Gender Differences in Disability-Free Life Expectancy for Selected Risk Factors and Chronic Conditions in Canada

SUMMARY

This article shows how mortality and morbidity patterns differ for women and men 45 years of age and older. The impact on disability-free life expectancy was calculated for selected risk factors and chronic conditions: low income, low education, abnormal body mass index, lack of physical activity, smoking, cancer, diabetes, and arthritis. For each factor, the expected number of years free of disability was calculated for men and women using multi-state life tables. In terms of disability-free life expectancy, the greatest impacts on affected women were for diabetes (14.1 years), arthritis (8.8 years), and physical inactivity (6.0 years), while for affected men, the greatest impacts were for diabetes (10.5 years), smoking (6.9 years), arthritis (6.5 years), and cancer (6.4 years). The implications of these results are discussed from the perspective of developing programs designed to improve population health status.     

Life with and without disease: women experience more of both

This paper examines gender differences in life with and without six major diseases, including both mortal and morbid conditions. Disease prevalence and health behavior data are from the 1993-1995 National Health Interview Surveys for the United States. Vital registration data are the source of mortality rates used in computing life expectancy. The Sullivan method is used to estimate life lived with and without disease and risky behavior for men and women at various ages. Women live more years with each of the diseases examined, and, for arthritis, the extended years with disease are greatest. Women also live more years than men free of each of these diseases with the exception of arthritis. Gender differences in life without two health-risk behaviors are also discussed. Men spend more years of their lives overweight and have fewer years during which they see a doctor.     

Health profiles and profile-specific health expectancies of older women and men: The Netherlands

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65-85 years. For both women and men, six profiles were found: I. cancer; II. "other" chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.     

Health Profiles and Profile-Specific Health Expectancies of Older Women and Men: The Netherlands

SUMMARY

This study focuses on gender differences in health profiles, and examines which health profiles drive gender differences in remaining life expectancy in women and men aged 65 and over in The Netherlands. Data from the first two cycles of the Longitudinal Aging Study Amsterdam (n = 2,141 and 1,659, respectively) were used to calculate health profiles for individuals of 65–85 years. For both women and men, six profiles were found: I. cancer; II. “other” chronic diseases; III. cognitive impairment; IV. frailty or multimorbidity; V. cardiovascular diseases; and VI. good health. The further characterization of these types showed some gender differences. Remaining life expectancy for women was greater than for men in each health profile. A decomposition into health expectancies showed that both women and men could expect to live about 5 years in good health from age 66. The greatest gender differences in years spent with health problems were found for profile IV and for profile III. Their greater number of years spent in these health states have direct consequences for the type and cost of care women need.     

The contribution of a history of heavy smoking to Scotland's mortality disadvantage

Scotland has a lower life expectancy than any country in Western Europe or North America, and this disadvantage is concentrated above age 50. According to the Human Mortality Database, life expectancy at age 50 has been lower in Scotland than in any other developed country since 1980. Relative to 15 developed countries that we have chosen for comparison, Scotland's life expectancy in 2009 at age 50 was lower by an average of 2.5?years for women and 1.6?years for men. We estimate that Scottish women lost 3.6?years of life expectancy at age 50 as a result of smoking, compared to 1.4?years for the comparison countries. The equivalent figures among men are 3.1 and 2.1?years. These differences are large enough for the history of heavy smoking in Scotland to account both for most of the shortfall in life expectancy for both sexes and for the country's unusually narrow sex differences in life expectancy.     

Social inequalities in disability-free life expectancy in the french male population, 1980–1991

We calculate aggregate indicators of population health for occupational groups to gauge changes in health disparities during the 1980-1991 period. The study is based on the experiences of French adult men in three major occupational classes: managers, manual workers, and an intermediary occupational group. Life table models show that managers have longer life expectancy and disability-free life expectancy (DFLE) than manual workers, and a shorter life expectancy with disability. The concurrent increases in life expectancy and DFLE during the period maintained the occupational disparities in health; the years lived with disability, however, declined for all groups, as for the entire French population.     

Disparities in Physical Health Conditions Among Lesbian and Bisexual Women: A Systematic Review of Population-Based Studies

We conducted a systematic review to assess evidence for disparities for lesbian and bisexual women (i.e., sexual minority women [SMW]) in comparison with heterosexual women across a range of nine physical health conditions. Among the k = 11 studies meeting eligibility criteria, almost every comparison (i.e., heterosexual vs. (a) lesbian, (b) bisexual, or (c) both lesbian and bisexual women) was in a direction indicating SMW disparities. Despite limited power due to small samples of SMW, we found evidence of disparities as indicated by a statistically significant adjusted odds ratios for asthma (5 of 7 comparisons), obesity (8 of 12), arthritis (2 of 3), global ratings of physical health (4 of 7), and cardiovascular disease (1 of 1). Evidence was lacking for cancer (1 of 4), diabetes and hypertension (both 1 of 5), and high cholesterol (0 of 3). Future work should confirm findings in more diverse, larger samples and should examine potential explanatory factors.     

Declining sex differences in mortality from lung cancer in high-income nations

After decades of widening, the difference in mortality from lung cancer between men and women has begun to narrow in recent years. Recognizing that the increase in smoking among women relative to men is the proximate cause of the changing sex difference in rates of lung cancer, I analyzed two approaches to identify the more distant sources of the changes. A gender-equality argument suggests that the difference is related to the more general equalization of women's and men's work and family roles, which also encourages the adoption of harmful behaviors such as smoking by women. An alternative explanation suggests that the convergence in mortality from lung cancer among men and women is the byproduct of a lag in the adoption, diffusion, and abatement of smoking by women. Using mortality data on 21 nations from 1955 to 1996, an analysis of logged rates of men's and women's lung cancer mortality and the logged ratio of the rates demonstrated little relationship between the sex difference and gender equality. However, I found a strong and consistent relationship between the sex difference and the stage of diffusion of the use of cigarettes.     

Risk factors associated with osteoporosis in Hispanic women

This study examined risk factors for osteoporosis in Hispanic women. Factors examined included ethnicity, gender, age, height, weight, family and personal history of fractures, height loss, exercise, diet, time since menopause or hysterectomy, hormone replacement therapy (HRT), calcium supplementation, hypertension, thyroid disease, diabetes, arthritis, chemotherapy, family history of breast cancer, use of water pills, fosamax, steroids, alcohol, and smoking. Most results found parallel those found in the Caucasian population. Heavier patients had greater bone density, as well as patients who exercised and those using HRT. Older patients had lower bone density as did diabetic patients. Results not anticipated were higher bone density in patients not taking calcium supplements, and in patients who consumed alcohol.     

The role of smoking in the explanation of the Israeli Jewish pattern of sex differentials in mortality

The difference in life expectancy between women and men among Israeli Jews is very low relative to the difference in other developed countries, and the reasons for this are not fully understood. This paper explores the contribution of smoking to the observed patterns of sex-specific mortality among Israeli Jews, and to the sex difference in mortality exhibited by this population. The results show that the mortality of Israeli Jewish men is low owing to the relatively weak impact of smoking-related mortality, and that this also contributes to an explanation of the small sex difference. The result is explained by the high level of health-protective behaviour of Israeli Jewish men, including a low intensity of smoking (though not a low prevalence). The findings could have implications for some debates on the determinants of divergences and convergences in mortality, and research into the relationship between mortality and the Mediterranean diet.     

Change in disability-free life expectancy for Americans 70 years old and older*

In this article, we examine changes in life expectancy free of disability using longitudinal data collected from 1984 through 2000 from two cohorts who composed the Longitudinal Studies of Aging I and II. Life expectancies with and without ADL and/or IADL disability are calculated using a Markov-based multistate life table approach. At age 70, disability-free life expectancy increased over a 10-year period by 0.6 of a year in the later cohort, which was the same as the increase in total life expectancy, both increases marginally statistically significant. The average length of expected life with IADL and ADL disability did not change. Changes in disability-free life expectancy resulted from decreases in disability incidence and increases in the incidence of recovery from disability across the two survey cohorts. Age-specific mortality among the ADL disabled declined significantly in the later cohort after age 80. Mortality for the IADL disabled and the nondisabled did not change significantly. Those with ADL disability at age 70 experienced substantial increases in both total life expectancy and disability-free life expectancy. These results indicate the importance of efforts both to prevent and delay disability and to promote recovery from disability for increasing life expectancy without disability. Results also indicate that while reductions in incidence and increases in recovery work to decrease population prevalence of disability, declining mortality among the disabled has been a force toward increasing disability prevalence.     

Continued Reductions in Mortality at Advanced Ages

Mortality data for 30 mostly developed countries available in the Kannisto–Thatcher Database on Old‐Age Mortality (KTDB) are drawn on to assess the pace of decline in death rates at ages 80 years and above. As of 2004 this database recorded 37 million persons at these ages, including 130,000 centenarians (more than double the number in 1990). For men, the probability of surviving from age 80 to age 90 has risen from 12 percent in 1950 to 26 percent in 2002; for women, the increase has been from 16 percent to 38 percent. In the lowest‐mortality country, Japan, life expectancy at age 80 in 2006 is estimated to be 6.5 years for men and 11.3 years for women. For selected countries, average annual percent declines in age‐specific death rates over the preceding ten years are calculated for single‐year age groups 80 to 99 and the years 1970 to 2004. The results are presented in Lexis maps showing the patterns of change in old‐age mortality by cohort and period, and separately for men and women. The trends are not favorable in all countries: for example, old‐age mortality in the United States has stagnated since 1980. But countries with exceptionally low mortality, like Japan and France, do not show a deceleration in death rate declines. It is argued that life expectancy at advanced ages may continue to increase at the same pace as in the past.     

Heart Disease and Older Women

Heart disease has traditionally been thought of as a man's disease. However, one in three older women develop heart disease, making it the leading cause of death in older women. Current treatment for heart disease is based largely on studies using males as subjects. Doctors are just now beginning to learn about differences in men and women who have heart disease. The focus of this discussion is heart disease as it relates specifically to women. Risk factors considered are smoking, high blood pressure, elevated blood lipids, diabetes mellitus, obesity, stress, family history and physical inactivity. Diagnosis, treatment options and strategies for living productively with heart disease are presented.     

Origins and Destinations,but How Much and When? Educational Disparities in Smoking and Drinking Across Adolescence and Young Adulthood

Educational inequalities in health behaviors change dynamically across the life course. Yet, how parental and personal education interactively shape age-specific behavioral inequalities across the transition to adulthood has yet to be understood. Drawing on national Add Health data (N?=?12,605; 6,675 women and 5,930 men), we analyze age- and gender-specific trajectories of current smoking and binge drinking from adolescence to young adulthood. In line with previous work, we find that parental education associates with smoking and drinking disparities even after respondents’ own education is completed. Reciprocally, we also find that disparities by eventual educational attainment appear early. During the college years, higher parental education predicts higher—not lower—rates of binge drinking. We find that attaining higher education “against the odds” of an educationally disadvantaged family background circumscribes the lowest rates of smoking and drinking for men and women alike, and especially during the college years, while “falling from grace” by not attaining higher education at levels matching one’s parents predicts the highest levels of smoking and drinking for both genders during or after college. These results shed new light on the interactive socioeconomic processes that help to explain behavioral health gradients across adolescence and adulthood.

     

The Legacy of the Great Recession in Italy: A Wider Geographical,Gender, and Generational Gap in Working Life Expectancy

Under the pressure of population aging the Italian pension system has undergone reforms to increase labor force participation and retirement age, and, thus, the length of working life. However, how the duration of working life has developed in recent years is not well understood. This paper is the first to analyze trends in working life expectancy in Italy. We use data from a nationally representative longitudinal sample of 880,000 individuals from 2003 to 2013 and estimate working life expectancy by gender, occupational category, and region of residence using a Markov chain approach. We document large and increasing heterogeneity in the length of working life. From 2003–2004 to 2012–2013, working life expectancy for men declined from 35.2 to 27.2 years and for women from 34.7 to 23.7 years, increasing the gender gap to 3.5 years. Both young and old were hit, as roughly half of the decline was attributable to ages below 40, half above 40. Working life expectancy declined for all occupational groups, but those in manual occupations lost most, 8.5 years (men) and 10.5 years (women). The North–South economic gradient widened such that men living in the North were expected to work 8 years longer than women living in the South. The fraction of working life of total life expectancy at age 15 declined to record lows at 40% for men and 34% for women in 2012–2013. Policies aiming at increasing total population working life expectancy need to take into consideration the socio-demographic disparities highlighted by our results.

     

The Retrenchment of Marriage: Results from Marital Status Life Tables for the United States, 1995

Marital status life tables were calculated using 1995 US rates of marriage, divorce, and mortality. Compared to figures for 1988, the proportion of persons surviving to age 15 who ever marry remained fairly steady at about five‐sixths of all men and seven‐eighths of all women. The average age at first marriage rose substantially: to 28.6 years for men and 26.6 years for women. The probability of a marriage ending in divorce changed little and was .437 for men and .425 for women. It is likely that no US period or cohort will ever have half of all marriages end in legal divorce, though the highest cohort may reach 47 percent. Patterns of marriage and divorce observed since 1970 show the effect that cohabitation continues to have on the American family, where it is delaying, but not replacing, marriage.     

Gender differences in body esteem among older adults

Ninety-five adults aged 60-91 completed measures of Body-as-Object Esteem (BOE) (i.e., appearance) and Body-as-Process Esteem (BPE) (i.e., function) to explore gender differences in body esteem among older adults. As hypothesized, a significant age by gender interaction revealed that men become more disparaging of the appearance and function of their bodies in their last decades of life, while women do not. Level of physical disability was negatively correlated with BOE, particularly for disabled women. Furthermore, as is seen across the lifespan, self-esteem is a significant predictor of BOE. Disabled participants who were older than 74 years had disproportionately low BPE scores and similarly poor global self-esteem. Whether working with older adults or studying body esteem in this population, it is vital that both dimensions of body esteem are assessed along with the impact of disability status, gender, self-esteem, and age.     

Stressors,Coping Resources,Functioning, and Role Limitations Among Older Korean Immigrants: Gender Differences

This study explored the differential impacts of stressors and coping resources on the functioning and roles of 246 older Korean immigrant men and women. Older Korean immigrant women were significantly more likely than men to have acculturation and socioeconomic stressors, physical/social functioning problems, and role limitations. English-language barriers and lack of transportation were significantly related to lower functioning and higher role limitations of older Korean women compared to those of older men. Providing social and health care services with bilingual and transportation services to older Korean immigrant women is recommended to increase their physical/social functioning and role performance.     

Late Marriage and Less Marriage in Japan

Between 1975 and 1995, the singulate mean age at marriage in Japan increased from 24.5 to 27.7 years for women and from 27.6 to 30.7 years for men, making Japan one of the latest‐marrying populations in the world. Over the same period, the proportion of women who will never marry, calculated from age‐specific first‐marriage probabilities pertaining to a particular calendar year, increased from 5 to 15 percent for women and from 6 to 22 percent for men—behaviors sharply different from those characterizing the universal‐marriage society of earlier years. This article investigates how and why these changes have come about. The reasons are bound up with rapid educational gains by women, massive increases in the proportion of women who work for pay outside the home, major changes in the structure and functioning of the marriage market, extraordinary increases in the prevalence of premarital sex, and far‐reaching changes in values relating to marriage and family life.