (OR = 0.84, 95%CI = 0.79-0.89), diagnostic imaging (OR = 0.92, 95%CI = 0.84-0.99) and specialist referrals (OR = 0.85, 95%CI = 0.79-0.91) than men, but more laboratory diagnostics (OR = 1.27, 95%CI = 1.19-1.35). Women received disease diagnoses less often than men for their common somatic symptoms (OR = 0.94, 95%CI = 0.89-0.98). Mediation analysis showed that the fewer disease diagnosis in female patients were mediated by the fewer diagnostic interventions conducted in women compared to men.

CONCLUSION

This study shows that sex inequalities are present in primary care diagnostic trajectories of patients with common somatic symptoms and that these lead to unequal health outcomes in terms of diagnoses between women and men. FPs have to be aware of these inequalities to ensure equal high-quality care for all patients.

Is it adding up? The cumulative effect of sickness benefits on life expectancy in old age in 15 OECD countries 1960-2015

Since the 1950s, high-income countries have experienced an immense increase in life expectancy. Previous studies have largely assessed how individual-level factors influence longevity, whereas cumulative dis/advantage theory (CDA) has in general been used to explain the relationship between individual resources and mortality in relation to aging. Rare studies have investigated the institutional impact on mortality within the framework of CDA. The research field is thus lacking studies that compare more than a handful of countries over a longer period. This study attempts to align CDA and comparative welfare state research by analysing the relationship between sickness benefits and life expectancy at age 65, comparing fifteen affluent countries over the period 1960 to 2015. The found results demonstrate that countries with higher benefit coverage have a larger increase in life expectancy, among both men and women. The effect of income replacement was mixed and appear to depend on the share of population covered by sickness benefits. This institutional interplay between coverage and income replacement supports previous insights about the beneficial effects of universal programs on population health.

The Health Status Transition and Medical Expenditure Evaluation of Elderly Population in China

(1) Background: Because of the rapid expansion of the aging population in China, their health status transition and future medical expenditure have received increasing attention. This paper analyzes the health transition of the elderly and how their health transition impacts medical expenditures. At the same time, feasible policy suggestions are provided to respond to the rising medical expenditure and the demand for social care. (2) Methods: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 and analyzed using the Markov model and the Two-Part model (TPM) to forecast the size of the elderly population and their medical expenditures for the period 2020-2060. (3) Results: The study indicates that: (1) for the elderly with a mild disability, the probability of their health improvement is high; in contrast, for the elderly with a moderate or severe disability, their health deterioration is almost certain; (2) the frequency of the diagnosis and treatments of the elderly is closely related to their health status and medical expenditure; alternatively, as the health status deteriorates, the intensity of the elderly individuals' acceptance of their diagnosis and treatment increases, and so does the medical expense; (3) the population of the elderly with mild and moderate disability demonstrates an inverted "U"-shape, which reaches a peak around 2048, whereas the elderly with severe disability show linear growth, being the target group for health care; (4) with the population increase of the elderly who have severe disability, the medical expenditure increases significantly and poses a huge threat to medical service supply. Conclusions: It is necessary to provide classified and targeted health care according to the health status of the elderly. In addition, improving the level of medical insurance, establishing a mechanism for sharing medical expenditure, and adjusting the basic demographic structure are all important policy choices.

Prevalence and Persistence of Cost-Related Medication Nonadherence Among Medicare Beneficiaries at High Risk of Hospitalization

IMPORTANCE

The unaffordability of drugs has been a persistent and elusive challenge in the US health care system. Little is known about the prevalence and persistence of cost-related medication nonadherence (CRN) in a population with high-cost, high-need resource utilization.

OBJECTIVE

To evaluate the prevalence and persistence of CRN among Medicare beneficiaries at high risk of hospitalization as well as the characteristics associated with CRN in this population.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used survey data from Medicare patients at high risk of hospitalization and with a life expectancy greater than 12 months at an urban academic medical center from November 6, 2012, to January 30, 2018. Patients were followed up for 12 months at 3-month intervals from baseline, for a total of 5 surveys. Data were analyzed from September 1, 2020, to January 5, 2021.

MAIN OUTCOMES AND MEASURES

Self-reported CRN, using a metric of persistence and transiency. Based on the results of the 5 surveys, CRN was categorized as persistent (3 or more surveys), intermittent (2), transient (1), and any (1 or more). Multiple logistic regression analyses were used to evaluate factors associated with persistent and transient CRN.

RESULTS

Of the 1655 Medicare beneficiaries followed up during the 15-month study period, 1036 (62.6%) were women and 1452 (87.7%) were Black or African American; 769 (46.5%) were younger than 65 years, and 886 (53.5%) were 65 years or older (mean [SD] age, 62.4 [15.9] years). A total of 374 patients (22.6%) reported CRN at baseline, 810 (48.9%) reported any CRN, and 230 (13.9%) reported persistent CRN (148 [19.2%] of those younger than 65 years and 82 [9.3%] of those 65 years or older). The 230 patients who had persistent CRN accounted for 28% of those who reported CRN at least once during the 15-month study period. Younger age (eg, <50 years vs 75 years: adjusted odds ratio [AOR], 3.07; 95% CI, 1.61-5.86; P = .001), worse self-reported health (AOR, 1.59; 95% CI, 1.10-2.31; P = .01), and depression (AOR, 1.58; 95% CI, 1.11-2.24; P = .01) were associated with greater likelihood of persistent CRN. The population-adjusted prevalence of CRN was 53.6% (887 patients).

CONCLUSIONS AND RELEVANCE

The findings suggest that CRN is prevalent, moderately persistent, and variable in the Medicare population at high risk of hospitalization despite coverage by insurance. Longitudinal follow-up and refined predictive modeling of CRN appear to be needed to identify and target more precisely those with persistent CRN and to develop effective interventions.

Gender differences in health insurance coverage in China

BACKGROUND

China initiated a reform of the health insurance system in the late 1990s. The new insurance, Urban Employee Basic Medical Insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance.

METHODS

Based on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.

RESULTS

Based on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group.

CONCLUSIONS

This paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women's greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI's implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.

Decomposition of gendered socioeconomic-related inequality in outpatient health care utilization: A cross-sectional study from Iran

INTRODUCTION

Unequal access to required health care services could deteriorate inequality in health outcomes and increase mortality and morbidity, especially among disadvantaged groups. One of the most debated factors in shaping health care inequalities is gender. This study aimed to measure and explains gendered socioeconomic-related inequality in outpatient health care utilization in Iran.

METHODS

This is a cross-sectional research conducted at a national level in Iran. The required data was obtained from an Iranian health care utilization household survey conducted in 2015. Erreygers Concentration Index (ECI) was used to measure the socioeconomic inequality in outpatient health care utilization. A regression-based decomposition analysis was also used to explain socioeconomic-related inequalities.

RESULTS

There was a significant pro-rich inequality in outpatient health care utilization between males (ECI = 0.115, SE = 0.014) and females (ECI = 0.083 SE = 0.011) indicating that utilization of these services was concentrated on the better-offs. The decomposition analysis revealed that economic status (males = 50.58%, females = 37.42%) was the main contributor to the observed inequality. Location of residence, health insurance and education were other main driver of these inequalities.

CONCLUSIONS

Different factors have different contribution to socioeconomic-related inequality in utilization of outpatient health care services and these could be diversified considering gender. Hence, it seems that policy makers could be able to address these inequalities effectively through gender-oriented policies.

Awareness and utilization of urgent care services among patients attending Al-Wazarat PHCC in Riyadh, Saudi Arabia 2020

Background:

Urgent Care Clinics (UCCs) offer unscheduled appointments with a “treat and release” length of visits not exceeding 60 min. The growth of clinics is dictated by patients’ demand for quality care that is unscheduled, expedited, and ubiquitous, making them accessible and available.

Objectives:

This study aimed to assess the patient's level of awareness and utilization pattern of UCCs in Wazarat Health Care Center (WHCC) and assess factors associated with them.

Aim:

This study aims to provide information contributing to the support of decision-makers about the level of awareness among patients on urgent care services and their pattern of use within primary health care.

Methods:

This cross-sectional study included 288 patients visiting PHC clinics to measure their level of awareness and pattern of utilization using a self-administered questionnaire.

Results:

A total of 288 patients participated, 55.99% were females, and the highest percentage was in the age group of 18-38 years at 60.07%. Only one quarter, 73 (25.35%) of the patients were aware of the term urgent clinics, from them, more than a half (53.42%) visited such clinics 1–3 times in the three months before the time of study conduction, and the main cause of the visits was the common cold (25.76%). Less than half of the participants reported visiting the primary clinics without booking an appointment in advance at 44.79%. The reason for this was mainly because of having difficulty booking appointments at 54.55%. Awareness level was the highest (28.32%) among the lowest age group (18-38 years) and decreased gradually by increasing the age. A significantly higher percentage of low educational level participants reported visiting primary clinics without booking an appointment in advance at 51.33% vs. 37.68% of the university and above participants. According to patients ‘ income, there was a significant (0.023) difference in the awareness level; the highest was among participants with an income of 6000-12000 SAR at 32.86%.

Conclusion:

Only one-quarter of the studied patients know about the UCCs. More than half of the patients reported visiting these clinics because of difficulties in booking an appointment at the primary healthcare centers and convenience with the services provided at the UCCs. The common cold was the main reason for visiting the UCCs.

Population norms of health-related quality of life in Moscow, Russia: the EQ-5D-5L-based survey

Purpose

To develop population norms for the EQ-5D-5L questionnaire based on a representative sample of Moscow citizens.

Methods

We used quota sampling accounting for sex, age group and administrative district of residence. Respondents in randomly selected outdoor and indoor locations were surveyed with the official Russian paper-and-pencil version of the EQ-5D-5L questionnaire and a set of socio-demographic questions. We estimated four types of EQ-5D results: the distribution of limitations according to EQ-5D-5L dimensions, the perception of the health-related quality of life (HRQoL) with a visual analogue scale (EQ VAS), the unweighted score for a respondent’s health state (Level Sum Score, LSS) and the Russian health preferences-based weighted score (EQ index). In order to estimate the EQ-5D-5L index, we used a newly developed Russian EQ-5D-3L value set, together with EuroQol Group cross-over methodology.

Results

A total of 1020 respondents (18–93 years old) from the general Moscow adult population completed the EQ-5D-5L questionnaire. HRQoL domains with the largest number of identified health limitations were pain/discomfort (48.6%) and anxiety/depression (44.1%). Two hundred seventy-nine respondents (27.0%) did not report any health restrictions. The mean EQ VAS and EQ-5D-5L index were 74.1 (SD 17.3) and 0.907 (0.106) respectively. Multivariate analysis showed that female sex, advanced age and lack of access to the Internet had a negative influence on HRQoL, whereas residence in certain districts had a positive impact.

Conclusions

The study provides population norms of health-related quality of life in Moscow, measured according to the EQ-5D-5L questionnaire. These reference values can be used to optimise the effectiveness of resource allocation in healthcare.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02705-0) contains supplementary material, which is available to authorised users.

'No time for health:' exploring couples' health promotion in Indian slums

Joint involvement of couples is an effective strategy to increase contraceptive use and improve reproductive health of women. However, engaging couples to understand how their gender attitudes affect their personal and family health is an idea in search of practice. This mixed-methods study explores opportunities and barriers to couples' participation in health promotion in three slums of Delhi. For each couple, surveys and semi-structured interviews were conducted with husbands and wives individually to contrast self and spousal work, time, interest in health, sources of information related to health and depth of knowledge (n = 62). Urban poverty forces men to work long hours and women to enter part-time work in the informal sector. Paid work induces lack of availability at home, lack of interest in health information and in performing household chores and a self-perception of being healthy among men. These factors inhibit men's' participation in community-based health promotion activities. Women's unpaid work in the household remains unnoticed. Women were expected to be interested in and to make time to attend community-based health-related activities. Men recalled significantly less sources of health information than their spouse. Men and their wives showed similar depth of health-related knowledge, likely due to their spousal communication, with women acting as gatekeepers. Health promotion planners must recognize time constraints, reliance on informal interpersonal communication as a source of health information and the need to portray positive masculinities that address asymmetric gender relations. Innovative, continuous and collaborative approaches may support couples to proactively care about health in low-resource settings.

The Healthy Aging Index analyzed over 15 years in the general population: The Doetinchem Cohort Study

The Healthy Aging Index (HAI), an index of physiological aging, has been demonstrated to predicts mortality, morbidity and disability. We studied the longitudinal development of the HAI to identify aging trajectories and evaluated the role of baseline sociodemographic characteristics and lifestyle factors of the trajectories. Four measurements with intervals of 5 years were included from the Doetinchem Cohort Study. The HAI reflects levels of systolic blood pressure, non-fasting plasma glucose levels, global cognitive functioning, plasma creatinine levels and lung functioning. The HAI score ranges from 0 to 10: higher scores indicate a better health profile. Latent class mixture modelling was used to model within-person change and to identify aging trajectories. Area under the curve was calculated per trajectory to estimate total healthy years. In total, 2324 women and 2013 men were included. One HAI trajectory was identified for women, and two trajectories for men, labelled 'gradual' aging (76%) and 'early' aging (24%). Men who were medium/high educated, below 36 years at baseline, complied with guidelines on physical activity and were not obese in any round were associated with increased odds to 'gradual' aging of 1.46 (CI: 1.18-1.81), 1.93 (CI: 1.42-2.62), 1.26 (1.02-1.57) and 1.76 (1.32-2.35), respectively. Between 30 and 70 years of age, men in the 'early' aging trajectory had the least healthy years (29.6 years), followed by women (30.1 years), and 'gradual' aging men (34.7 years). This study emphasizes that 'physiological aging' is not only an issue of older ages. Between 30 and 70 years of age, 'early' aging men and women had approximately five healthy years less compared to 'gradual' aging men. Lifestyle factors (e.g. nutrition and physical activity) seem to play an important role in optimal aging.

Self-Rated Healthy Life Expectancy Changes in Jiangxi Province of China by Gender and Urban-Rural Differences, 2013-2018

Background: Globalization has brought about rapid economic and technological development, and life expectancy (LE) is constantly increasing. However, it is not clear whether an increase in LE will result in an increase in healthy life expectancy (HLE). This study evaluates trends in the self-rated healthy life expectancy (SRHLE) of residents aged 15 and older in Jiangxi Province of China from 2013 to 2018 and analyzes gender differences and urban-rural differences. This study provides a basis for the formulation of relevant public health policies. Methods: Based on two National Health Services Survey databases of Jiangxi in 2013 and 2018 as well as infant mortality rates and under-5 mortality rates from the Health Commission of Jiangxi, the Sullivan method was used to calculate SRHLE. The changes in SRHLE were decomposed into health and mortality effects using the decomposition method. Results: SRHLE decreased from 56.55 to 55.54 years and from 60.00 to 57.87 years for men and women aged 15 from 2013 to 2018, respectively. The SRHLE of women aged 15 was 3.45 and 2.34 years longer than that of men in 2013 and 2018, respectively. The SRHLE of urban men aged 15 was 2.9 and 4.46 years longer than that of rural men in 2013 and 2018, respectively, and that of urban women aged 15 was 3.28 and 5.57 years longer than that of rural women. Conclusions: The decreased SRHLE indicated that the self-rated health (SRH) status of residents in Jiangxi has worsened, and it provided evidence for the expansion of morbidity, mainly due to the increased prevalence of chronic diseases and the improvement in residents' health awareness. Policy efforts are necessary to control the increased morbidity of chronic diseases and reduce gender and urban-rural differences in the quantity and quality of years lived.

Exploring the Use of Complementary and Alternative Medicine in Cancer Patients

In Australia, it is estimated that around 17% to 87% of cancer patients have used one form of complementary therapy during their cancer treatment. There are numerous reasons and contributing factors for cancer patients to consider using complementary and alternative medicine (CAM). CAM information and products are readily available. However, the level of evidence to support the benefits of use in the cancer setting is limited, and the associated adverse effects and interactions with conventional medicine may not be fully studied. Besides, not all health professionals favor the concept of integrative health approaches, or have the confidence in dealing with CAM due to a lack of knowledge and standardization of practices. A thematic review of the literature was performed on the main contributing factors to cancer patients’ use of CAM, as well as the current issues that may be encountered by the patients and health professionals.

Exploring the Use of Complementary and Alternative Medicine in Cancer Patients

In Australia, it is estimated that around 17% to 87% of cancer patients have used one form of complementary therapy during their cancer treatment. There are numerous reasons and contributing factors for cancer patients to consider using complementary and alternative medicine (CAM). CAM information and products are readily available. However, the level of evidence to support the benefits of use in the cancer setting is limited, and the associated adverse effects and interactions with conventional medicine may not be fully studied. Besides, not all health professionals favor the concept of integrative health approaches, or have the confidence in dealing with CAM due to a lack of knowledge and standardization of practices. A thematic review of the literature was performed on the main contributing factors to cancer patients’ use of CAM, as well as the current issues that may be encountered by the patients and health professionals.

Health and Well-Being in Late Life: Gender Differences Worldwide

Maintaining health and quality of life and decreasing the number of years lived with disabilities in old age are among the main challenges of aging societies worldwide. This paper aims to present current worldwide health-related gender inequalities throughout life, and especially in late life, as well as gender gaps in social and personal resources which affect health, functioning and well-being. This paper also addresses the question of whether gender gaps at younger ages tend to narrow in late life, due to the many biological and social changes that occur in old age. Based on international data regarding these gender gaps and the trends of change in personal resources and health-related lifestyles in the more and less developed nations, conclusions regarding future changes in gender gaps are presented, along with practical implications for future improvements in women's health and well-being.

Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers

OBJECTIVE

To analyse whether gender-specific health behaviour can be an explanation for why women outlive men, while having worse morbidity outcomes, known as the morbidity-mortality or gender paradox.

SETTING

The working population in Sweden.

PARTICIPANTS

Thirty per cent random sample of Swedish women and men aged 40-59 with a hospital admission in the 1993-2004 period were included. The sample for analysis consists of 233 274 individuals (115 430 men and 117 844 women) and in total 1 867 013 observations on sickness absence.

INTERVENTION

Hospital admission across 18 disease categories.

MAIN OUTCOME MEASURES

The main outcome measures were sickness absence (morbidity) and mortality. Longitudinal data at the individual level allow us to study how sickness absence changed after a hospital admission in men and women using a difference-in-differences regression analysis. Cox regression models are used to study differences in mortality after the admission.

RESULTS

Women increased their sickness absence after a hospital admission by around five more days per year than men (95% CI 5.25 to 6.22). At the same time, men had higher mortality in the 18 diagnosis categories analysed. The pattern of more sickness absence in women was the same across 17 different diagnosis categories. For neoplasm, with a 57% higher risk of death for men (54.18%-59.89%), the results depended on the imputation method of sickness for those deceased. By using the premortality means of sickness absence, men had an additional 14.47 (-16.30- -12.64) days of absence, but with zero imputation women had an additional 1.6 days of absence (0.05-3.20). Analyses with or without covariates revealed a coherent picture.

CONCLUSIONS

The pattern of increased sickness absence (morbidity) and lower mortality in women provides evidence on the more proactive and preventive behaviour of women than of men, which could thus explain the morbidity-mortality paradox.

Frailty as a predictor of falls in HIV-infected and uninfected women

BACKGROUND

Frailty and falls occur commonly and prematurely in HIV-infected populations. Whether frailty in middle-age predicts future falls among HIV-infected women is unknown.

METHODS

We evaluated associations of frailty with single and recurrent falls 10 years later among 729 HIV-infected and 326 uninfected women in the Women's Interagency HIV Study (WIHS) with frailty measured in 2005 and self-reported falls in 2014-2016. Frailty was defined as ≥3 of 5 Fried Frailty Index components: slow gait, reduced grip strength, exhaustion, unintentional weight loss and low physical activity. Stepwise logistic regression models determined odds of single (versus 0) or recurrent falls (≥2 versus 0) during the 2-year period; separate models evaluated frailty components.

RESULTS

HIV-infected women were older (median 42 versus 39 years; P<0.0001) and more often frail (14% versus 9%; P=0.04) than uninfected women. Over 2 years, 40% of HIV-infected versus 39% of uninfected women reported a fall (single fall in 15% HIV+ versus 18% HIV- women; recurrent falls in 25% HIV+ versus 20% HIV- women [overall P=0.20]). In multivariate models, frailty independently predicted recurrent falls (adjusted odds ratio [aOR] 1.84, 95% CI: 1.13, 2.97; P=0.01), but not a single fall. Among frailty components, unintentional weight loss independently predicted single fall (aOR 2.31, 95% CI: 1.28, 4.17; P=0.005); unintentional weight loss (aOR 2.26, 95% CI: 1.32, 3.86; P=0.003) and exhaustion (aOR 1.66, 95% CI: 1.10, 2.50; P=0.02) independently predicted recurrent falls.

CONCLUSIONS

Early frailty measurement among middle-aged women with or at-risk for HIV may be a useful tool to assess future fall risk.

Trends in gender differences in health at working ages among West and East Germans

Before 1990, Germany was divided for more than 40 years. While divided, significant mortality disparities between the populations of East and West Germany emerged. In the years following reunification, East German mortality improved considerably, eventually converging with West German levels. In this study, we explore changes in the gender differences in health at ages 20–59 across the eastern and western regions of Germany using data from the German Socio-Economic Panel (SOEP) for the 1990–2013 period. We apply random-effects linear regressions to the SOEP data to identify trends in health, measured as self-assessed health satisfaction, after German reunification.

The findings indicate that women were substantially less satisfied with their health than men in both West and East Germany, but that the gender gap was larger in East Germany than in West Germany. Furthermore, the results show that respondents’ satisfaction with their health decreased over time, and that the decline was steeper among men – and particularly among East German men – than among women. Thus, the initial male advantage in health in East and West Germany in the years immediately after reunification diminished over time, and even reversed to become a female advantage in East Germany. One interpretation of this finding is that stress-inducing post-reunification changes in the political and social landscape of East Germany had lasting damaging consequences for men’s health.

Ongoing risky health behaviors and high levels of economic insecurity due to unemployment could have had long-lasting effects on the health of the working-aged population. A partial explanation for our finding that health declined more sharply among East German men than among their female counterparts could be that women have better compensatory mechanisms than men for dealing with psychosocial stress.

Women's health status in urban Ghana: dimensions and differentials using short form 36

BACKGROUND

Global discourse on population, health and development have placed women's health issues at the top of development agenda. Women's reproductive health has received some attention in Ghana since the mid-1990s. However, studies on women's general health status, dimensions and the differentials in a rapidly growing urban setting is poorly understood and under-researched. This study sought to examine the various pathways in which individual socio-demographic factors, economic characteristics and endowment influence self-assessed health status among women living in the city of Accra, Ghana.

METHODS

The paper draws on a cross-sectional study carried out in 2008 and 2009 using a representative sample of urban women 20 years and older (n = 2814). Multivariate stepwise linear regression models were performed to investigate the influence of socio-demographic, economic and health indicators on health-related quality of life, measured by eight sub-scales of the Short Form-36 (SF-36). Interaction effects between some demographic and socio-economic variables were also performed.

RESULTS

The analyses show diverse relationships between demographic, socio-economic and health indicators and health outcomes assessed using eight SF-36 sub-scales. Education, disease symptoms and age of the respondent were the most significant factors influencing good overall health status. Interestingly, age has no significant effect on mental health after controlling for all other explanatory variables.

CONCLUSIONS

The findings show that health issues are multi-faceted requiring socio-cultural, health and economic policy interventions. Investing in women's education is important to improve health status. There is also the need for more effective collaboration across various sectors to improve the health and well-being of women in general. Ageing has increasing relationship with poor physical health status and the elderly should be given needed attention and support.

The aging population in China: Subjective well-being of empty nesters in rural eastern China

In this article, we explore the subjective well-being of empty nesters who lived in rural eastern China (N = 967). The Memorial University of Newfoundland Scale of Happiness is used to measure subjective well-being. The results indicate that Memorial University of Newfoundland Scale of Happiness is appropriate for empty nesters in rural China due to its reliability and validity. Generally, male empty nesters report greater subjective well-being scores than females. Negative factors include low levels of education, being a widow or widower, or being unmarried. It is argued that the empty nesters' incapability to access adequate social service and home care leads to their poor subjective well-being.

The differential rates in cost-related non-adherence to medical care by gender in the US adult population

BACKGROUND

Cost-related non-adherence (CRN) to medical care is a persistent challenge in healthcare in the US. Gender is a key determinant of many healthcare behaviors and outcomes. Understanding variation in CRN by gender may provide opportunities to reduce disparities and improve outcomes.

AIMS

This study aims to examine the differential rates in CRN by gender across a spectrum of socio-economic factors among the adult population in the US.

METHOD

Data from the 2015 National Financial Capability Study (NFCS) were used for this study. CRN is identified if a respondent indicated not filling a prescription for medicine because of the cost and/or skipping a medical test, treatment, or follow-up recommended by a doctor because of the cost in the past 12 months. The differential rates in CRN by gender were assessed across socio-economic strata. A multivariable logistic regression analysis was performed to evaluate the difference in CRN rates by gender, controlling for potential confounders.

RESULTS

A total of 26,287 adults were included in the analyses. Overall, the weighted CRN rate in the adult population is 19.8% for men and 26.2% for women. There was a clear pattern of differential rates in CRN across socio-economic strata by gender. Overall, men were less likely to report CRN (AOR = 0.74; 95% CI = 0.69-0.79), controlling for other risk factors.

CONCLUSIONS

More research is needed to understand the behavioral aspects of gender difference in CRN. Patient-centered healthcare needs to take gender difference into account when addressing cost-related non-adherence behavior.

Gender and the structure of self-rated health across the adult life span

Despite the widespread use of self-rated health (SRH) in population health studies, the meaning of this holistic health judgment remains an open question. Gender differences in health, an issue of utmost importance in population research and policy, are often measured with SRH; the comparisons could be biased if men and women differ in how they form their health judgment. The aim of this study is to examine whether men and women differ in how health inputs predict their health rating across the adult life span. We use the 2002-2015 National Health Interview Survey data from US-born respondents aged 25-84. Ordered logistic models of SRH as a function of 24 health measures including medical conditions and symptoms, mental health, functioning, health care utilization, and health behaviors, all interacted with gender, test how the measures influence health ratings and the extent to which these influences differ by gender. Using a Bayesian approach, we then compare how closely a select health measure (K6 score) corresponds to SRH levels among men and women. We find little systematic gender difference in the structure of SRH: men and women use wide-ranging health-related frames of reference in a similar way when making health judgments, with some exceptions: mid-life and older men weigh physical functioning deficits and negative health behaviors more heavily than women. Women report worse SRH than men on average but this only holds through mid-adulthood and is reversed at older ages; moreover, the female disadvantage disappears when differences in socio-economic and health covariates are considered. Our findings suggest that the meaning of SRH is similar for women and men. Both groups use a broad range of health-related information in forming their health judgment. This conclusion strengthens the validity of SRH in measuring gender differences in health.

Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling study

Background

Reliable estimation of future trends in life expectancy and the burden of disability is crucial for ageing societies. Previous forecasts have not considered the potential impact of trends in disease incidence. The present prediction model combines population trends in cardiovascular disease, dementia, disability, and mortality to forecast trends in life expectancy and the burden of disability in England and Wales up to 2025.

Methods

We developed and validated the IMPACT-Better Ageing Model—a probabilistic model that tracks the population aged 35–100 years through ten health states characterised by the presence or absence of cardiovascular disease, dementia, disability (difficulty with one or more activities of daily living) or death up to 2025, by use of evidence-based age-specific, sex-specific, and year-specific transition probabilities. As shown in the English Longitudinal Study of Ageing, we projected continuing declines in dementia incidence (2·7% per annum), cardiovascular incidence, and mortality. The model estimates disability prevalence and disabled and disability-free life expectancy by year.

Findings

Between 2015 and 2025, the number of people aged 65 years and older will increase by 19·4% (95% uncertainty interval [UI] 17·7–20·9), from 10·4 million (10·37–10·41 million) to 12·4 million (12·23–12·57 million). The number living with disability will increase by 25·0% (95% UI 21·3–28·2), from 2·25 million (2·24–2·27 million) to 2·81 million (2·72–2·89 million). The age-standardised prevalence of disability among this population will remain constant, at 21·7% (95% UI 21·5–21·8) in 2015 and 21·6% (21·3–21·8) in 2025. Total life expectancy at age 65 years will increase by 1·7 years (95% UI 0·1–3·6), from 20·1 years (19·9–20·3) to 21·8 years (20·2–23·6). Disability-free life expectancy at age 65 years will increase by 1·0 years (95% UI 0·1–1·9), from 15·4 years (15·3–15·5) to 16·4 years (15·5–17·3). However, life expectancy with disability will increase more in relative terms, with an increase of roughly 15% from 2015 (4·7 years, 95% UI 4·6–4·8) to 2025 (5·4 years, 4·7–6·4).

Interpretation

The number of older people with care needs will expand by 25% by 2025, mainly reflecting population ageing rather than an increase in prevalence of disability. Lifespans will increase further in the next decade, but a quarter of life expectancy at age 65 years will involve disability.

Funding

British Heart Foundation.

Does an Empty Nest Affect Elders' Health? Empirical Evidence from China

The "empty-nest" elderly family has become increasingly prevalent among old people in China. This study aimed to explore the causality between empty nests and elders' health using effective instrumental variables, including "whether old parents talk with their families when they are upset" and "ownership of housing". The results showed that empty nests had a significantly adverse influence on elders' physical health, cognitive ability and psychological health. Furthermore, urban elders' cognitive ability was more influenced by empty nests than that of rural elders. Additionally, the effects of an empty nest on elders" health were more significant among female, single elders and senior rural elders. "Living resources", "availability of medical treatment" and "social activity engagement" were found to be significant mediators between empty nests and elders' health, accounting for 35% of the total effect.

Physical Illness in Gay, Lesbian, and Heterosexual Marriages: Gendered Dyadic Experiences

The inclusion of same-sex married couples can illuminate and challenge assumptions about gender that are routinely taken for granted in studies of physical illness. We analyze gender dynamics in gay, lesbian, and heterosexual marriages with in-depth interview data from 90 spouses (45 couples) to consider how spouses co-construct illness experiences in ways that shape relationship dynamics. Overall, findings indicate that men tend to downplay illness and thus provide minimal care work, whereas women tend to construct illness as immersive and involving intensive care work-in both same-sex and different-sex marriages. Yet same-sex spouses describe similar constructions of illness much more so than different-sex couples, and as such, same-sex spouses describe less illness-related disagreement and stress. These findings help inform policies to support the health of gay and lesbian, as well as heterosexual, patients and their spouses, an important goal given health disparities of gay and lesbian populations.

Changes in physical functioning among men and women aged 50-79 years in Germany: an analysis of National Health Interview and Examination Surveys, 1997-1999 and 2008-2011

Background

This study examines changes in physical functioning among adults aged 50-79 years in Germany based on data from two German National Health Interview and Examination Surveys conducted in 1997–1999 (GNHIES98) and 2008–2011 (DEGS1).

Methods

Using cross-sectional data from the two surveys (GNHIES98, n = 2884 and DEGS1, n = 3732), we examined changes in self-reported physical functioning scores (Short Form-36 physical functioning subscale (SF-36 PF)) by sex and age groups (50–64 and 65–79 years). Covariables included educational level, living alone, nine chronic diseases, polypharmacy (≥5 prescribed medicines), body mass index, sports activity, smoking and alcohol consumption. Multimorbidity was defined as ≥2 chronic diseases. Multivariable models were fitted to examine consistency of changes in physical functioning among certain subgroups and to assess changes in mean SF-36 PF scores, adjusting for changes in covariables between surveys.

Results

Mean physical functioning increased among adults aged 50–79 years between surveys in unadjusted analyses, but this change was not as marked among men aged 65–79 years who experienced rising obesity (20.6 to 31.5%, p = 0.004) and diabetes (13.0 to 20.0%, p = 0.014). Prevalence of multimorbidity and polypharmacy use increased among men and women aged 65–79 years. In sex and age specific multivariable analyses, changes in physical functioning over time were consistent across subgroups. Gains in physical functioning were explained by improved education, lower body mass index and improved health-related behaviours (smoking, alcohol consumption, sports activity) in women, but less so among men.

Conclusions

Physical functioning improved in Germany among adults aged 50–79 years. Improvements in the population 65–79 years were less evident among men than women, despite increases in multimorbidity prevalence among both sexes. Changes in health behaviours over time differed between sexes and help explain variations in physical functioning. Targeted health behaviour interventions are indicated from this study.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0377-0) contains supplementary material, which is available to authorized users.

The Female Role and Menstrual Distress: An Explanation for Inconsistent Evidence

Numerous studies of either sex role behavior (masculinity/femininity) or women's role attitudes (contemporary/traditional) as related to menstrual distress have amassed inconsistent and contradictory results. It was proposed that these two role variables may hold an interactive relationship with menstrual distress, and their study in isolation may have provoked less reliable results. An interaction was found with masculine women preferring a contemporary role and feminine women committed to traditional role values reporting greater menstrual and premenstrual distress. Feminine contemporary and masculine traditional women revealed less distress associated with the menstrual cycle.

The Politics of Personality Disorder

This research tested the hypothesis that the gender distribution of personality disorders stems from the resemblance between each personality disorder and the role/role-stereotype of the status group for whom the disorder is prevalent. The first study found that undergraduates attributed descriptions of each personality disorder to the gender, social class, and marital status of the group that tends to receive that label; the second study found that the Sadistic and the Self-Defeating Personality Disorders of the DSM-IIIR were attributed to white males and middle-class females, respectively. It is suggested that personality disorders represent the roles/role-stereotypes of both genders.

The Social Rights and Responsibilities of Pregnant Women: An Application of Parsons's Sick Role Model

A study sought to identify the role expectations ascribed to pregnancy, and to examine whether such expectations differed across categories of socioeconomic status, age, race, and gender. In particular, the adequacy of Parsons `s model of the sick role for describing social expectations for pregnant women was analyzed. For each of the four components of Parsons `s sick role, items were developed for a questionnaire administered to a sample of 329 adults in a metropolitan community. The results indicate that for the vast majority of the respondents, the behavior expected of pregnant women is similar to Parsons's sick role. A factor analysis of item responses, however, reveals that they are not unidimensional. Furthermore, significant variation occurred across categories of socioeconomic status, gender, race, and age in the extent to which respondents ascribed the four implications of these findings are discussed.

Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey

BACKGROUND

While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE).

AIMS

Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference.

DATA AND METHODS

Using two rounds of nationally representative panel data-the India Human Development Survey (IHDS) 2004-2005 and 2011-2012 (IHDS I & II)-we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors.

RESULTS

Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206-0.091). For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male-female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect), whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect).

INTERPRETATION

Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE.

Social Support Resources

Although considerable research effort has been spent in documenting the beneficial effects of social support to individual well-being, little is known about the determinants of this resource or its distribution across sociocultural groups. The present study assessed the influence among college students of sex and sex role on three levels of social support resources: network characteristics, availability of several modes of support, and perceived supportiveness of family and friends. On a composite measure of overall support resources, females were superior to males, and feminine and androgynous individuals were superior to masculine and undifferentiated individuals. Only some specific social support variables differed across these groups specifically, network size and homogeneity, emotional support, and perceived supportiveness of family for sex role.