Gender differences in health in later life: the new paradox?

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Abstract

This paper examines gender differences in health, based on data from over 14,000 men and women aged 60 and above from 3 years of the British General Household Survey, 1992–1994. There is little difference between the sexes in the reporting of self-assessed health and limiting longstanding illness, but older women are substantially more likely to experience functional impairment in mobility and personal self-care than men of the same age. These findings persist after controlling for the differential social position of men and women according to their marital status, social class, income and housing tenure. The results reveal a paradox in health reporting among older people; for a given level of disability, women are less likely to assess their health as being poor than men of the same age after accounting for structural factors. Older women’s much higher level of functional impairment co-exists with a lack of gender difference in self-assessed health.

Section snippets

Gender differences in health

It has become accepted wisdom that ‘men die and women become disabled’. Women have an expectation of life which is 5–6 years longer than men (Waldron, 1976; ONS, 1996), but have higher morbidity rates. This was discussed by Nathanson (1975)as a ‘contradiction’ which required explanation. She put forward various alternative explanations for this apparent contradiction. Other authors in the US repeatedly demonstrated that “females have higher rates of illness than males” (Verbrugge, 1979a, p.

Gender and living in residential care

Most national health surveys are drawn from samples of residents living in private households and thereby exclude people living in institutions. This is unimportant when analysing the health of people at younger ages, but among the older population is increasingly important with advancing age. It is particularly pertinent when considering gender differences in health, because gender is closely associated with entry into residential care. Over twice as many women over 65 (6.4%) as men (3%) lived

Methodology

The paper analyses data from the British General Household Survey (GHS), which is a nationally representative survey interviewing all adults aged 16 and over in about 10,000 private households each year in Great Britain (Bennett et al., 1996). The response rate was about 80% in 1992–94. The paper is primarily based on analyses of men and women aged 60 and over. To produce more robust results for specific age groups of older people aged 60+, we have pooled 3 years of GHS data, for 1992/93 (n

Gender differences in health

A commonly used global indicator of ill-health is self-assessed health, which is measured by the GHS question “Over the last twelve months, would you say that your health has on the whole been good, fairly good or not good?”. Poor self-assessed health has been shown to be a good predictor of mortality in other studies (Mossey and Shapiro, 1982; Idler and Benyamini, 1997).

The proportion of older people rating their health as ‘less than good’ rises from about 50% of men and women in their early 60

Class inequalities in health among men and women

Despite the very modest gender differences in self-assessed health in later life [shown in Table 2(a)], the health differences according to class based on last main occupation are very striking across the full age range of older men and women (see Fig. 1). In each 5 year age group under 80, about 30% more men previously in a professional occupation rate their health as ‘good’ than men previously in a semi- or unskilled occupation. Even among men in their 80 s, 20% more professional men report

Gender differences in health: multivariate analyses

This section uses logistic regression analysis to examine how gender differences in self-assessed health and in ‘severe’ disability change when social and structural characteristics of older men and women are included in the same analysis. One aim of this section is to assess whether gender differences in health can be explained by older women’s more disadvantaged social and economic circumstances.

Model 1 gives the odds ratio for ‘less than good’ health for women with men as the reference

Conclusion

This paper has examined gender differences in health among older people in Britain in the mid-1990 s, focusing on self-assessed health, and the likelihood of experiencing functional impairments that adversely affect activities of daily living. Our research shows that minimal gender differences in self-assessed health coexist alongside substantial gender differences in disability, representing a new paradox.

Older women are disadvantaged compared to older men both because of their greater level of

Acknowledgements

We are to grateful to the Office of National Statistics for permission to use data from the General Household Survey, and to the Data Archive and Manchester Computing Centre for access to the data. We would like to thank the Health Education Authority for funding research on which parts of this paper are based. We particularly appreciate the helpful comments of Jay Ginn on an earlier version of this paper and those of the anonymous referees.

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