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Gender and healthy ageing in Gender and healthy ageing in BritainBritain
Emily Grundy, LSHTM, UK.Emily Grundy, LSHTM, UK.
GeNET Seminar October GeNET Seminar October 2005 2005
Topics coveredTopics covered
Mortality - changing trendsMortality - changing trends
Morbidity and disability, including causes of disabilityMorbidity and disability, including causes of disability
Gender, socio-demographic circumstances and healthGender, socio-demographic circumstances and health
Gender and living arrangementsGender and living arrangements
Gender and intergenerational supportGender and intergenerational support
Gender and IADL performance - changes over timeGender and IADL performance - changes over time
Sex Ratio (Males per 100 Females), England & Wales 2001, 2011 & 2021
0 20 40 60 80 100 120
65-69
70-74
75-79
80-84
85-89
90-94
95-99
100 & over
Ag
e g
rou
p
202120112001
Female life expectancy at birth and difference between female and male life expectancy at birth, selected European countries
1995-2000
-20
0
20
40
60
80
100
Fem
ale
e0 a
nd m
-f e
0
female e0male-female e0
Trends in further life expectancy at age Trends in further life expectancy at age 65, England & Wales, 1901 to 199565, England & Wales, 1901 to 1995
0
5
10
15
20
Male Female
Yea
rs
1900/1
1950/1
1970/1
1995
Female advantage in life expectancy at various ages, England and Wales 1960-2021
0
1
2
3
4
5
6
7
Year
Ye
ars
Age 0
Age 65
Age 80
Sex ratio of death rates from neoplasms by age group, England and Wales, 1911-15 to
1999
0
0.5
1
1.5
2
2.5
1911-15 1931-35 1951-55 1971-75 1987-91 1999
Rat
io M
/F d
eath
rat
es 55-59
60-64
65-69
70-74
75-79
80+
Survivorship (%) to age 80 by year of Survivorship (%) to age 80 by year of birth, England and Walesbirth, England and Wales
Year of birth Men Women
1861 10 16
1881 14 25
1901 17 34
1911 23 41
1921 29 47
Source: data from Government Actuary’s Dept.
Indicators of health by gender, Britain 2001/2002
Age group (years)
Gender
65-69 70-74 75-79 80-84 85+ 65+
M 19 23 31 33 31 25 Health in general in preceding year ‘not good’
F 17 24 28 32 36 25
M 8 10 12 18 35 12 Reported inability to manage one or more locomotion activities alone1 F 9 16 21 29 50 21
M 3 3 6 7 18 5 Reported inability to usually manage bathing/showering/ washing all over alone (%)
F 3 7 7 14 23 9
M 11 11 10 18 17 12 Psychological morbidity2 (England)
F 15 11 17 15 20 15
M 17 21 25 25 23 21 Taking three or more prescribed medications (England) F 18 20 23 31 30 22
Sources: 2001 General Household Survey; 2002 Health Survey for England
Rate per 1,000 of long standing illness or disability by condition group, England 1993, private household
population aged 65+
Condition group Men Women(ICD chapter, 9threvision)
Prevalence Rank Prevalence Rank
Musculoskeletal
system
264 2 388 1
Heart and circulatory
system
342 1 262 2
Respiratory system 135 3 92 4
Digestive system 86 4 94 3
Endocrine and
metabolic
75 5 79 5
Eye complaints 56 6 63 6
Source: Health Survey for England 1993.
Persons aged 70 and over reporting selected chronic conditions (%),
USA 1995
0
10
20
30
40
50
60
70
80
90
100
Arthritis Hypertension Heart disease Diabetes Respiratorydisease
Stroke Cancer
%
Men
Women
Persons aged 80+ needing daily help, Britain Persons aged 80+ needing daily help, Britain 1996/7 (private household population) 1996/7 (private household population)
% reporting need for daily help with:
Men Women
Practical care 22 27
Day-time personal care
13 18
Night-time personal care
6 10
Source: 1996/7 survey of disability, Grundy et al 1999.
Determinants of health in later lifeDeterminants of health in later life
Life course influences recognized to be Life course influences recognized to be important, but most attention paid to socio-important, but most attention paid to socio-economic (and early life) factorseconomic (and early life) factorsLargely separate literature has shown Largely separate literature has shown differences by socio-demographic factors differences by socio-demographic factors such as marital and household status and such as marital and household status and social supportsocial supportNeed to consider both socio-economic and Need to consider both socio-economic and socio-demographic influences and historysocio-demographic influences and history
Social influences on health & well-being in later lifeSocial influences on health & well-being in later life
Personal capital & resilienceInfluenced by education & life history
Family status & social support Socio-economic resources & status
GenderEnvironmentPolicy
583 619
240
392
2,462
3,160
189
627
2,300
2,072
312 310
1,940
2,661
266
840
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Widowed2001
Never married2001
Married2001
Divorced2001
(00
0s
)
Males
Females
Marital Status of Population aged 65 & over, England and Wales, 2001 &
2021
Men and women aged 85+ by family/household
type, England & Wales, 2001.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men Women
Pe
rce
nt
Institution
Lives with non relative
Lives with other relative
Lives with a child
Couple+others
Couple only
Solitary
Health Survey for England
• Nationally representative sample of individuals in private households
• Stratified multi-stage random probability design using Postcode Address File as sampling frame.
• Data Collected through
– Interviewer administered questionnaire
– Nurse administered measurements
– Laboratory analysis of blood samples
– Co-operation from 77-81% of eligible households
ONS Retirement SurveyBaseline 1988/9Interviews with a nationally representative sample of
3,543 adults aged 55-69.
Questions on numbers and ages of children, help given to children and help received from children
Follow- up 19942,247 re-interviewed (70% of survivors)
Re-weighting undertaken to adjust for differential loss to follow up.
In this analysis the childless and remarried men excluded (16%).
Socio-demographic characteristics of men and women aged 65-84, England 1993-5
65-74 75-84
Men Women Men Women
% Married 77 55 68 29
% no lack ofsocialsupport
52 62 54 62
% owneroccupiers
72 68 65 58
% Noeducationalquals.
58 71 61 78
% receiveincomesupport
8 13 13 23
N 2694 3271 1213 1951
Prevalence of psychiatric morbidity among elderly people by whether living with a
spouse, others, or alone, Britain 1993-95
0
5
10
15
20
25
30
35
40
45
65-69 70-74 75-79 80-84 85+ 65+
%
lives with spouse lives with others lives alone
Source: Analysis of HSfE data in Grundy 2001
05
1015202530354045
65-69 70-74 75-79 80-84 85+ 65+
Men Women
Health inequalities & differentials
Odds of perceived severe lack of social support by marital Odds of perceived severe lack of social support by marital status and by living arrangement, England 1993-5status and by living arrangement, England 1993-5
MenMen WomenWomen65-7965-79 80+80+ 65-7965-79 80+80+
Never-marriedNever-married 2.8***2.8*** 4.3***4.3*** 2.0***2.0*** 1.61.6
MarriedMarried 1.01.0 1.01.0 1.01.0 1.01.0
Wid/divWid/div 1.5**1.5** 1.01.0 1.01.0 0.90.9
NN 32883288 628628 42184218 12551255
Lives aloneLives alone 1.91.9 1.31.3 1.11.1 1.01.0
Lives with spouseLives with spouse 1.01.0 1.01.0 1.01.0 1.01.0
Lives with othersLives with others 1.51.5 1.41.4 1.11.1 0.70.7
NN 32873287 628628 42054205 12481248
Source: Analysis of HSfE data
Associations between living arrangements and health among people aged 65 and over in private households, England 1993-5
Psychiatric Morbidity (GHQ 4+)
Poor self rated health
Household Type Model 1 Odds Ratio
Model 2 Odds Ratio
Model 1 Odds Ratio
Model 2 Odds Ratio
Men
Lives alone 1.68*** 1.60*** 1.18* 1.07 Lives with spouse
1.00 1.00 1.00 1.00
Lives with others
1.67** 1.47* 1.55** 1.32
N 4124 4108 4199 4103 Women
Lives alone 1.05 1.01 0.99 0.89 Lives with spouse
1.00 1.00 1.00 1.00
Lives with others
1.37** 1.28* 1.19 1.09
N 5744 5724 5728 5709 ***P<.001; **P<.01; *P<.05 Model 1: Controlling for age Model 2: Controlling for age, smoking habit, social class, number of somatic health conditions and year of survey
Associations between receipt of income support (for those on very low incomes) and health, men and women, England 1993-5
Health indicator
Men Women
Does not receive IS
Receives IS Does not receive IS
Receives IS
Reports health as bad or very bad
1.0 2.78** 2.06-3.76
1.0 2.24** 1.76-2.84
Longstanding illness
1.0 1.34* 1.04-1.73
1.0 1.58** 1.32-1.90
2 or more physical complaints
1.0 1.37* 1.06-1.75
1.0 1.40** 1.18-1.66
Psychiatric morbidity (GHQ score)
1.0 1.80** 1.31-2.47
1.0 1.28* 1.04-1.59
Controlling for age, marital status, smoking, education, tenure, height and social support. Source: analysis of HsfE data
Social status and health
• Problems of measurement in older ages, especially for older women: few still in employment; many be educationally relatively homogenous.
• Different sources of status in later life and for women and men?
• Different life course of women and men may mean alternative/additional indicators needed, of demographic as well as work history
Odds ratios (95% confidence intervals) of fair or Odds ratios (95% confidence intervals) of fair or not good health by each of the socio-economic not good health by each of the socio-economic status variables, women 1988/9 (aged 55-69)status variables, women 1988/9 (aged 55-69)
0
1
2
3
4
5
6
7
IIIn
m
IV &
V
o le
vel
no
ne
2n
d
low
est 1
3 o
r m
ore 1
3 o
r m
ore
pri
vate
Od
ds
Ra
tio
Social Class
Educational Attainment
Income QuartileConsumer Durables
Townsend Poverty Indicators
Housing Tenure
Car Access
Analysis of RS data in Grundy & Holt 2001Ref. categories: most advantaged
Odds ratios (95% confidence intervals) of fair or not good health by various socio-economic status variables, men 1988/9
(aged 55-69) (Source Grundy and Holt 2001)
0
2
4
6
8
10
12
14
16
IIIn
m
IIIm
IV &
V
o le
vel
trad
e
none
2nd
3rd
low
est 1 2
3 or
mor
e 1 2
3 or
mor
e
priv
ate
LA
/HA
no a
cces
s
Od
ds R
ati
o
Social Class
Educational Attainment
Income Quartile
Household resources lacked
Townsend Deprivation Indicators
Housing Tenure
Car Access
Proportions with living child(ren) and frequent contact by age and social class, Women,
Britain,1999
Kin availability & family support
Proportions with living child(ren) and frequent contact by age and social
class, Men, Britain,1999
Kin availability & family support
% of non co-resident children with at least weekly face-to-face contact with a parent, by gender of child and parent,
Britain 1999
0
10
20
30
40
50
60
70
80
90
100
22-29 30-39 40-54Age group of child
%
D-M
D-F
S-M
S-F
0
10
20
30
40
50
60
Non Manual Manual Non Manual Manual
Social Class
Pe
rce
nt 1
2
3
4+
MothersFathers
% of parents receiving regular help from a child by Social Class and number of children, Britain 1994
3rd Age adults regularly providing help to/receiving help
from adult children, 1988 & 1994.
Help tochildren
Help fromchildren
Men 1988 1994 1988 1994Married 65 68 30 31Unmarried 34 40 41 47All 62 63 32 33WomenMarried 65 61 30 34Unmarried 55 49 55 62All 57 56 37 44
Demographic factors associated with frequent face to face contact between adult children and their mothers/fathers, Britain
1999
(among children with a living mother/father; controlling for education, proximity, region and housing tenure).
Co-variate Contact withmother
Contact withfather
Daughter (v.son) +++ +++Age (adult child’s) -- NSNo. sibs --- --Has dependent child -- NSCo-parent dead NS (OR=1.2) -- (OR=0.6)
% of elderly people unable to cook a meal on their own, by gender, Britain 1980-94
0
5
10
15
20
25
30
35
40
65-9 70-4 75-9 80-4 85-9
Age group
%
Men 1980
Men 1895
Men 1994
Women 1980
Women 1985
Women 1994
Women v Men: advantages and disadvantages of being a woman when old
• Advantages• Longer life expectancy
• More contact with/support from children
• Stronger social networks
• Better relevant life skills?
• Disadvantages• More disability - higher
prevalence and higher proportion of life
• Less likely to have spouse, more likely to live alone
• Greater risk institutional residence
• Poorer
Conclusions
• Women have fewer material resources in later life, but more social ones. However also greater needs for assistance
• Men’s ‘social disability’ in some IADLs reducing; women’s mortality from ‘men’s diseases’ increasing, but extent of convergence varies between countries and social groups.
• Implications for future cohorts?