Social determinants of sex differences in disability among older adults: a multi-country decomposition analysis using the World Health Survey

International Journal for Equity in Health

Somnath Chatterji⁴  Aleksandra Posarac³  Alana Officer⁵  Paul Kowal¹  Ben Jann²  Jennifer Stewart Williams¹  Ahmad Reza Hosseinpoor⁴ 

[1] Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle, Callaghan, 2308, Australia;Institute of Sociology, University of Bern, Lerchenweg 36, 3000, Bern 9, Switzerland;Social Protection and Labor, Human Development Network, The World Bank, Washington, DC, 20433, USA;Department of Health Statistics and Information Systems, World Health Organization, 20 Avenue Appia, Geneva, 27 1211, Switzerland;Department of Violence, Injury Prevention and Disability, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland

关键词: Social determinants;    Inequalities;    Equity;    Aging;    Ageing;    Functional limitation;    Chronic disease;    Disability;   

Others  :  826243
DOI  :  10.1186/1475-9276-11-52

 received in 2012-05-08, accepted in 2012-08-27,  发布年份 2012

【 摘 要 】

Introduction

Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women.

Methods

World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into “disabled” vs. “not disabled”. We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the “explained” part that arises because of differences between males and females in terms of age and social and economic characteristics, and an “unexplained” part attributed to the differential effects of these characteristics.

Results

Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants.

Conclusions

There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.

【 授权许可】

   
2012 Hosseinpoor et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Leonardi M, Bickenbach J, Ütsun TB, Kostanjek N, Chatterji S: The definition of disability: what is in the name? The Lancet 2006, 368:1219-1220.
• [2]Officer A, Grace NE: Key concepts in disability. Lancet 2009, 374(9704):1795-1796.
• [3]World Health Organization, The World Bank: World Report on Disability. WHO, Geneva; 2011:350.
• [4]Zarocostas J: World’s one billion people with disabilities face widespread barriers to healthcare. BMJ 2011, 342:1.
• [5]Bickenbach JE, Chatterji S, Badley EM, Üstün TB: Models of disablement, universalism and the international classification of impairments, disabilities and handicaps. Soc Sci Med 1999, 48(9):1173-1187.
• [6]World Health Organization: International classification of functioning, disability, and health. WHO, Geneva; 2006.
• [7]World Health Organization: Closing the gap in a generation. Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health, Geneva; 2008:246.
• [8]Phillips SM: Defining and measuring gender: A social determinant of health whose time has come. Int J Equity in Health 2005, 4(11):4.
• [9]Buivnić M, Médici A, Fernández E, Torres AC: Gender differentials in health. In Disease Control Priorities in Developing Countries. 2nd edition. , Washington DC; 2006:1440.
• [10]Sen G, Ostlin P, George A: Unequal, unfair, ineffective and inefficient. Gender inequity in health: why it exists and how we can change it. In Final Report to the WHO Commission on Social Determinants of Health. Karolinska Institutet, Stockholm; 2007:145.
• [11]World Health Organization: Women and Health. Today's evidence tomorrow's agenda. WHO, Geneva; 2009:91.
• [12]World Health Organization: Equity, social determinants and public health programmes. Edited by Blas E, Kurup AS. , Geneva; 2010:303.
• [13]Crimmins EM, Kim JK, Solé-Auró A: Gender differences in health: results from SHARE, ELSA and HRS. The Eur J Public Health 2011, 21(1):81-91.
• [14]Hoogendijk E, van Groenou M, van Tilburg T, Deeg D: Educational differences in functional limitations: comparisons of 55–65-year-olds in the Netherlands in 1992 and 2002. Int J Public Health 2008, 53(6):281-289.
• [15]Park SM, Jang SN, Kim DH: Gender differences as factors in successful ageing: a focus on socioeconomic status. J Biosoc Sci 2010, 42(01):99-111.
• [16]Espelt A, Font-Rebera L, Rodriguez-Sanz M, Artazcoz L, Ferrando J, Plaza A, Borrell C: Disability Among Older People in a Southern European City in 2006: Trends in Gender and Socioeconomic Inequalities. J Women's Health 2010, 19(5):927-933.
• [17]Nagata KK: Gender and disability in the Arab region: the challenges in the new millennium. Asia Pacific Disabil Rehabil J 2003, 14:10-17.
• [18]Beydoun MA, Popkin BM: The impact of socio-economic factors on functional status decline among community-dwelling older adults in China. Soc Sci Med 2005, 60(9):2045-2057.
• [19]Eide AH, Loeb ME: Living conditions among people with activity limitations in Zambia: a national representative study. SINTEF A262, Oslo; 2006:190.
• [20]Grech S: Living with disability in rural Guatemala: exploring connections and impacts on poverty. Int J Disabil Comm Rehabil 2008., 72(2)
• [21]Ustün T, Chatterji S, Mechbal A, Murray C: The World Health Surveys. In Health systems performance assessment debates, methods and empiricisms. Edited by Murray CL, Evans DB. World Health Organization, Geneva; 2003.
• [22]Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet 2007, 370:851-858.
• [23]Ayuso-Mateos JL, Nuevo R, Verdes E, Naidoo N, Chatterji S: From depressive symptoms to depressive disorders: the relevance of thresholds. The British J Psychiatry 2010, 196:365-371.
• [24]World Bank: World Development Report 2005. World Bank, Washington DC; 2005:288.
• [25]Sadana R, Tandon A, Murray CJL, Serdobova I, Cao Y, Xie W, Chatterji S, Ustün BL: Describing population health in six domains: comparable results from 66 household surveys. , Geneva; 2002:76. [Global Programme on Evidence for Health Policy Discussion Paper No 43]
• [26]Salomon JA, Mathers C, Chatterji S, Sadana R, Ustün TB: Quantifying individual levels of health definitions, concepts and measurement issues. In Health systems performance assessment debates, methods and empiricisms. Edited by Murray CJL, Evans DB. World Health Organization, Geneva; 2003.
• [27]Wilson M, Allen DD, Li JC: Improving measurement in health education and health behaviour research using item response modeling: comparison with the classical test theory approach. Health Educ Res 2006, 21(S1):i19-i32.
• [28]Marmot M, Friel S, Bell R, Houweling TA, Taylor S: Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet 2008, 372(9650):1661-1669.
• [29]Ferguson B, Murray CL, Tandon A, Gakidou E: Estimating permanent income using asset and indicator variables. In Health systems performance assessment debates, methods and empiricism. Edited by Murray CL, Evans DB. World Health Organization, Geneva; 2003.
• [30]Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, Patel R, Webb EA, Lawlor DA, Hargreaves JA: Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol 2012.
• [31]Hosseinpoor AR, Mohammad K, Majdzadeh R, Naghavi M, Abolhassani F, Sousa A, Speybroeck N, Jamshidi HR, Vega J: Socioeconomic inequality in infant mortality in Iran and across its provinces. Bulletin WHO 2005, 83(11):837-844.
• [32]Gakidou E, Oza S, Fuetes CV, Li AY, Lee DK, Sousa A, Hogan MC, Vander Hoorn S, Ezzati M: Improving child survival through environmental and nutritional interventions. The importance of targetting interventions towards the poor. JAMA 2007, 298(16):1876-1887.
• [33]Oaxaca RL: Male–female wage differentials in urban labor markets. Int Econ Rev 1973, 14(3):693-709.
• [34]Stewart Williams JA: Using non linear decomposition to explain the discriminatory effects of male–female differentials in access to care. A cardiac rehabilitation case study. Soc Sci Med 2009, 69(7):1072-1079.
• [35]Jann B: The Blinder-Oaxaca decomposition for linear regression models. The Stata J 2008, 8(4):453-479.
• [36]Neumark D: Employers' discriminatory behavior and the estimation of wage discrimination. The J Human Resources 1988, 23(3):279-295.
• [37]Yun M: Decomposing differences in the first moment. Econ Letters 2004, 82:275-280.
• [38]Leveille S, Penninx B, Melzer D, Izmirlian G, Guralnik J: Sex differences in the prevalence of mobility disability in old age: The dynamics of incidence, recovery, and mortality. J Gerontol: Soc Sci 2000, 55B(I):S41-S50.
• [39]Murtagh KN, Hubert HB: Gender Differences in Physical Disability Among an Elderly Cohort. Am J Public Health 2004, 94(8):1406-1411.
• [40]Abdulraheem IS: Health needs assessment and determinants of health-seeking behaviour among elderly Nigerians: a house-hold survey. Annals of Afr Med 2007, 6(2):58-63.
• [41]Avlund K, Damsgaard MT, Osler M: Social position and functional decline among non-disabled old men and women. The Eur J Public Health 2004, 14(2):212-216.
• [42]Huisman M, Kunst AE, Mackenbach JP: Socioeconomic inequalities in morbidity among the elderly; a European overview. Soc Sci Med 2003, 57:861-873.
• [43]Kaneda T, Zimmer Z: Education, Gender, and Functional Transitions Among Indonesian Elderly. J Cross-Cultural Gerontol 2007, 22(3):303-322.
• [44]Yount K, Agree EM: Differences in disability among older women and men in Egypt and Tunisia. Demography 2005, 42(1):169-187.
• [45]Hardy S, Allore H, Guo Z, Gill T: Explaining the effect of gender on functional transitions in older persons. Gerontol 2008, 54(2):79-86.
• [46]Phillips SP: Measuring the health effects of gender. J Epidemiol and Community Health 2008, 62:368-371.
• [47]Rodrigues MAP, Facchini LA, Thume E, Maia F: Gender and incidence of functional disability in the elderly: a systematic review. Cadernos de Saúde Pública 2009, 25(Sup 4):S464-S476.
• [48]Hosseinpoor AR, Stewart Williams J, Amin A, de Carvalho Araujo I, Beard J, Boerma T, Kowal P, Naidoo N, Chatterji S: Social determinants of self-reported health in women and men: understanding the role of gender in population health. PLoS ONE 2012, 7(4):9.