Elsevier

Social Science & Medicine

Volume 60, Issue 6, March 2005, Pages 1229-1240
Social Science & Medicine

Differences in quality of life between women and men in the older population of Spain

https://doi.org/10.1016/j.socscimed.2004.07.003Get rights and content

Abstract

The objective of the study was to examine the contribution of sociodemographic factors, lifestyle, social network, chronic morbidity and use of healthcare services to the poorer health-related quality of life (HRQL) of women, as compared to that of men, among the older population of Spain. Data were collected by home-based personal interview and physical examination of 3260 subjects representative of the Spanish non-institutionalized population aged 60 years and over. HRQL was assessed with the SF-36 health questionnaire. Relative differences in HRQL between women and men were summarized using odds ratios of suboptimal health (score <100) on each scale of the SF-36, obtained from logistic regression. The contribution of the variables of interest to the relative differences in HRQL between the sexes was evaluated as the percentage change in the odds ratio before and after adjustment for such variables. The odds ratio of suboptimal health among women versus men was higher than 2 (p<0.0001) on all SF-36 scales. Adjustment for sociodemographic variables led to a reduction of 23% (95% confidence limits (CL): −38 to −5%) in the odds ratio on the social functioning scale, while adjustment for lifestyle reduced the odds ratio on the general health and social functioning scales by 45% (95%CL: −64 to −15%) and 29% (95%CL: −42 to −13%), respectively. Adjustment for the social network, chronic morbidity and use of healthcare services variables did not lead to significant changes in the odds ratios on any of the SF-36 scales. In general, the contribution of the study variables to differences in HRQL between the sexes was smaller in the oldest age groups. We conclude that sociodemographic and lifestyle factors may explain a substantial part of the differences between women and men in certain HRQL dimensions. Some of these factors, such as the lower educational level and the higher frequency of sedentary lifestyles and obesity among women, are potentially modifiable.

Introduction

Health-related quality of life (HRQL) provides a subjective overview of the state of health of individuals. Worse HRQL is associated with higher mortality (Ries, Kaplan, Limbreg, & Prewitt, 1995) and a greater use of healthcare services (Conelli, Philbrick, Smith, Kaiser & Wymer, 1989; Siu, Reuben, Ouslander & Osterweil, 1993). Women tend to report a poorer HRQL than men, both in selected samples of subjects (Meléndez Hernández, Montero Herrero, Jiménez Sánchez & Blanco Montagut, 2001; Walters, Munro & Brazier, 2001) and in the general population (Alonso, Regidor, Barrio, Prieto, Rodríguez, & De la Fuente, 1998; Azpiazu et al., 2003; Hopman et al., 2000; Loge & Kaasa, 1998; López García et al., 2003b; Scott, Tobias, Sarfati & Haslett, 1999; Sullivan & Karlsson, 1998). Although there is a substantial amount of literature on possible explanatory factors of the greater morbidity and disability, and worse subjective health reported by women (Rohlfs, Borrell & Fonseca, 2000; Ruiz & Verbrugge, 1997), very few studies have specifically addressed the possible determinants of the differences in HRQL between men and women. Moreover, such studies are particularly infrequent among samples representative of the older adult population (Arber & Cooper, 1999; Arber & Ginn, 1993; Dahl & Birkelund, 1997).

The determinants of the differences in health between women and men may differ with the measure of health used (Macintyre, Hunt & Sweeting, 1996) and, consequently, the results obtained on subjective health or disability may not apply to HRQL. Similarly, factors that explain differences in health status may vary across the life cycle (Macintyre et al., 1996). The study of such factors in older adults is particularly relevant. First, because in this population segment, whose size is progressively growing, health needs are much greater than among the young; second, because the predominance of women over men increases with age and HRQL is worse among the former.

Furthermore, differences in HRQL between women and men may change with population's cultural values and degree of economic development, which differ between southern European countries and those in the north of Europe and North America. Cultural values may influence not only the meaning, interpretation, knowledge and potential determinants of health and disease, but also the manner of reporting them. Moreover, cultural values and degree of economic development influence women's incorporation to paid work and fulfillment of their social role, with possible effects on differences in HRQL between sexes (Annandale & Hunt, 2001).

Lastly, theories explaining the differences in health between women and men include strictly biological factors (genes, anatomy, hormones, reproductive history, etc.), factors stemming from women's social role (social network and support, non-paid work at home, etc.) and mixed factors that are a combination of the previous two (health-related lifestyles, use of healthcare services, mental health disorders, etc.) (Dahl & Birkelund, 1997). The contribution of these types of factors to differences in HRQL between women and men depends on two elements: (a) the effect of each on health, something that may vary with sex (e.g., whereas tobacco and alcohol have a greater influence on men's health, sedentary lifestyle and obesity have a greater influence on women's health) (Denton & Walters, 1999); and (b) the frequency and distribution of such factors in each sex. Both elements may vary with the country, culture, age and calendar time (Hunt, 2002; Wiggins et al., 2002).

Accordingly, this study examines the contribution of sociodemographic factors, lifestyle, social network, chronic morbidity and use of healthcare services to the poorer HRQL of women, as compared to that of men, in the older population of Spain; it also ascertains whether the contribution of such factors changed with age. To our knowledge this is the first study of its type conducted in a European Mediterranean country.

Section snippets

Study design and subjects

This was a cross-sectional survey covering a sample of 4000 subjects representative of the non-institutionalized Spanish population aged 60 years and over. The study was approved by the Clinical Research Ethics Committee of the “La Paz” University Hospital in Madrid.

Study subjects were selected through probabilistic multistage cluster sampling. Firstly, clusters were stratified by region of residence and size of town. Thereafter, census sections were selected at random in each cluster, followed

Results

The study sample comprised 1768 (54.2%) women and 1492 (45.8%) men, with a mean age of 72.2 and 70.8 years, respectively.

Table 1 shows the distribution by sex of the variables of interest organized into four groups, i.e., sociodemographic, lifestyle, social network and health-related. Differences between women and men (p<0.05) were observed for most of the variables, except for size of town of residence and use of healthcare services. A total of 80.8% of men, versus 45.6% of women, were

Discussion

Among the older population of Spain, women have a substantially worse HRQL than men, on both the physical and mental scales. The study variables had an impact on gender differences in HRQL only for a minority of dimensions. However, sociodemographic factors, such as not being head of the family and having a lower educational level, and lifestyle-related variables, such as a higher BMI and less physical activity, may partly explain the worse score registered by women on the general health and

Acknowledgements

This work was funded, in part, by a grant (Dossier 24/02) from the Instituto de la Mujer, Ministerio de Trabajo y Asuntos Sociales and by ISCIII (Red de Centros RCESP C03/09). During this study, Esther Lopez-García was the recipient of a Fulbright fellowship from Secretaría de Estado de Educación y Universidades, Ministerio de Educación y Cultura de España, y el Fondo Social Europeo.

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