Sex differences in health and mortality in Moscow and Denmark

Cross-sectional association of food insecurity with loneliness in older adults: The role of sex, age, and psychosomatic factors

OBJECTIVE

Food insecurity (FI) is a critical social determinant of poor psychosocial health. While data on the specific roles of sex and age in the FI-loneliness link among older adults are limited, the underlying mechanisms are largely unknown. This study examines the age-sex-specific associations of FI with loneliness among older adults in Ghana and quantifies the extent to which psychosomatic factors mediate the association.

METHODS

We analyzed cross-sectional data from the Aging, Health, Psychological, and Health-seeking Behavior Study in Ghana. The past 30-day FI was assessed using items on hunger and breakfast skipping frequency due to a lack of resources. We assessed loneliness severity with the University of California, Los Angeles 3-item Loneliness Scale. Multivariable OLS regressions and bootstrapping mediation analysis using the Hayes PROCESS macro plug-in were used to evaluate the associations.

RESULTS

We included 1,201 individuals aged ≥50 years (mean = 62.9 [SD = 11.9]; women = 63.3%). The prevalence of loneliness was 17.7%. The prevalence of moderate and severe FI was 44.0% and 8.5%, respectively. In the adjusted model, greater FI was significantly associated with loneliness severity (B = .22, SE = .029, p < .001). We found significant interactive effects of FI × age (B = -.17, SE = .023, p < .01) and FI × sex (B = -.28, SE = .036, p < .001) on loneliness. Thus, the FI-loneliness link was respectively more marked among women (B = .25, SE = .035, p < .001) and ≥65 age groups (B = .34, SE = .041, p < .001) than men (B = .16, SE = .051, p < .01) and those aged 50-64 (B = .22; SE = .040, p < .001). Finally, comorbid depression/anxiety (41.07%), hopelessness (48.6%), worthlessness (42.1%), functional limitations (8.2%), and pain severity (6.4%) mediated the FI-loneliness association.

CONCLUSIONS

Age- and sex-specific associations between FI and loneliness exist among older Ghanaians. Addressing FI in concert with psychosomatic problems in older adults may contribute meaningfully to reducing loneliness in later life.

Excess Mortality of Males Due to Chronic Obstructive Pulmonary Disease (COPD) in Poland

At present, female life expectancy exceeds male life expectancy almost worldwide. However, numerous studies indicate that this disparity is gradually decreasing. In Poland, the gender gap in life expectancy peaked in 1991 when it amounted to 9.2 years. Since then, a narrowing of the gap has been observed, reaching 8 years in 2021. Decreasing differences in life expectancy between men and women in Poland were mainly the result of a reduction in mortality due to ischaemic heart disease, cerebrovascular disease, and a number of malignancies.Less attention has been paid to chronic obstructive pulmonary disease (COPD) although it is the third leading cause of death worldwide. This paper includes an analysis of mortality due to chronic obstructive pulmonary disease COPD. The male excess mortality was calculated as the ratio of mortality rates in the male population scaled up to the corresponding rates in the female population using both crude and standardised detailed mortality rates. The Joinpoint model was used to determine time trends. It was shown that from 2008 to 2021, the excess mortality of men due to COPD in Poland decreased by 3.3% per year from 2.4 to 1.7 when using crude coefficients, while when standardised coefficients were applied, it decreased significantly by 3.9% per year from 3.8 to 2.4. The decrease in the excess mortality of men in Poland was due to a simultaneous decrease in mortality in the population in general; however, a greater decrease was observed in the male population. The mortality of men and women, and, at the same time, the excess mortality of men caused by COPD in Poland decreased faster in the period studied than in other European countries.

Sex differences in cause-specific mortality: regional trends in seven European countries, 1996-2019

BACKGROUND

Male excess mortality is mostly related to non-biological factors, and is thus of high social- and health-policy concern. Previous research has mainly focused on national patterns, while subnational disparities have been less in the focus. This study takes a spatial perspective on subnational patterns, covering seven European countries at the crossroad between Eastern and Western Europe.

METHODS

We analyze a newly gathered spatially detailed data resource comprising 228 regions with well-established demographic methods to assess the contribution of specific causes of death to the evolution of sex mortality differentials (SMDs) since the mid-1990s.

RESULTS

Our results show that declines in SMDs were mostly driven by a reduction of male excess mortality from cardiovascular diseases and neoplasms (about 50-60% and 20-30%, respectively). In Western Europe, trends in deaths from neoplasms contributed more to the reduction of SMDs, while among regions located in Eastern-Central Europe narrowing SMDs were mostly driven by changes in cardiovascular disease-related deaths. Moreover, men show up to three times higher mortality levels from external causes as compared to women in several analyzed regions. But in absolute terms, external deaths play only a minor role in explaining SMDs due to their small contribution to overall mortality.

CONCLUSIONS

We conclude that examining the regional development of SMDs is useful for introducing targeted social and health policies in order to reduce and prevent mortality inequalities between women and men.

Decomposition and comparative analysis of health inequities between the male and female older adults in China: a national cross-sectional study

BACKGROUND

This study aimed to examine the factors influencing self-rated health (SRH) among Chinese older adults by gender differences and provide suggestions and theoretical references to help make policies for older adults' health concerns by government agencies.

METHODS

Chinese Longitudinal Health Longevity Survey (CLHLS) in 2018 was adopted, the chi-squared test and the logistic regression analysis were performed to analyse self-rated health reported by Chinese female and male older adults and its influencing factors. In addition, Fairlie decomposition analysis was performed to quantify the contribution level of different influencing factors.

RESULTS

Among older adults, males (48.0%) reported a significantly higher level of good self-rated health than females (42.3%). Residence, body mass index (BMI), self-reported income, smoking, drinking, exercise, and social activity were the factors that influenced SRH reported by male and female respondents, with age, marital status and education reaching the significance level only in women. The Fairlie decomposition model can explain the underlying reasons for 86.7% of the gender differences in SRH, with self-reported income (15.3%), smoking (32.7%), drinking (42.5%), exercise (17.4%), social activity (15.1%) and education (-14.6%) being the major factors affecting gender differences in SRH.

CONCLUSIONS

The study results can help promote the implementation of the Healthy China Initiative, inform intervention measures, and offer new proposals on creating policies for older adults' health issues by the Chinese government to improve health equity.

Different health systems - Different mortality outcomes? Regional disparities in avoidable mortality across German-speaking Europe, 1992-2019

BACKGROUND

Evaluating the impact of health systems on premature mortality across different countries is a very challenging task, as it is hardly possible to disentangle it from the influence of contextual factors such as cultural differences. In this respect, the German-speaking area in Central Europe (Austria, Germany, South Tyrol and large parts of Switzerland) represents a unique 'natural experiment' setting: While being exposed to different health policies, they share a similar culture and language.

METHODS

To assess the impact of different health systems on mortality differentials across the German-speaking area, we relied on the concept of avoidable mortality. Based on official mortality statistics, we aggregated causes of death below age 75 that are either 1) amenable to health care or 2) avoidable through primary prevention. We calculated standardised death rates and constructed cause-deleted life tables for 9 Austrian, 96 German, 1 Italian and 5 Swiss regions from 1992 to 2019, harmonised according to the current territorial borders.

RESULTS

There are strong north-south and east-west gradients in amenable and preventable mortality across the studied regions to the advantage of the southwest. However, the Swiss regions still show significantly lower mortality levels than the neighbouring regions in southern Germany. Eliminating avoidable deaths from the life tables reduces spatial inequality in life expectancy in 2017/2019 by 30% for men and 28% for women.

CONCLUSIONS

The efficiency of health policies in assuring timely and adequate health care and in preventing risk-relevant behaviour has room for improvement in all German regions, especially in the north, west and east, and in eastern Austria as well.

COVID-19 Vaccine Hesitancy in Denmark and Russia: A qualitative typology at the nexus of agency and health capital

Vaccination of the world population is being embraced by 184 countries as the main strategy to end the COVID-19 pandemic; vaccination rates are stalling even in countries with high vaccine availability, though. This article investigates the phenomenon of vaccine hesitancy in two such countries, the Kingdom of Denmark and the Russian Federation, through a qualitative study of the different types of hesitancy to COVID-19 vaccination programs and their underlying mechanisms. The analysis reveals a typology along the dimensions of agency and health capital: resisting hesitancy based on mistrust of authority, paralyzed hesitancy based on personal fear, informed hesitancy based on informed choice, and empowered hesitancy based on empowered choice. While the mechanisms underlying vaccine hesitancy are to a great extent comparable between the two countries, differences in population size, societal cohesion, and political culture seem to impact the prevalence and severity of types and, thereby, the outcomes of national COVID-19 vaccination programs and national campaigns for mitigating COVID-19 vaccine hesitancy. The implications of these findings extend beyond the particular context of COVID-19 and the countries studied, supporting and nuancing existing models for vaccine hesitancy, as well as providing a starting point for tailored campaigns for mitigating vaccine hesitancy.

Physical activity and gender buffer the association of retirement with functional impairment in Ghana

Females on average live longer but with higher rates of functional impairment and lower physical and economic activities than men. However, research linking retirement to functional impairment and the modifying role of gender and physical activity (PA) is limited especially in low- and middle-income countries. This paper examines the association between retirement and functional impairment in Ghana and evaluates the effect modification of the association by gender and PA. The sample included 1201 adults aged ≥ 50 years from a population-based study. Functional impairment was assessed with the activities of daily living scale. Ordinary least squares regression models adjusted for confounding variables and estimated gender-wise and PA heterogeneity effect of retirement on functional impairment. Regressions showed that retirement predicted an increase in functional impairment score in the full sample (β = .76, p < .001) and in men (β = 1.96, p < .001), but not in women. Interestingly, retirement significantly increased functional impairment in ≥ 65 age cohort (full sample: β = .71, p < .005; men: β = 1.86, p < .001) although not in women. However, the effect was significantly moderated by PA such that retirement × PA predicted a decrease in functional impairment in the full sample (β = −.81, p < .005) and the ≥ 65 age group (β = −.43, p < .005). Functional impairment risk of retirement is gender-specific, but PA buffers the relationship. Retirement is generally commonplace, but these findings imply that promoting PA may hold promise for addressing functional impairment in old age. Attending to the physical health needs of men during retirement should be a social policy priority.

The Effects of “Diet–Smoking–Gender” Three-Way Interactions on Cognitive Impairment among Chinese Older Adults

Investigations on gender variations in the risk factors of cognitive impairment are required to promote future precision medicine among older adults, as well as to contribute to a better understanding of the “male–female health-survival paradox”. With this study, we aimed to investigate the effects of “diet–smoking–gender” three-way interactions on cognitive impairments among Chinese older adults. We conducted a 16-year prospective cohort study among 15,953, 15,555, 16,849, 9716, 7116, and 13,165 older adults from the 2002, 2005, 2008–2009, 2011–2012, 2014, and 2017–2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), respectively. Cognitive impairment was measured by the Mini-Mental State Examination (MMSE). The dietary diversity score (DDS) was calculated using the CLHLS food frequency questionnaire. Generalized estimating equations (GEE) were used to assess the “diet–smoking–gender” three-way interaction effects on cognitive impairment across the six waves of CLHLS. We found that higher dietary diversity was associated with lower probability of cognitive impairment among older adults (OR = 0.92; 95%CI = 0.90, 0.98). However, smoking behavior may negatively influence the protective effect of higher dietary diversity on cognitive function among females (OR = 1.26; 95%CI = 1.07, 1.49). Our findings imply that we should take gender differences and lifestyle behaviors into consideration in implementing dietary interventions to improve cognitive function among older adults.

Prevalence and Social Risk Factors of Functional Limitations Among Slum-Dwelling Older Adults: Findings From the Nairobi Urban Health and Demographic Surveillance System

Objective: In this study, we investigate the patterns and the risk factors of functional limitations in a sample of 1323 slum-dwelling older adults in Kenya who participated in the Nairobi Urban Health and Demographic Surveillance Systems. Methods: We conducted crude and adjusted logistic regression analyses to evaluate the associations. Results: The prevalence of activities of daily living (ADL) and instrumental ADL (IADL) limitations were approximately 5% and 8%, respectively; some 4.5% reported both limitations. Estimates varied significantly between sexes and age (p < .001). After adjustments, age, female, and Garre ethnic group were associated with ADL and IADL limitations. ADL decline was determined by co-residence (aOR = 0.93, 95% CI = 0.34–0.95), household size (aOR = 1.19, 95% CI = 1.04–1.37) and educational level (aOR = 0.45, 95% CI = 0.05–0.72). Conclusions: Older slum-dwellers in Nairobi experience functional impairments with marked age and sex differences. These findings may encourage salient policy planning and public health interventions to promote healthy aging in informal settlements.

Depression Risk Factors for Knowledge Workers in the Post-Capitalist Society of Taiwan

This study aimed to examine the depression risk factors for knowledge workers aged 20–64 in the post-capitalist society of Taiwan. Interview data from 2014 and 2019 were adopted for quantitative analysis of the depression risk by demographic and individual characteristics. The results showed that the depression risks of knowledge workers were not affected by demographic variables in a single period. From 2014 to 2019, the prevalence of high depression risk in knowledge workers aged 20–64 years increased over time. The more attention is paid to gender equality in society, the less the change in the gender depression index gap may be seen. Positive psychological state and family relationships are both depression risk factors and depression protective factors. Being male, married, religious, and aged 45–49 years old were found to be critical risk factors. Variables of individual characteristics could effectively predict depression risk.

Sex-Specific Age-Related Changes in Methylation of Certain Genes

The aim of the study was to conduct a functional analysis of sex-specific age-related changes in DNA methylation.

Living longer but less healthy: The female disadvantage in health expectancy. Results from the KORA-Age study

OBJECTIVES

We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents.

METHODS

HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, "limited" vs "not limited").

RESULTS

Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI ≥ 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences.

CONCLUSIONS

In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men.

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.

Risk of Psychological Distress Among Community-Dwelling Older Adults Experiencing Spousal Loss in Ghana

BACKGROUND

Spousal loss, common in older age, has been linked to negative mental health outcomes and well-being, yet the mechanisms linking spousal loss and mental health are still unclear.

OBJECTIVE

To investigate whether physical activity, social support, and gender modify the psychological distress effects of marital loss among community-dwelling older persons in Ghana.

METHODS

Data from a 2016/2017 Ageing, Health, Psychological Well-being, and Health-seeking Behavior Study (N = 1,200) were examined. OLS regression models examined associations between spousal loss and psychological distress outcomes and interaction terms.

RESULTS

Spousal loss (widowhood and divorce/separation) was associated with psychological distress (measured by the Kessler Psychological Distress Scale [KPDS-10]) for the full sample (β = .798, p < .001), women (β = .831, p < .001) and for men (β = .533, p < .05). After adjusting for potential confounders, the associations between spousal loss and psychological distress persisted for the full sample (β = .727, p < .001) and females only (β = .730, p < .001). In particular, when experiencing spousal loss, those with meaningful social support (β = -.856, p < .005) and engaged in physical activity (β = -.258, p < .001) were less likely to be psychologically distressed.

CONCLUSIONS

Spousal loss precipitates an independent risk of psychological distress in older age particularly among women, but social support and physical activity engagements moderate the relationship. These findings support the premise that providing opportunities to improve social support and regular physical activity may buffer the effects of psychological distress among older persons experiencing spousal loss. Providing support for older adults in times of divorce and widowhood, and working towards changes in social attitudes towards divorce are important considerations.

The Gender Gap in Reaching "Old Age" in the Russian Federation: A Regional Approach

Reaching older age and longevity in later life is determined by health and mortality across the life course. In the case of Russia, the history of high male mortality skews the interaction between population aging and gender. These differentials can be viewed through a spatial lens in order to both understand their causes, and to better determine policy responses, especially in a federal political system. Using alternative conceptualizations of the "boundary to old age", we produce the first estimates of the gender gap in reaching "old age" for all Russian Federal Subjects using 2017 data. We identify some regional differentiations, but uncertainties around the consistency of registration as well as overall heterogeneity mean that clear-cut regional patterns are hard to ascribe. Our analysis shows the highly significant gender gap at the age of "becoming old" in Russia when disaggregated by region. When looking at the regional level and comparing to other countries, the range of male "boundaries to old age" is almost as great as the global range. We argue that when applying alternative "old-age thresholds", this gap represents a more accurate representation of interaction between space, gender, and mortality in Russia. We conclude with policy and research priorities to better understand and ameliorate the drivers of these spatial and gendered inequalities.

Disability-free life expectancy and life expectancy in good self-rated health in Chile: Gender differences and compression of morbidity between 2009 and 2016

Background

Chile has one of the highest life expectancies at 60 years in South America. This study was aimed to determine healthy life expectancies among Chilean older people, according to self-rated health and disability, and to explore gender differences.

Methods

Data from the National Survey of Health (2009 and 2016) were used to estimate prevalence of less than good self-rated health and disability among people aged 60 years and above. Health expectancies were calculated with the Sullivan method.

Results

In both years, women expected to live a lower proportion of their life expectancy in good self-rated health (54.5% [95% CI 50.0–58.8] for men and 37.6% [95% CI 34.3–40.8] for women in 2009; 46.1% [95% CI 42.6–49.7] for men and 38.5% [95% CI 35.6–41.4] for women in 2016). Life expectancy in less than good self-rated health increased for men (9.4 years [95% CI 8.4–10.3] in 2009; 11.5 years [95% CI 10.7–12.2]). Women expected to live a lower proportion of their remaining life without disabilities (65.3% [95% CI 61.2–69.4] for men and 44.9% [95% CI 41.9–47.9] for women in 2009; 71.9% [95% CI 68.7–75.0] for men and 61.1% [95% CI 58.5–63.8] for women in 2016). In 2016, disability-free life expectancy increased among women, but they still had a higher life expectancy with mild disability (2.8 years [95% CI 2.3–3.4] for men and 6.0 years [95% CI 5.4–6.7] for women).

Conclusions

Women expected to spend more years in less than good self-rated health and disabled. There was an expansion of life expectancy in less than good SRH among men and a compression of disability in both sexes. The high proportion of years expected to be lived in less than good self-rated health and gender differences in disability-free life expectancy of older adults should be addressed by public health policies in Chile.

Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study

Objective

To examine the prevalence of atrial fibrillation (AF), its impacts on cardiovascular disease (CVD) and all-cause mortality, and the associations between AF and inflammatory and serum biomarkers in a population-based sample of Muscovites.

Methods

The study is a secondary analysis of data from the Stress, Aging and Health in Russia (SAHR) survey that includes information on 1800 individuals with an average age of 68.5 years at baseline, and on their subsequent mortality during 7.4 years on average. AF is detected by 12-lead electrocardiogram (ECG) and 24-hour Holter monitoring. The statistical analysis includes proportional hazard and logistic regression models.

Results

Of the 1732 participants with relevant Holter data, AF was detected in 100 (74 by ECG and Holter, 26 by Holter only). The prevalence of AF was 5.8% for men and 7.4% for women. The fully adjusted model showed strongly elevated hazard of CVD and all-cause mortality in men and women with long non-self-limiting AF (LAF). LAF was found to be negatively associated with elevated total and low-density lipoprotein cholesterol and to be positively associated with elevated markers of inflammation in women.

Conclusions

The study assessed for the first time the prevalence and the risks of death related to AF among older Russians. LAF was shown to be a strong and independent predictor of CVD and all-cause mortality. AF is unlikely to contribute to the large excess male mortality in Russia. The finding that one-quarter of AF cases were detected only by Holter monitoring demonstrates the usefulness of diagnostics with prolonged ECG registration.

Sex Differences in Comorbidity and Frailty in Europe

OBJECTIVES

To examine sex differences in prevalent comorbidity and frailty across age and European regions.

METHODS

This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004-2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions.

RESULTS

European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07-1.15) and frailty (OR 1.56, 95% CI 1.51-1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18-1.44), Southern (OR 1.23, 95% CI 1.15-1.30), and Northern (OR 1.08, 95% CI 1.01-1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72-1.96).

CONCLUSIONS

European women are frailer and have slightly more comorbidity than European men lending support for the male-female health survival paradox.

Gender differences in cognitive performance and health status in the Faroese Septuagenarians cohort

The aim was to determine cognitive performance and health status in the Faroese Septuagenarians cohort in relation to gender differences. In this cross-sectional study of 713 Faroese septuagenarians who underwent a clinical, neurophysiological and neuropsychological examinations and questionnaire, women performed better on tests covering the memory domain, while there was no gender difference in other cognitive domains. Men suffered more frequently from cardiovascular events while women more frequently suffered from arthrosis, hypothyroidism and muscle pain. We observed a considerable heterogeneity and gender difference in some cognitive domains and health in Faroese septuagenarians.

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.

Uncovering the hidden impacts of inequality on mental health: a global study

Women are nearly twice as likely as men to suffer from mental illness. This gender disparity in depressive disorders may relate to social inequalities and living standards across nations. Currently, these disparities were not reflected at the level of health policies. This study utilized global data for depressive disorders and socioeconomic data from the United Nations' World Bank databases and Global Burden of Disease database to demonstrate the correlation between social inequality and gender disparities in mental health. This study investigated the association among the ratio of female to male depressive disorder rates, gross domestic product, the GINI Index, and the gender inequality index for 122 countries. The research yielded some major findings. First, there exists a significant correlation between gender inequality and gender disparities in mental health. Second, the GINI index is significantly associated with male-but not female-depressive disorder rates. Third, gender disparities in depressive disorders are associated with a country's wealth. These findings can help to inform society, policy-makers, and clinicians to improve the overall health level globally.

Sex differences in associations between multimorbidity and physical function domains among community-dwelling adults in Singapore

Objectives

The aims of the study were to identify the associations between multimorbidity and specific physical function domains among community-dwelling adults in Singapore, and to examine sex differences in the associations.

Methods

This study was conducted using baseline data of 1,940 participants in the Population Health Index Survey conducted in the Central Region of Singapore from November 2015 to November 2016. Physical function was assessed using the Function Component of the Late-life Function and Disability Instrument and compared between men and women. Multiple linear regressions were conducted to examine associations between multimorbidity and different physical function domains for all participants, and in men and women separately.

Results

The prevalence of multimorbidity in the study population was 35.0% for adults aged 21 years and above, with no differences between men and women. Multimorbidity was associated with reduced upper extremity function, basic and advanced lower extremity function, and overall function in men and women after adjusting for demographic factors. Multimorbidity had a stronger association with advanced lower extremity function and overall physical function in women than in men.

Conclusions

The findings of this study indicate that multimorbidity is associated with physical function domains in men and women, and in particular advanced lower extremity for women. Effective community-based interventions need to be implemented to preserve physical function in individuals with multimorbidity to keep them functionally independent and physically active in the community. Additional focus on advanced lower extremity function for women is needed.

Political regimes, income and health: Evidence from sub-national comparative method

This paper investigates the effect of political regimes on healthcare outcomes with a novel approach. Instead of focusing on cross-country comparisons, like most studies do, we utilize the within-country variation of political regimes across individual regions. We use the case of the Russian Federation, where large sub-national differences exist in both health outcomes and political regimes in different provinces. General differences in sub-national politics in Russia have been subject of investigation of a large literature our paper adds to. The paper shows that the effect of political regimes on health is heterogeneous and depends on the type of health problems more salient for the region. More pluralist and competitive regimes are able to produce better results than the less competitive ones in rich regions, while in poor regions political pluralism and competition have an adverse impact on health.

Handgrip strength and its prognostic value for mortality in Moscow, Denmark, and England

Background

This study compares handgrip strength and its association with mortality across studies conducted in Moscow, Denmark, and England.

Materials

The data collected by the Study of Stress, Aging, and Health in Russia, the Study of Middle-Aged Danish Twins and the Longitudinal Study of Aging Danish Twins, and the English Longitudinal Study of Ageing was utilized.

Results

Among the male participants, the age-standardized grip strength was 2 kg and 1 kg lower in Russia than in Denmark and in England, respectively. The age-standardized grip strength among the female participants was 1.9 kg and 1.6 kg lower in Russia than in Denmark and in England, respectively. In Moscow, a one-kilogram increase in grip strength was associated with a 4% (hazard ratio [HR] = 0.96, 95% confidence interval [CI]: 0.94, 0.99) reduction in mortality among men and a 10% (HR = 0.90, 95%CI: 0.86, 0.94) among women. Meanwhile, a one-kilogram increase in grip strength was associated with a 6% (HR = 0.94, 95%CI: 0.93, 0.95) and an 8% (HR = 0.92, 95%CI: 0.90, 0.94) decrease in mortality among Danish men and women, respectively, and with a 2% (HR = 0.98, 95%CI: 0.97, 0.99) and a 3% (HR = 0.97, 95%CI: 0.95, 0.98) reduction in mortality among the English men and women, respectively.

Conclusion

The study suggests that, although absolute grip strength values appear to vary across the Muscovite, Danish, and English samples, the degree to which grip strength is predictive of mortality is comparable across national populations with diverse socioeconomic and health profiles and life expectancy levels.

Express Estimation of the Biological Age by the Parameters of Body Composition in Men and Women over 50 Years

Original formulas for rapid assessment of biological age in men and women over 50 were developed using factor analysis. The proposed technique is mainly based on the parameters of the body component composition (fat, musculoskeletal, and active cell mass, and specific metabolism) obtained using bioimpedance recording widely used in modern medicine and anthropology. The proposed formulas were tested on other samples (481 examined subjects). The developed method of express estimation of biological age differs from other models by its convenience, simplicity, low financial and time costs, and the possibility of using it in mass medico-anthropological examinations for identification of individuals/groups with accelerated rates of aging.

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.

"Healthy Men" and High Mortality: Contributions from a Population-Based Study for the Gender Paradox Discussion

BACKGROUND

Inequalities between men and women in morbidity and mortality show a contrast, which has been called gender paradox. Most studies evaluating this paradox were conducted in high-income countries and, until now, few investigations have been performed in Brazil. This study aims to estimate the magnitude of inequalities between adult men and women in several dimensions: demographic and socioeconomic, health behaviors, morbidity, use of health services and mortality.

METHODS

The data were obtained from population-based household survey carried out in Campinas (Campinas Health Survey 2008/09) corresponding to 957 people, and data from the Mortality Information System (MIS) between 2009 and 2011. Prevalences and prevalence ratios were analyzed in order to verify the differences between men and women regarding socioeconomic and demographic variables, health behaviors, morbidities and consultations in the last two weeks. Mortality rates and the ratio between coefficients considering the underlying causes of death were calculated.

RESULTS

Women had a greater disadvantage in socioeconomic indicators, chronic diseases diagnosed by a health professional and referred health problems as well as make more use of health services, while men presented higher frequency of most unhealthy behaviors and excessive mortality for all causes investigated.

CONCLUSIONS

The findings contribute to the discussion of gender paradox and demonstrate the need to employ health actions that consider the differences between men and women in the various health dimensions analyzed. The premature male mortality from preventable causes was outstanding, making clear the need for more effective prevention and health promotion directed to this segment of the population.

Gender differences in symptoms of hypothyroidism: a population-based DanThyr study

OBJECTIVES

We examined the gender-specific symptom prevalences in hypothyroidism and in healthy controls and explored the extent to which symptoms indicative of thyroid status may be different in women and men.

DESIGN AND METHODS

Patients newly diagnosed with overt autoimmune hypothyroidism (n = 140) and controls free of thyroid disease (n = 560) recruited from the same population participated in a population-based study of The Danish Investigation of Iodine Intake and Thyroid Diseases (DanThyr). Participants underwent a comprehensive programme including blood tests and completion of questionnaires. The gender-specific distribution of 13 hypothyroidism-associated symptoms and a simple combined score (0-13) was explored in conditional uni- and multivariate models taking into account a broad spectrum of possible confounders. Diagnostic odds ratios (DORs) were calculated as measures for the association between participant status (case vs control) and presence of symptoms (yes vs no).

RESULTS

In overt autoimmune hypothyroidism, 94·9% of women and 91·3% of men (P = 0·62) reported at least one of the hypothyroidism-associated symptoms, with tiredness as the most common symptom followed by dry skin and shortness of breath. In contrast, women free of thyroid disease self-reported at least one hypothyroidism-associated symptom considerably more often than men (73·7% vs 51·1%, P < 0·001). DORs (±SEM) for 0-1/2-3/4-13 symptoms were 0·07 (0·04-0·10)/2·15 (1·57-2·94)/7·99 (6·15-10·4) in men and 0·21 (0·16-0·28)/0·62 (0·58-0·66)/1·99 (1·90-2·09) in women.

CONCLUSION

The presence of symptoms is more indicative for overt autoimmune hypothyroidism in men than in women, and presumably persistent symptoms after therapy of hypothyroidism will be more common in women.

Sex Differences in Biological Markers of Health in the Study of Stress, Aging and Health in Russia

BACKGROUND

The apparent contradiction that women live longer but have worse health than men, the so called male-female health-survival paradox, is very pronounced in Russia. The present study investigates whether men in Moscow are healthier than women at the level of biomarkers, and whether the associations between biomarkers and subjective health have sex-specific patterns.

MATERIALS

Previously collected data in the study of Stress, Aging, and Health in Russia (SAHR, n = 1800) were used to examine sex differences in biomarkers and their associations with physical functioning and self-rated health.

RESULTS

The present study found mixed directions and magnitudes for sex differences in biomarkers. Women were significantly disadvantaged with regard to obesity and waist circumference, whereas men had a tendency toward higher prevalence of electrocardiographic abnormalities. No sex differences were indicated in the prevalence of immunological biomarkers, and mixed patterns were found for lipid profiles. Many biomarkers were associated with physical functioning and general health. Obesity and waist circumference were related to lower physical functioning among females only, while major Q-wave abnormalities with high probabilities of myocardial infarction and atrial fibrillation or atrial flutter were associated with physical functioning and self-rated health among males only.

CONCLUSION

No clear patterns of sex differences in prevalence of high-risk levels of biomarkers suggest that the male-female health-survival paradox is weaker at the level of health biomarkers. We found some evidence that certain biomarkers reflecting pathophysiological changes in the organism that do not possess acute health risks, but over many years may lead to physical disability, are associated with physical functioning and self-rated health in women, whereas others reflecting more serious life-threatening pathophysiological changes are associated with physical functioning and self-rated health in men.

Health-related quality of life and related factors among elderly people in Jinzhou, China: a cross-sectional study

OBJECTIVES

With rapid reductions in fertility and mortality, China has to face the dramatic ageing of its population. Although an ageing population is associated with greater life expectancy, and reflects a huge improvement in people's living standards and health care services, it also means that more elderly people suffer from non-communicable diseases (NCDs). The prolonged course of illness and disability associated with chronic diseases may significantly reduce health-related quality of life (HRQoL) among elderly people. The aims of this study were to evaluate HRQoL of elderly people living in Jinzhou, and to identify the predictors of HRQoL.

STUDY DESIGN

Cross-sectional study with stratified sampling.

METHODS

A cross-sectional survey was conducted among 1015 elderly people (≥60 years) living in the three administrative regions (Linghe, Guta and Taihe) of Jinzhou. A demographic questionnaire and Short Form-36 were employed to collect demographic variables and evaluate HRQoL, respectively. Multiple stepwise linear regression analysis was performed to estimate factors related to HRQoL of the subjects.

RESULTS

Lowest HRQoL scores were obtained in the following dimensions: general health (65.44), role-emotional (69.74) and role-physical (70.20). Multiple stepwise regression showed that factors associated with HRQoL of elderly people were medical health checks, age, socio-economic status, NCDs, and various unhealthy lifestyle behaviours such as smoking, excessive drinking and insufficient exercise.

CONCLUSIONS

This study described overall HRQoL of elderly people in Jinzhou, and found that medical health checks, age, socio-economic status, NCDs, smoking, excessive drinking and insufficient exercise affected HRQoL. These findings will provide a basis for recommendations regarding health management of elderly people, and will also help local government to devise appropriate health intervention strategies for promoting the health status of elderly people in this region.