The weaker sex? Vulnerable men and women's resilience to socio-economic disadvantage

Identifying low acuity Emergency Department visits with a machine learning approach: The low acuity visit algorithms (LAVA)

OBJECTIVE

To improve the performance of International Classification of Disease (ICD) code rule-based algorithms for identifying low acuity Emergency Department (ED) visits by using machine learning methods and additional covariates.

DATA SOURCES

We used secondary data on ED visits from the National Hospital Ambulatory Medical Survey (NHAMCS), from 2016 to 2020.

STUDY DESIGN

We established baseline performance metrics with seven published algorithms consisting of International Classification of Disease, Tenth Revision codes used to identify low acuity ED visits. We then trained logistic regression, random forest, and gradient boosting (XGBoost) models to predict low acuity ED visits. Each model was trained on five different covariate sets of demographic and clinical data. Model performance was compared using a separate validation dataset. The primary performance metric was the probability that a visit identified by an algorithm as low acuity did not experience significant testing, treatment, or disposition (positive predictive value, PPV). Subgroup analyses assessed model performance across age, sex, and race/ethnicity.

DATA COLLECTION

We used 2016-2019 NHAMCS data as the training set and 2020 NHAMCS data for validation.

PRINCIPAL FINDINGS

The training and validation data consisted of 53,074 and 9542 observations, respectively. Among seven rule-based algorithms, the highest-performing had a PPV of 0.35 (95% CI [0.33, 0.36]). All model-based algorithms outperformed existing algorithms, with the least effective-random forest using only age and sex-improving PPV by 26% (up to 0.44; 95% CI [0.40, 0.48]). Logistic regression and XGBoost trained on all variables improved PPV by 83% (to 0.64; 95% CI [0.62, 0.66]). Multivariable models also demonstrated higher PPV across all three demographic subgroups.

CONCLUSIONS

Machine learning models substantially outperform existing algorithms based on ICD codes in predicting low acuity ED visits. Variations in model performance across demographic groups highlight the need for further research to ensure their applicability and fairness across diverse populations.

Neural correlates of perceived and relative resilience in male and female patients with irritable bowel syndrome

BACKGROUND

Patients with irritable bowel syndrome (IBS) show lower resilience than healthy controls (HCs), associated with greater symptom severity and worse quality of life. However, little is known about affected markers of resilience or the influence of sex. Furthermore, as resilience is complex, a comprehensive assessment, with multiple resilience measures, is needed. Therefore, we aimed to evaluate perceived and relative resilience and their neural correlates in men and women with IBS.

METHODS

In 402 individuals (232 IBS [73.3% women] and 170 HCs [61.2% women]), perceived resilience was assessed by the Connor-Davidson Resilience Scale (CDRISC) and Brief Resilience Scale (BRS); relative resilience was assessed by the standardized residual of the Short Form-12 mental component summary score predicted by the Adverse Childhood Experiences score. Non-rotated partial least squares analysis of region-to-region resting-state connectivity data was used to define resilience-related signatures in HCs. Disease and sex-related differences within these signatures were investigated.

KEY RESULTS

Scores on all resilience measures were lower in IBS than in HCs (p's < 0.05). In all three resilience-related signatures, patients with IBS showed reduced connectivity largely involving the central autonomic network (p's < 0.001). Men with IBS showed lower CDRISC scores than women with IBS, and greater reductions in CDRISC-related connectivity, associated with worse symptom severity (p < 0.05).

CONCLUSIONS AND INFERENCES

Individuals with IBS show reduced perceived and relative resilience, with reduced connectivity suggesting impaired homeostasis maintenance. Men with IBS may show additional impairment in specific aspects of resilience. Treatments aimed at improving resilience may benefit patients with IBS, especially men with IBS.

Gender Disparities in Blood Pressure and the Role of Body Mass Index: A Birth Cohort Analysis in China

BACKGROUND

The slow decline in cardiovascular disease (CVD) mortality and the stagnant or increasing hypertension prevalence in low- and middle-income countries necessitate investigation. Evolving gender disparities suggested that male cardiovascular health disadvantage may be preventable, offering potential for enhancing population cardiovascular health. Despite global body mass index (BMI) increases, its role in shaping the gender disparities remains underexplored.

OBJECTIVE

This study investigated the birth cohort dynamics of gender disparities in systolic/diastolic blood pressure (SBP/DBP) in China, one of the world's largest low- and middle-income countries, and explored the potential role of BMI in explaining the changing gender disparities.

METHODS

Data from the China Health and Nutrition Survey (1991-2015) were analyzed using multilevel growth-curve models to estimate gender- and cohort-specific SBP/DBP trajectories among individuals born between 1950 and 1975.

RESULTS

Men had higher SBP and DBP than women at the sample's mean age of 41.7 years. The gender disparities in SBP and DBP increased with each successive one-year cohort from 1950 to 1975 by 0.14 mm Hg and 0.09 mm Hg, respectively. Adjusting for BMI reduced the increasing gender disparities in SBP and DBP by 31.9% and 34.4%, respectively.

CONCLUSION

Chinese men experienced a greater increase in SBP/DBP across successive cohorts compared to women. The increasing gender disparities in SBP/DBP were partially attributable to a greater BMI increase across cohorts among men. Given these findings, prioritizing interventions that aim to reduce BMI, particularly among men, could potentially alleviate the burden of CVD in China through lowering SBP/DBP.

Illnesses and hardship financing in India: an evaluation of inpatient and outpatient cases, 2014-18

BACKGROUND

Progress towards universal health coverage requires strengthening the country's health system. In developing countries, the increasing disease burden puts a lot of stress on scarce household finances. However, this burden is not the same for everyone. The economic burden varies across the disease groups and care levels. Government intervention is vital in formulating policies in addressing financial distress at the household level. In India, even when outpatient care forms a significant proportion of out-of-pocket expenditure, government schemes focus on reducing household expenditure on inpatient care alone. Thus, people resort to hardship financing practices like informal borrowing or selling of assets in the event of health shocks. In this context, the present study aims to identify the disease(s) that correlates with maximum hardship financing for outpatients and inpatients and to understand the change in hardship financing over time.

METHODS

We used two waves of National Sample Survey Organisation's data on social consumption on health- the 71^st and the 75^th rounds. Descriptive statistics are reported, and logistic regression is carried out to explain the adjusted impact of illness on hardship financing. Pooled logistic regression of the two rounds is estimated for inpatients and outpatients. Marginal effects are reported to study the changes in hardship financing over time.

RESULTS

The results suggest that cancer had the maximum likelihood of causing hardship financing in India for both inpatients (Odds ratio 2.41; 95% Confidence Interval (CI): 2.03 - 2.86 (71^st round), 2.54; 95% CI: 2.21 - 2.93 (75^th round)) and outpatients (Odds ratio 6.11; 95% CI: 2.95 - 12.64 (71^st round), 3.07; 95% CI: 2.14 - 4.40 (75^th round)). In 2018, for outpatients, the hardship financing for health care needs was higher at public health facilities, compared to private health facilities (Odds ratio 0.72; 95% CI: 0.62 - 0.83 (75^th round). The marginal effects model of pooled cross-section analysis reveals that from 2014 to 2018, the hardship financing had decreased for inpatients (Odds ratio 0.747; 95% CI:0.80 - -0.70), whereas it had increased for outpatients (Odds ratio 0.0126; 95% CI: 0.01 - 0.02). Our results also show that the likelihood of resorting to hardship financing for illness among women was lesser than that of men.

CONCLUSION

Government intervention is quintessential to decrease the hardship financing caused by cancer. The intra-household inequalities play an important role in explaining their hardship financing strategies. We suggest the need for more financial risk protection for outpatient care to address hardship financing.

Invarianza factorial de dos versiones breves de la Escala de Resiliencia de Connor–Davidson (cd-risc) en estudiantes universitarios de Arequipa

La resiliencia es una característica individual que posibilita el reajuste biopsicosocial y espiritual que ayuda al bienestar psicológico y al desenvolvimiento académico de los estudiantes universitarios. El objetivo de esta investigación fue analizar la invarianza de medición según el sexo, de dos versiones breves de la Escala de Resiliencia de Connor–Davidson (cd-risc) y determinar si existen diferencias entre hombres y mujeres. Se evaluó con la cd-risc-10, que incluye la cd-risc-7, a una muestra de 491 universitarios arequipeños (312 mujeres; 179 hombres) con edad promedio de 20.56 años (de = 3.18),de una institución privada. Inicialmente se realizó un análisis factorial multigrupo con cada versión para valorar el grado de invarianza de medición alcanzado, y luego de ello se compararon las medias latentes de resiliencia entre hombres y mujeres. En cuanto a los resultados, la cd-risc-7 presentó indicadores estructurales más favorables (e.g., λ > .50; en mujeres:cfi = .981, rmsea = .087, wrmr = 0.683; en hombres: cfi = .966, rmsea = .124, wrmr = 0.783), que la cd-risc-10(e.g., λ < .50, índices de ajuste en mujeres: cfi = .974, rmsea = .073, wrmr = 0.774; en hombres: cfi = .960, rmsea = .095, wrmr = 0.803) incluyendo la invarianza de medición (invarianza estricta: Δcfi = .003; δrmsea = .001), y al comparar las medias latentes fueron halladas diferencias significativas a favor de los hombres (d = .471). Finalmente, se discuten las implicancias teóricas y metodológicas de los hallazgos, así como la necesidad de ampliar los estudios considerando otros aspectos relevantes para una mejor comprensión del constructo resiliencia.

A Unified Model of Cohort Mortality

We propose a dynamic production function of population health and mortality from birth onward. Our parsimonious model provides an excellent fit for the mortality and survival curves for primate and human populations since 1816. The model sheds light on the dynamics behind many phenomena documented in the literature. Simple extensions of the model can reproduce (1) the existence and evolution of mortality gradients across socioeconomic statuses documented in the literature, (2) nonmonotonic dynamic effects of in utero shocks, (3) persistent or scarring effects of wars, and (4) mortality displacement after large temporary shocks, such as extreme weather.

Welfare state decommodification and population health

A generous welfare state decommodifies social relations and frees citizens from relying excessively on markets. We argue that decommodification is associated with population health in two ways: directly, as it provides better social protection to households and indirectly, as it mitigates health-damaging labour market polarization and reduces the incidence of labour market risks. Using time-series cross-sectional quantitative analysis for 21 OECD countries from 1971 to 2010, we observe a negative relationship between decommodification and the age-standardized death rate. We then analyze three correlates of decommodification—income redistribution, labour market polarization and the reduction of labour market risk incidence—and find that only the latter two are associated with population health. Higher labour market polarization, measured by the share of market income allocated to the richest decile relative to the share of the poorest decile, is associated with a higher death rate. A new measure of risk reduction, the degree to which the welfare state reduces the prevalence of large income losses, is also associated with lower death rates, especially for men. Welfare state decommodification thus contributes to population health directly, and indirectly, via the attenuation of labour market polarization and the mitigation of labour market risks.

The association between educational attainment and longevity using individual-level data from the 1940 census

We combine individual data from the 1940 full-count census with death records and other information available on the Family Tree at familysearch.org to create the largest individual dataset to date (17 million) to study the association between years of schooling and age at death. Conditional on surviving to age 35, one additional year of education is associated with roughly 0.4 more years of life for both men and women for cohorts born 1906-1915 and smaller for earlier cohorts. Focusing on the 1906-1915 cohort we find that this association is identical when we use sibling or twin fixed effects. This association varies substantially by place of birth. For men, the association is stronger in places with greater incomes, higher quality of school, and larger investments in public health. Women also exhibit great heterogeneity in the association, but our measures of the childhood environment do not explain it.

Urbanization and systolic/diastolic blood pressure from a gender perspective: Separating longitudinal from cross-sectional association

There has been a generally negative view of the impact of urbanization on a rising burden of non-communicable diseases including cardiovascular disease. However, the evidence on the relationship between urbanization and cardiovascular health has remained inconclusive. A comprehensive picture of the relationship is lacking, given an implicit assumption that the longitudinal association between changes in cardiovascular health and an increasingly urbanized environment is similar between less and more urbanized communities, men and women. We used the longitudinal data on adults (18-64 years) from the China Health and Nutrition Survey (1991-2015) and employed within-between random-effects models to disaggregates the longitudinal and cross-sectional associations between urbanization and systolic/diastolic blood pressure (SBP/DBP) and examined heterogeneities in the longitudinal association by average urbanization level and gender. We found that the positive longitudinal association of urbanization with SBP/DBP was stronger in less urbanized than more urbanized communities. The cross-sectional association between urbanization and SBP was negative and significant, although the cross-sectional association between urbanization and DBP was of no statistical significance. Moreover, the positive longitudinal association between urbanization and DBP was stronger among men than women, although the gender heterogeneity in the longitudinal association of urbanization with SBP was not significant.

Does democracy make taller men? Cross-country European evidence

We study whether a democracy improves a measure of individual wellbeing: human heights. Drawing on individual-level datasets, we test the democracy and height hypothesis using a battery of eight different measures of democracy and we account for several potential confounders, regional and cohort fixed effects. We document that democracy - or its quality during early childhood - shows a strong and positive conditional correlation with male, but not female, adult stature. Our preferred estimates suggest that being born in a democracy increases average male stature from a minimum of 1.33 to a maximum of 2.4 cm. We also show a positive association when democracy increases from childhood to adolescence, and when we adopt measures of existing democratic capital before birth, and at the end of height plasticity in early adulthood. We also document that democracy is associated with a reduction in inequality of heights distribution. Our estimates are driven by period-specific heterogeneity, namely, early democratizations are associated with taller people more than later ones. Results are robust to the inclusion of countries exposed to communism.

The Gender Gap in Life Expectancy in Urban and Rural China, 2013–2018

Background

Gender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China.

Methods

We use age-, gender-, urban-rural- and cause-specific mortality data (2013–2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence.

Results

Women had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013–2018. In urban areas, the gender gap decreased from 5.17 years in 2013–2015 to 4.98 years in 2016–2018. In rural areas, the gender gap stayed rather constant (2013–2015: 5.68 years; 2016–2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: −0.07 years; rural: −0.10 years), especially in the 0–44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas.

Conclusions

The urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity.

Sex Differences in Cancer-Specific Survival Are Pronounced during Adolescence and Young Adulthood: A SEER Population-Based Study

Sex differences in cancer survival may be related to hormonal changes during puberty and menopause; therefore, we investigated sex differences in the cancer-specific survival rates of children, adolescents and young adults (AYAs), and older adults with sex-nonspecific cancers. We interrogated the November 2019 submission of the SEER 18 database and included microscopically confirmed cases of first primary malignant tumors. We stratified the dataset into children (&lt;15 years), AYAs (modified; 15-49 years), and older adults (≥50 years). For each age group, we used the Kaplan-Meier method to estimate the sex-stratified 5-year all-site cancer-specific survival probabilities. Of 3,386,276 eligible patients, 45,124 (1.3%) were children, 548,158 (16.2%) were AYAs, and 2,792,994 (82.5%) were older adults. The 5-year all-site cancer-specific survival probabilities were 84.0% (95% CI, 83.5%-84.5%) for boys, 84.8% (95% CI, 84.3%-85.3%) for girls, 70.4% (95% CI, 70.2%-70.6%) for male AYAs, 80.8% (95% CI, 80.6%-81.0%) for female AYAs, 52.0% (95% CI, 51.9%-52.1%) for older adult men, and 52.2% (95% CI, 52.1%-52.3%) for older adult women. The all-site survival rate for female patients with cancer is markedly higher than for male patients with cancer during adolescence and young adulthood, although this difference diminishes in older adulthood.

The triple burden of communicable and non-communicable diseases and injuries on sex differences in life expectancy in Ethiopia

BACKGROUND

Ethiopia has experienced great improvements in life expectancy (LE) at birth over the last three decades. Despite consistent increases in LE for both males and females in Ethiopia, the country has simultaneously witnessed an increasing discrepancy in LE between males and females.

METHODS

This study used Pollard's actuarial method of decomposing LE to compare age- and cause- specific contributions to changes in sex differences in LE between 1995 and 2015 in Ethiopia.

RESULTS

Life expectancy at birth in Ethiopia increased for both males and females from 48.28 years and 50.12 years in 1995 to 65.59 years and 69.11 years in 2015, respectively. However, the sex differences in LE at birth also increased from 1.85 years in 1995 to 3.51 years in 2015. Decomposition analysis shows that the higher male mortality was consistently due to injuries and respiratory infections, which contributed to 1.57 out of 1.85 years in 1995 and 1.62 out of 3.51 years in 2015 of the sex differences in LE. Increased male mortality from non-communicable diseases (NCDs) also contributed to the increased difference in LE between males and females over the period, accounting for 0.21 out of 1.85 years and 1.05 out of 3.51 years in 1995 and 2015, respectively.

CONCLUSIONS

While injuries and respiratory infections causing male mortality were the most consistent causes of the sex differences in LE in Ethiopia, morality from NCDs is the main cause of the recent increasing differences in LE between males and females. However, unlike the higher exposure of males to death from injuries due to road traffic injuries or interpersonal violence, to what extent sex differences are caused by the higher male mortality compared to female mortality from respiratory infection diseases is unclear. Similarly, despite Ethiopia's weak social security system, an explanation for the increased sex differences after the age of 40 years due to either longer female LE or reduced male LE should be further investigated.

Disasters, Gender, and HIV Infection: The Impact of the 2010 Haiti Earthquake

Although disasters threaten all people who experience them, they do not affect all members of society in the same way. Its effects are not solely restricted to the economic sphere; they also affect the physical and mental health of those who suffer from them, having a particular impact on women and limiting their life chances. The aim of this study was to examine the impact the 2010 Haiti earthquake had on the seropositivity of female survivors.

METHOD

Using data from the Demographic and Health Survey, this study examines the impact of the 2010 Haiti earthquake on gender relations associated with the probability of being HIV positive through the differences-in-differences strategy.

RESULTS

A differential of four percentage points is observed in the probability of HIV seropositivity between men and women, favoring men. Additionally, it is observed that the probability of seropositivity intensifies when the cohabitation household is headed by a woman.

CONCLUSION

Disasters are not indifferent to the gender of the people affected. In the second decade of the 21st century, the conclusions obtained show, once again, the need for incorporating the gender perspective into the management of natural hazards in the field of health. This is the case of the differential exposure to HIV after the earthquake in Haiti.

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.

Sex differences in the effects of physical and sexual abuse on the odds of past 30-day opioid misuse among Florida justice-involved children

AIM

Opioid misuse is a severe threat to justice-involved children and adolescents. Identifying risk factors and sex differences is critical to design accurate risk assessments and person-centered interventions. Stress theory and research posit that abuse may be linked to opioid misuse, and the consequences may be harsher for females. The study tests the hypothesis that physical and sexual abuse will individually and cumulatively increase the risk for opioid misuse, and females will have a higher risk than males.

METHODS

A statewide sample of 79,960 justice-involved children in Florida were examined. Opioid misuse, illicit and non-medical use, was measured by urine analysis or self-disclosure within the past-30 days. Bivariate and multivariate logistic regression analyses were employed. Marginal effects were estimated to investigate the interaction between abuse and sex.

RESULTS

Over 2000 youth met the criteria for opioid misuse. One-third of female opioid users experienced both physical and sexual abuse. Compared to those with no history of physical or sexual abuse, those who were physically abused had 43% higher odds of opioid misuse, those who were sexually abuse had 78% higher odds, and those who experienced both had twice as high odds of opioid misuse. The individual and combined effects of these abuse types were higher for females. For example, female youth who were sexually abused had 2.7-times higher odds of opioid misuse than males who were sexually abused.

CONCLUSION

Intervention efforts can be improved by integrating physical and sexual abuse into risk assessments and tailoring assessments by sex.

New Perspective on Why Women Live Longer Than Men: An Exploration of Power, Gender, Social Determinants, and Capitals

BACKGROUND

Women live longer than men, even though many of the recognised social determinants of health are worse for women than men. No existing explanations account fully for these differences in life expectancy, although they do highlight the complexity and interaction of biological, social and health service factors.

METHODS

this paper is an exploratory explanation of gendered life expectancy difference (GLED) using a novel combination of epidemiological and sociological methods. We present the global picture of GLED. We then utilise a secondary data comparative case analysis offering explanations for GLED in Australia and Ethiopia. We combine a social determinant of health lens with Bourdieu's concepts of capitals (economic, cultural, symbolic and social).

RESULTS

we confirmed continuing GLED in all countries ranging from less than a year to over 11 years. The Australian and Ethiopian cases demonstrated the complex factors underpinning this difference, highlighting similarities and differences in socioeconomic and cultural factors and how they are gendered within and between the countries. Bourdieu's capitals enabled us to partially explain GLED and to develop a conceptual model of causal pathways.

CONCLUSION

we demonstrate the value of combing a SDH and Bourdieu's capital lens to investigate GLED. We proposed a theoretical framework to guide future research.

Gender Differences in COVID-19 Lockdown Impact on Mental Health of Undergraduate Students

Background: Prolonged university closures and social distancing-imposed measures due to the COVID-19 pandemic obliged students to at-home learning with online lectures and educational programs promoting potential social isolation, loneliness, hopelessness, and episodes of clinical decompensation. Methods: A web-based cross-sectional survey was carried out in a university institute in Milan, Northern Italy, to assess the COVID-19 lockdown impact on the mental health of the undergraduate students. We estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) using adjusted logistic regression models. Results: Of the 8,177 students, 12.8% reported depressive symptoms, 25.6% anxiety, 8.7% insomnia, and 10.6% reported impulsive tracts, with higher proportions among females than males. Mental health symptoms were positively associated with caring for a person at home, a poor housing quality, and a worsening in working performance. Among males compared with females, a poor housing quality showed a stronger positive association with depressive symptoms and impulsivity, and a worsening in the working performance was positively associated with depressive and anxiety symptoms. In addition, the absence of private space was positively associated with depression and anxiety, stronger among males than females. Conclusions: To our knowledge, this is the first multidisciplinary consortium study, involving public mental health, environmental health, and architectural design. Further studies are needed to confirm or refute our findings and consequent recommendations to implement well-being interventions in pandemic conditions.

Male survival advantage on the Baja California peninsula

A consistent finding from contemporary Western societies is that women outlive men. However, what is unclear is whether sex differences in survival are constant across varying socio-ecological conditions. We test the universality of the female survival advantage with mortality data from a nineteenth century population in the Baja California peninsula of Mexico. When examined simply, we find evidence for a male-biased survival advantage. However, results from Cox regression clearly show the importance of age intervals for variable survival patterns by sex. Our key findings are that males: (i) experience significantly lower mortality risk than females during the ages 15-30 (RR = 0.69), (ii) are at a significantly increased risk of dying in the 61+ category (RR = 1.30) and (iii) do not experience significantly different mortality risk at any other age interval (0-14, 31-45, 46-60). We interpret our results to stem from differing intrinsic and extrinsic risk factors for sex-biased mortality across age intervals, highlighting the relevance of a lifecourse approach to the study of survival advantage. Ultimately, our results make clear the need to more broadly consider variability in mortality risk factors across time and place to allow for a clearer understanding of human survival differences.

Non-communicable diseases are key to further narrow gender gap in life expectancy in Shanghai, China

Background

To address change in the gender gap of life expectancy (GGLE) in Shanghai from 1973 to 2018, and to identify the major causes of death and age groups associated with the change over time.

Methods

The temporal trend in GGLE was evaluated using retrospective demographic analysis with Joinpoint regression. Causes of death were coded in accordance with the International Classification of Diseases and mapped with the Global Burden of Disease (GBD) cause list. The life table technique and decomposition method were used to express changes in GGLE.

Results

The trend of GGLE in Shanghai experienced two phases, i.e., a decrease from 8.4 to 4.2 years in the descent phase (1973–1999) and a fluctuation between 4.0 and 4.9 years in the plateau phase (1999–2018). The reduced age-specific mortality rates tended to concentrate to a narrower age range, from age 0–9 and above 30 years in the descent phase to age above 55 years in the plateau phase. Gastroesophageal and liver cancer, communicable, chronic respiratory, and digestive diseases were once the major contributors to narrow GGLE in the descent phase. While, importance should be attached to a widening effect on GGLE by lung cancer, cardiovascular diseases, other neoplasms like colorectal and pancreatic cancer, and diabetes in the recent plateau phase.

Conclusions

Non-communicable diseases (NCDs) have made GGLE enter a plateau phase from a descent phase in Shanghai, China. Public efforts to reduce excess mortalities for male NCDs, cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes in particular and health policies focused on the middle-aged and elderly population might further narrow GGLE. This will also ensure improvements in health and health equity in Shanghai China.

Implications of gendered behaviour and contexts for social mobility in the USA: a nationally representative observational study

BACKGROUND

We constructed measures of an individual's gendered behaviour and their gendered environment to investigate the salience of gender norms during adolescence for social mobility during the next decade of life.

METHODS

In this nationally representative observational study, we collected individual-level data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which enrolled a cohort of nationally representative school students aged 11-19 years from across the USA and followed them up for 14 years (ie, to age 25-33 years). We characterised gendered behaviour for adolescents in a performative sense via self-reports of behaviours and beliefs. We aggregated this individual-level measure to create a proxy measure of an individual's social context by taking averages for an individual's peers of the same sex and school year.

FINDINGS

Between Jan 5, 1994, and Dec 26, 1995, Add Health collected data on a cohort of 20 745 students. 14 540 respondents were followed-up 14 years later between April 3, 2007, and Feb 1, 2009, of whom 7722 (53·1%) were female. More masculine male respondents were downwardly mobile; they were enrolled in school for fewer years and were more likely to have lower status jobs than their less masculine same-sex school peers. More masculine male respondents were also more likely to have jobs in occupational categories with larger proportions of males than their same-sex school peers. Gendered behaviour was not predictive of future educational and occupational attainment for female respondents. Male adolescents in school years with more masculine same-sex peers than male adolescents in other school years also tended to have lower educational and occupational attainment than their male peers. Educational and occupational attainment in early midlife for female respondents was not affected by their gendered environment.

INTERPRETATION

Gender, when measured as a set of gender-distinct behaviours in adolescence, was associated with differential patterns of social mobility from adolescence to young adulthood. Moreover, variation in an individual's local gender norms has implications for subsequent socioeconomic attainment, especially for male adolescents. These findings have potential implications for observed health disparities.

FUNDING

Bill & Melinda Gates Foundation.

XX > XY?: The changing female advantage in life expectancy

Females live a lot longer than males in most parts of the world today. But that was not always the case. We ask when and why the female advantage emerged. We show that reductions in maternal mortality and fertility are only partial reasons. Rather, the sharp reduction in infectious disease in the early twentieth century played a role. Those who survive most infectious diseases carry a health burden that affects organs and impacts general well-being. We use newly collected data from Massachusetts containing information on cause of death since 1887 to show that females between the ages of 5 and 25 were disproportionately affected by infectious diseases. Both males and females lived longer as the burden of infectious disease fell, but women were more greatly impacted. Our explanation does not tell us precisely why women live longer than men, but it does help understand the timing of their relative increase.

Gender norms and health: insights from global survey data

Despite global commitments to achieving gender equality and improving health and wellbeing for all, quantitative data and methods to precisely estimate the effect of gender norms on health inequities are underdeveloped. Nonetheless, existing global, national, and subnational data provide some key opportunities for testing associations between gender norms and health. Using innovative approaches to analysing proxies for gender norms, we generated evidence that gender norms impact the health of women and men across life stages, health sectors, and world regions. Six case studies showed that: (1) gender norms are complex and can intersect with other social factors to impact health over the life course; (2) early gender-normative influences by parents and peers can have multiple and differing health consequences for girls and boys; (3) non-conformity with, and transgression of, gender norms can be harmful to health, particularly when they trigger negative sanctions; and (4) the impact of gender norms on health can be context-specific, demanding care when designing effective gender-transformative health policies and programmes. Limitations of survey-based data are described that resulted in missed opportunities for investigating certain populations and domains. Recommendations for optimising and advancing research on the health impacts of gender norms are made.

Social inequalities in health and mental health in France. The results of a 2010 population-based survey in Paris Metropolitan Area

The present study aimed to assess socioeconomic inequalities in general and mental health, depression and substance use disorders (daily tobacco use, hazardous alcohol use). Data from the 2010 SIRS (French acronym for Health, Inequalities, and Social Ruptures) study, which is deemed to be representative of the French-speaking adult population living in the Paris Metropolitan Area, were analysed. Different socioeconomic position indicators were selected: education, income and perceived financial status. Absolute measures (the slope index of inequality (SII)) and relative measures (the odds ratio (OR) and relative index of inequality (RII)) of health inequalities were used. The OR, RII and SII were adjusted for age, household type and migration characteristics and all analyses were performed separately for men and women. The study included 3,006 adults. The results showed significant relative and absolute socioeconomic inequalities in general, mental health and depression for all socioeconomic position indicators considered (education, income, and perceived financial status). The absolute inequalities were greater for women than for men. Strongest inequalities were observed by perceived financial status for men and women. Education seemed to play a stronger role in inequalities for women, whereas, for men, income seemed to play a stronger role. Only few socioeconomic inequalities were found in daily tobacco use, while a reversed gradient was observed for hazardous alcohol use. We hope that these results will be regularly re-evaluated and compared across time in order to monitor socioeconomic inequalities in health.

Gender, health and the 2030 agenda for sustainable development

Gender refers to the social relationships between males and females in terms of their roles, behaviours, activities, attributes and opportunities, and which are based on different levels of power. Gender interacts with, but is distinct from, the binary categories of biological sex. In this paper we consider how gender interacts with the 2030 agenda for sustainable development, including sustainable development goal (SDG) 3 and its targets for health and well-being, and the impact on health equity. We propose a conceptual framework for understanding the interactions between gender (SDG 5) and health (SDG 3) and 13 other SDGs, which influence health outcomes. We explore the empirical evidence for these interactions in relation to three domains of gender and health: gender as a social determinant of health; gender as a driver of health behaviours; and the gendered response of health systems. The paper highlights the complex relationship between health and gender, and how these domains interact with the broad 2030 agenda. Across all three domains (social determinants, health behaviours and health system), we find evidence of the links between gender, health and other SDGs. For example, education (SDG 4) has a measurable impact on health outcomes of women and children, while decent work (SDG 8) affects the rates of occupation-related morbidity and mortality, for both men and women. We propose concerted and collaborative actions across the interlinked SDGs to deliver health equity, health and well-being for all, as well as to enhance gender equality and women’s empowerment. These proposals are summarized in an agenda for action.

Adult Empathy: Possible Gender Differences in Gene-Environment Architecture for Cognitive and Emotional Components in a Large Italian Twin Sample

Empathy plays a central role in prosocial behavior and human cooperation. Very few twin researchers have investigated innate and environmental effects in adult empathy, and twin research on gender differences in these effects is sparse. The goal of this study was to examine innate and environmental influences on three components of an empathy scale frequently used with adults - the expression of cognitive (CE), emotional (EE), and social skills (SS) empathy - and to explore gender differences in the influences. Study participants were ~1,700 twins (18-65 years) enrolled in the Italian Twin Registry. Empathy was assessed with the Italian version of the Empathy Quotient (EQ), for which the three-factor structure (i.e., CE, EE, and SS) was confirmed. Twin correlations in monozygotic and dizygotic pairs, and males and females were estimated for the total EQ and subscale scores, and univariate genetic model fitting was carried out. Women's empathy (i.e., total EQ as well as CE and EE subdimensions) was predominantly driven by genetic factors and individual experiences, whereas for males, no genetic contribution or important shared and individual environmental effects emerged. Although of large magnitude, the gender differences did not reach statistical significance. Age did not moderate empathy heritability in adulthood. Only for the SS subscale were genetic and environmental proportions of variance similar for men and women. This study suggests possible gender-specific innate and environmental influences on empathy and its cognitive and emotional components that need to be confirmed in future studies.

Social determinants of male health: a case study of Leeds, UK

BACKGROUND

The social determinants of health have a disproportionate impact on mortality in men. A study into the state of health of the male population in Leeds was undertaken to guide public health commissioning decisions. This paper reports on the data relating to the social lives of men.

METHODS

A cross-sectional study was undertaken, comprising descriptive analysis of data relating to educational attainment, housing, employment (including benefit claimants), marital status and relationships. Data was considered for the whole city and localised at the Middle Super Output Area (MSOA) level and mapped against the Index of Deprivation.

RESULTS

Boys' educational attainment was found to be lagging behind girls' from their earliest assessments (Early Years Foundation Stage Profile, 46% vs. 60%, P = 0.00) to GCSEs (53% vs. 63%, P = 0.00), leaving many men with no qualifications. There were 68% more men than women identified as being unemployed, with more men claiming benefits. Men living in social housing are more likely to be housed in high-rise flats. Almost 50% of men aged 16-64 are single, with 2254 lone fathers.

CONCLUSIONS

There appears to be a lack of sex/gender analysis of current cross city data. In areas of deprivation a complex picture of multiple social problems emerges, with marked gender differences in the social determinants of health, with males seeming to be more negatively affected. There is a need for more focused planning for reaching out and targeting boys and men in the most deprived inner city areas, so that greater efficiency in service delivery can be obtained.