Combining job and family demands and being healthy: what are the differences between men and women?

BACKGROUND: The objective of this study is to analyse gender inequalities in the combination of job and family life and their effect on health status and use of health care services. METHODS: The data come from the Navarra Survey of Working Conditions (Spain, 1997) carried out on a sample of 2185 workers. The analysis was restricted to 881 men and 400 women, aged 25-64 years, who were married or cohabiting. Dependent variables were self-perceived health status, psychosomatic symptoms, and medical visits, all of them dichotomized. Independent variables were family demands and number of hours of paid work a week. The analysis was adjusted for age and occupational social class. Multivariate logistic regression models, separated by sex, were fitted in order to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: Family demands were not associated with men's health whereas married women who lived in family units of more than three members had a higher risk of poor self-perceived health status (aOR=4.16; 95% CI: 1.37-12.65) and of psychosomatic symptoms (aOR=2.05; 95% CI: 1.12-3.75). Among women, working more than 40 hours a week was also associated with both health indicators and, additionally, with a higher probability of medical visits. CONCLUSION: In order to fully understand social determinants of workers' health, besides social class, gender inequalities in the distribution of family responsibilities should be considered.     

Gender perspective in the analysis of the relationship between long workhours, health and health-related behavior

OBJECTIVES: The objective of this study was to analyze gender differences in the impact of long workhours (>40 hours per week) on a variety of health outcomes and health-related behavior. METHODS: The sample included all salaried contract workers aged 16-64 years (1658 men and 1134 women) and interviewed in the 2002 Catalonian Health Survey. RESULTS: Whereas the men with a high job status were more likely to work >40 hours a week, long workhours were associated with situations of vulnerability (low job status and being separated or divorced) among the women. For both genders, working >40 hours was related to a shortage of sleep [adjusted odds ratio (aOR) 1.54, 95% confidence interval (95% CI) 1.21-1.98, for the men and aOR 1.63, 95% CI 1.11-2.38, for the women]. Among the women, long workhours were also associated with poor mental health status (aOR 1.58, 95% CI 1.04-2.40), hypertension (aOR 2.25, 95% CI 1.17-4.32), job dissatisfaction (aOR 1.77, 95% CI 1.08-2.90), and smoking (aOR 1.71, 95% CI 1.22-2.39). In addition, among the women working more hours at home, long workhours were related to sedentary leisure time activity (aOR 1.98, 95% CI 1.06-3.71). CONCLUSIONS: The relationship between long workhours and health and health-related behavior was found to be directly related to long worktime and indirectly related to long exposure to poor work conditions among the women and, to a less extent, to domestic work. The pathways that explain the relationship between long workhours and health and health-related behavior seems to depend on the outcome being analyzed.     

Inequalities in mental health in the working population.

Objectives: To analyze inequalities in mental health in the working population by gender and professional qualifications and to identify psychosocial risk factors and employment conditions related to the mental health of this population. Methods: We performed a cross-sectional study using data from the Barcelona Health Survey 2000. The working population aged 16-64 years (2322 men and 1836 women) was included. Mental health was measured with the General Health Questionnaire (GHQ-12). Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated by means of multivariate logistic regression models separated by job qualifications and gender. Results: The prevalence of poor mental health ranged from 8% among men working in non-manual occupations to 19% in women working in manual jobs. Women were more likely to report poor mental health status than men, although sex differences were greater among manual workers (aOR = 2.26; 95%CI, 1.68-3.05 for women compared to men in the same group). Differences according to qualifications were found among women only (aOR = 1.58 [95%CI, 1.22-2.05] for women working in manual jobs compared to those working in non-manual jobs), while no differences were found among men according to qualifications. Psychosocial risk factors were associated with mental health: demand was associated in all groups, autonomy only in non-manual occupations, and social support only in the most highly qualified working women. Employment conditions such as working a split shift (working day with a long lunch break) or having a temporary contract were associated with mental health in manual occupations only. Conclusions: Mental health among the working population is related to professional qualifications and gender. Women are at greater risk than men, especially those working in manual occupations. Psychosocial occupational factors are related to mental health status, showing different patterns depending on gender and professional qualifications.     

Gender differences in the influence of housework on health]

OBJECTIVE: To analyze the influence of domestic workload on the health of the working population of Catalonia, taking into account its differential impact on males and females. SUBJECTS AND METHODS: The study population were the 2,164 men and 1,215 women interviewed in the Catalonian Health Survey (ESCA) of 1994, with a paid work who were the main responsible for the family unit. The dependent variable was the self-perceived health status that was dichotomized for the bivariate and multivariate analysis. The domestic workload was measured with the number of people living at home (2, 3, 4 or more than 4), living with children younger than 15 and living with older than 65. The adjusting variables were age and occupational social class. The analysis was separated for men and women and crude, adjusted for age, and for all the predictor variables odds ratios (OR) were calculated with their 95% confidence intervals (95%CI). RESULTS: There was no relation between domestic workload and health status among men. Among women the risk or poor health status increased with the number of people living at home with adjusted OR associated to living with more than four persons of 2.35 (95%CI = 1. 33-4.15), as compared with living only with the spouse. Living with older than 65 was protector for women (adjusted OR = 0.63; 95%CI = 0. 39-1.03). CONCLUSIONS: The risk of poor health status associated to the domestic workload among women with paid work, suggests the need of increasing community resources for caring children, as well as, increasing the participation of men in the domestic work. Future health surveys should collect information about the number of people of different age strata living at home.     

Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour?

Social class understood as social relations of ownership and control over productive assets taps into parts of the social variation in health that are not captured by conventional measures of social stratification. The objectives of this study are to analyse the association between self-reported health status and social class and to examine the role of work organisation, material standards and household labour as potential mediating factors in explaining this association. We used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. This was a stratified sample, strata being the 10 districts of the city. The present study was conducted on the working population, aged 16-64 years (2345 men and 1874 women). Social class position was measured with Erik Olin Wright's indicators according to ownership and control over productive assets. The dependent variable was self-reported health status. The independent variables were social class, age, psychosocial and physical working conditions, job insecurity, type of labour contract, number of hours worked per week, possession of appliances at home, as well as household labour (number of hours per week, doing the housework alone and having children, elderly or disabled at home). Several hierarchical logistic regression models were performed by adding different blocks of independent variables. Among men the prevalence of poor reported health was higher among small employers and petit bourgeois, supervisors, semi-skilled (adjusted odds ratio-aOR: 4.92; 95% CI: 1.88-12.88) and unskilled workers (aOR: 7.69; 95%CI: 3.01-19.64). Work organisation and household material standards were associated with poor health status with the exception of number of hours worked per week. Work organisation variables were the main explanatory variables of social class inequalities in health, although material standards also contributed. Among women, only unskilled workers had poorer health status than the referent category of manager and skilled supervisors (aOR: 3.25; 95%CI: 1.37-7.74). All indicators of work organisation and household material standards reached statistical significance, excepting the number of hours worked per week. In contrast to men, among women the number of hours per week of household labour was associated with poor health status (aOR: 1.02; 95% CI: 1.01-1.03). Showing a different pattern from men in the full model, household material deprivation and hours of household labour per week were associated with poor health status among women. Our findings suggest that among men, part of the association between social class positions and poor health can be accounted for psychosocial and physical working conditions and job insecurity. Among women, the association between the worker (non-owner, non-managerial, and un-credentiated) class positions and health is substantially explained by working conditions, material well being at home and amount of household labour.     

Chronic fatigue among bank workers in Brazil

The present study examines the prevalence of chronic fatigue (CF) among bank workers in Brazil and possible associations with gender and working conditions. The study sample included all 735 workers from the department of data processing of a state bank. CF was assessed using the Chalder Fatigue Scale. Working conditions and socio-demographic, socio-economic and psychosocial factors at work were analysed. Psychiatric symptoms were measured with the SRQ-20. The overall estimate of the prevalence of CF was 8.7% [95% confidence intervals (95% CI) = 6.4-10.9%]: 7.8% (95% CI = 5.5-10.7%) among men and 11.0% (95% CI = 6.7-16.9%) among women. The male-female difference was not statistically significant, even after adjusting for minor psychiatric disorders. The overall prevalence of CF without minor psychiatric disorders was 4.5% (95% CI = 2.7-6.3%): 3.9% (95% CI = 1.9-5.9%) among men and 6.4% (95% CI = 2.0-10.1%) among women. In the final model, risk factors for CF were fast work speed [odds ratio (OR) = 3.5], dissatisfaction at work (OR = 3.1), minor psychiatric disorders (OR = 6.8), and medium (OR = 1.8) and heavy domestic workload (OR = 12.0). CF is common among these bank workers and is associated with psychosocial factors at work. Particularly among women, domestic workload, marital status and the presence of young children were associated with CF in the stratified analysis. Domestic workload may add physical and mental stress, putting employees at risk for CF from overload, or CF may cause workers to perceive domestic work as heavy.     

Gender,socioeconomic, medical,and environmental factors related to domestic accidents of the elderly in Spain. Findings of a national survey

Domestic accidents pose serious threats to the independence of the elderly. We explored associations between domestic accidents and gender, socioeconomic, medical, and environmental factors using data from the European Health Survey 2014 for elderly Spanish female and male nationals. Records of 5960 participants (mean age ± SD: 75.9 ± 7.6 years), 59.8% of whom were women, were examined. Domestic accidents occurred in 460 (7.1%) seniors, predominately in women (78.5%). Age (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 1.00-1.03, p = .003], female gender (aOR 2.04 [95% CI 1.60-2.60, p < .001]), difficulty managing 12 stairs (reference: none) (some: aOR 2.03 [95% CI 1.53-2.68, p < .001]; much: aOR 2.88 [95% CI 2.15-3.87, p < .001]; inability: aOR 3.09 [95% CI 2.14-4.45, p < .001]), and depressive symptoms severity (reference: absent) (mild: aOR 1.44 [95% CI 1.10–1.89, p = .008]; moderate: aOR 1.91 [95% CI 1.35–2.71, p < .001];. Very severe: aOR 2.53 [95% CI 1.72-3.71, p < .001]; extremely severe: aOR 2.38 [95% CI 1.45-3.93, p = .001]) were independently associated with domestic accidents. Severity of depressive symptoms was the most prominent feature for women, while inability to manage 12 stairs was the most prominent for men. Our results suggest important gender differences in factors associated with domestic accidents that are relevant to intervention and preventive programs.     

Gender and Social Class Differences in the Association between Early Retirement and Health in Spain

ObjectivesWe sought to examine the association between reasons for early retirement and health status and to assess whether this association differs by gender and social class.MethodsThe sample was all people currently working or retired between 50 and 64 years of age (2,497 men and 1,420 women) who were interviewed in the 2006 Spanish National Health Survey. The health outcomes analyzed were self-perceived health status and mental health. Multiple logistic regression models stratified by gender and occupational social class were fitted.ResultsFemale manual workers who were forced into early retirement due to organizational reasons were more likely to report poor self-perceived health status (adjusted odds ration [aOR], 4.04; 95% confidence interval [CI], 1.44–11.32) and poor mental health (aOR, 2.70; 95% CI, 1.15–6.33), whereas no such association was observed among male workers or among female nonmanual workers. Early retirement on health grounds was associated with both health outcomes in all groups, but retirement because of age, voluntary retirement, and retirement for other reasons were not related to poor health outcomes in any group analyzed.DiscussionForced early retirement owing to organizational reasons is related to poor health indicators only among female manual workers. Results highlight the importance of paying more attention to the potential vulnerability of female manual workers in downsizing processes as well as in early retirement policies.     

Physical activity levels in adults living in Bogotá (Colombia): prevalence and associated factors

OBJECTIVE: To determine the prevalence of physical activity levels in adults aged 18 to 65 years in Bogotá city and identify the factors associated with regular physical activity. METHODS: We conducted a population-based, cross-sectional survey in 3,000 adult residents of Bogotá in 2003 who were selected through a multistage probabilistic sample. Physical activity levels were determined using the short version of the International Physical Activity Questionnaire. Factors associated with regular physical activity were identified by logistic regression models. RESULTS: The adjusted prevalence of persons undertaking regular physical activity was 36.8%. After adjustment for potential confounders, regular physical activity was more likely in men (odds ratio [OR] = 1.62; 95% CI, 1.31-2.01) and in those whose self-perceived health status was good or very good (OR = 1.87; 95% CI, 1.41-2.49) and was less likely in those aged 30-49 years or 50-65 years (OR = 0.78; 95% CI, 0.63-0.96, and OR = 0.60; 95% CI, 0.43-0.82, respectively) and in those whose main activity in the previous 30 days was searching for a job (OR = 0.71; 95% CI, 0.51-0.97) or carrying out household tasks (OR = 0.72; 95% CI, 0.54-0.96). In women, unlike men, age groups showed no association with regular physical activity. CONCLUSION: This study shows gender differences in the prevalence of physical activity levels and associated factors. Future studies should establish, in the context of Latin American cities, whether it is appropriate to determine specific measures in each domain, in addition to overall physical activity levels.     

Health inequalities by education and age in four Nordic countries, 1986 and 1994

STUDY OBJECTIVE: To compare the age pattern of educational health inequalities in four Nordic countries in the mid-1980s and the mid-1990s. DESIGN: Cross sectional interview surveys at two points of time. SETTING: Data on self reported limiting longstanding illness, and perceived health were collected from Denmark, Finland, Norway, and Sweden in 1986/87 and in 1994/95. PARTICIPANTS: Representative samples of the non-institutionalised population at 15 years or older. Analyses were restricted to respondents aged between 25 and 75 (n= 23 325 men and 24 184 women). Response rates varied from 73% to 87%. MAIN RESULTS: The age adjusted prevalence of limiting longstanding illness in Finland was 10% higher in men and 6% higher in women than in other Nordic countries in 1986/87 but the gap narrowed by 1994/95. Educational health inequalities were largest in Norway. In 1986/87 the odds ratio (OR) for limiting longstanding illness was 11.25 (95% CI 8.66 to 14.62) among men and 8.23 (95% CI 6.60 to 10.27) among women in the oldest age group (65-74 years old) in Finland when the youngest age group (25-34 years old) was used as the reference category (OR=1.00). The age pattern in Finland was steeper than in Sweden (OR=5.02, 95% CI 3.97 to 6.34 in men and 5.29, 95% CI 4.18 to 6.71 in women) or Norway (OR=6.32, 95% CI 4.06 to 9.84 and 5.45, 95% CI 3.81 to 7.82, respectively). In 1994/95 relative health improved in the oldest age group in Finland (OR=5.80, 95% CI 4.33 to 7.78 in men and 5.94, 95% CI 4.52 to 7.79 in women) and in Norway (OR=4.55, 95% CI 3.01 to 6.88 and 3.96, 95% CI 2.70 to 5.81, respectively) but remained stable in Sweden. The study compared health differences by age in different educational categories and found that in Finland in 1986/87 the health in the oldest age group was poorer for secondary (OR=10.59, 95% CI 5.96 to 18.82) or basic educated (OR=9.76, 95% CI 6.66 to 14.30) men than for men with higher education (OR=5.15, 95% CI 2.59 to 10.22). The difference was not found among women or in other Nordic countries and it diminished among men in Finland in 1994/95. The results of perceived health were broadly similar to the above results of limiting longstanding illness. CONCLUSION: The results suggest that compared with other Nordic countries the comparatively poorer health in Finland is partly attributable to a cohort effect. This may be associated with the lower standard of living in Finland that lasted until the mid-1950s. The cohort effect is also likely to contribute to educational health inequalities among older Finnish men. The results suggest that not only current social policies but also past economic circumstances are likely to affect the overall health status as well as health inequalities.     

Gender and health inequalities among adolescents and adults in Brazil, 1998.

OBJECTIVES: To assess the extent of gender inequalities in health status and health services utilization among adolescents and adults in Brazil. METHODS: A representative sample of 217,248 individuals from 15 to 64 years of age was obtained from the National Household Sample Survey (Pesquisa Nacional de Amostras por Domicílios, PNAD) conducted in 1998 by the Brazilian Institute of Geography and Statistics and funded by the Ministry of Health. The study focused on three outcome variables (self-assessed health status, medical visits, and hospitalizations (except childbirth)) and five exposure variables (age, gender, ethnicity, income, and education). Unconditional logistic regression and Mantel-Haenszel stratified analysis was employed. Prevalence rate ratios were calculated for each stratum. Confidence intervals were calculated using the Taylor series, with a 95% confidence interval (95% CI). RESULTS: Women were more likely to report fair or poor health than men (odds ratio (OR) = 1.33; 95% CI: 1.31-1.35). Gender disparities were significant for all ages, household income brackets, and education levels, and were always unfavorable to women (1.17 < or = OR < or = 1.44). Gender disparities for medical visits were higher for those in good health; tended to fall as age, income, and education increased; and were always favorable for women (1.12 < or = OR < or = 2.06). Gender disparities in hospitalization rates decreased with age, varied according to income and education level in each age group, and were always favorable for women (1.16 < or = OR < or = 1.66). CONCLUSIONS: The difference in self-reported health status for men and women became even greater after adjusting for socioeconomic variables, suggesting that poorer women have more pronounced, relative differences than men do. The impact of structural determinants, such as education and income, is considerably smaller than the social construct of gender, although the former are more important predictors. Women use health services more often than men do, which is consistent with their health needs. However, medical visit rates show an inverse relationship to health care needs, suggesting an inequitable access to outpatient care, mainly preventive care.     

Women’s autonomy and reproductive health-care-seeking behavior in Ethiopia

This paper investigated the potential importance of women’s autonomy in reproductive health-care-seeking behavior of women in Ethiopia. Data from the 2011 Ethiopian Demographic and Health survey (DHS), which involved a total of 16,515 women, were analyzed. A weighted sub-sample of married women and women who had a live birth were included in analyses on family planning and antenatal care. Women’s autonomy was measured by participation in decision making, attitudes toward wife beating, and whether getting permission to seek medical care was a big problem. Nearly 54% of women participated in all major household decisions, and 69% said getting permission to go for medical care was not a large problem. Women’s participation in domestic decision making was significantly positively associated with use of family planning (adjusted odds ratio [aOR]: 1.37, 95% confidence interval [CI]: 1.17–1.62), and antenatal care (aOR: 1.36, 95% CI: 1.13–1.64) after adjusting for the effects of socio-demographic variables. Moreover, greater women’s education, paid employment, exposure to media, and better household economic status were related to both use of family planning and antenatal care. Improving women’s autonomy will help to attain both gender equality and improved use of health services.     

Body weight dissatisfaction by socioeconomic status among obese, preobese and normal weight women and men: results of the cross-sectional KORA Augsburg S4 population survey

ABSTRACT: BACKGROUND: Body weight dissatisfaction is an important factor in preventing weight gain and promoting weight loss or maintenance. This study focuses on differences in the rates of body weight dissatisfaction among obese, preobese and normal weight women and men by socioeconomic status within a general adult population in Germany. METHODS: Data were analyzed from 4186 adults aged 25 to 74 who participated in a cross-sectional, representative population-based health survey (KORA S4, 1999-2001, Augsburg region/Germany). Body mass was measured anthropometrically and indexed following international standards. Among the 2123 women participating in the survey, 40.3% had a normal weight, 34.9% were preobese, and 24.8% were obese (compared to 25.9%, 51.4% and 22.6% among men, respectively). Body weight dissatisfaction, educational level, household income and occupational status were assessed by computer-aided personal interviewing. An index for socioeconomic status was calculated and categorized into quintiles. Multiple logistic regressions were performed to test for differences in the odds of body weight dissatisfaction across socioeconomic strata in normal weight, preobese and obese groups. Body mass index, age, family status, place of residence and health behaviors were adjusted for. RESULTS: Overall, being dissatisfied with one's body weight was more prevalent in women (48.3%) than in men (33.2%). In the normal weight group, no significant differences in the odds of being dissatisfied were found across socioeconomic groups among women or men. Among preobese men, compared to the lowest socioeconomic stratum, increased odds of being dissatisfied with one's body weight were associated with the highest socioeconomic index group (OR=2.3, 95% CI: 1.4-3.8), middle and high educational level (OR=1.6, 95% CI: 1.1-2.3, and OR=1.9, 95% CI: 1.3-3.7), high income (OR=1.8, 95% CI: 1.2-2.7), and middle and high occupational status (both OR=1.8, 95% CI: 1.2-2.6). Among preobese women, the odds of being dissatisfied were only significantly elevated in those with a middle educational level (OR=1.6, 95% CI: 1.1-2.3). Among obese men, elevated odds were found in the highest socioeconomic index group (OR=3.7, 95% CI: 1.8-7.5) and in those with a high educational level (OR=2.3, 95% CI: 1.3-4.1), high income (OR=2.6, 95% CI: 1.4-4.7), and middle and high occupational status (both OR=2.2, 95% CI: 1.3-3.6). The odds of dissatisfaction among obese women were not associated with socioeconomic status as a whole, but were associated with a high educational level, albeit with a comparatively large confidence interval (OR=3.6, 95% CI: 1.0-12.8). CONCLUSIONS: In Germany, body weight dissatisfaction is more prevalent among obese and preobese men in high socioeconomic status groups, a pattern not found in women. The exception to this is a greater prevalence of dissatisfaction among obese and preobese women with a high educational level (albeit inconsistently). Moreover, there is a social gradient in body weight dissatisfaction, especially in obese men, which may partly explain why obesity is more prevalent in men with low socioeconomic status. It also suggests that they are a target group for obesity care in which body weight satisfaction is an important topic.     

2013-2017年北京市通州区34637例孕妇妊娠期糖尿病流行情况及其影响因素研究

  目的  了解北京市通州区孕妇妊娠期糖尿病（gestational diabetes mellitus,GDM）的流行情况及其相关影响因素。  方法  收集2013年1月1日至2017年12月31日期间在北京市通州区妇幼保健院住院分娩的34 637例单胎孕妇的社会人口学特征、既往史、糖尿病家族史及本次妊娠情况等资料,分析孕妇GDM患病率,利用多因素Logistic回归分析GDM相关影响因素。  结果  34 637例单胎孕妇的GDM患病率为23.19%（8 034/34 637）。多因素分析显示,高龄（aOR=1.87,95%CI:1.71~2.05）、高文化程度（aOR=1.19~1.23）、2016-2017年分娩（aOR=1.46,95%CI:1.38~1.55）、巨大儿分娩史（aOR=1.27,95%CI:1.02~1.59）、剖宫产史（aOR=1.18,95%CI:1.08~1.30）、自然流产史（aOR=1.23,95%CI:1.10~1.37）、药物及人工流产史（aOR=1.08,95%CI:1.01~1.14）、糖尿病家族史（aOR=1.51,95%CI:1.26~1.83）、经产妇（aOR=1.24,95%CI:1.15~1.34）、孕前超重（aOR=2.02,95%CI:1.89~2.15）、孕前肥胖（aOR=3.11,95%CI:2.81~3.43）、采用辅助生殖技术怀孕者（aOR=1.47,95%CI:1.03~2.10）是GDM的独立危险因素。  结论  北京市通州区住院分娩的孕妇中GDM处于较高的流行水平。应针对影响GDM发病的相关危险因素,开展孕前及孕期健康教育,及时监测及预防GDM的发生,以促进母婴健康。     

Ethnicity and Self-Perceived Oral Health in Colombia: A Cross-Sectional Analysis

To estimate the association between self-perceived oral health indicators and ethnic origin in Colombia, a cross-sectional study (Information from the 2007 National Public Health Survey) was conducted. Variables: belonging to an ethnic group (Exposure); oral health indicators (Outcomes); sex, age, education and self-rated health (control). Analyses were carried out separately for men (M) and women (W). The association between the exposure variable and the outcomes was estimated by means of adjusted odds ratio (OR) with confidence intervals (95 % CI) using logistic regression. Men were more likely to report gum bleeding (aOR 1.78; 95 % CI 1.44–2.23) and dental caries (aOR 1.69; 95 % CI 1.42–2.02), while women were more likely to report unmet dental needs (aOR 1.43; 95 % CI 1.27–1.49) and dental caries (aOR 1.34; 95 % CI 1.22–1.47). Indigenous and Palenquero were more likely to report most of the indicators analyzed. Minority ethnic groups in Colombia were at risk to report oral health problems.     

Explaining the gender gap in health services use among Ghanaian community-dwelling older cohorts

Although gender differences in use of health services have been documented, little is known about whether such disparities vary by marital and socioeconomic status in later life, especially in low- and middle-income countries. We examined the relation of gender to use of health care among community-dwelling older Ghanaians (N = 1200) and whether marital status and income moderated this relationship using data from the Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study conducted in 2016/2017. Multivariate logistic regression modeling showed no significant gender disparities in use of health care, adjusting for covariates. However, married women were less likely to use health care than married men (adjusted Odds Ratio [aOR] = 0.324, 95% confidence interval [CI]: 0.146–0.718). Further, while married older people with higher incomes had lower odds of using health care (aOR = 0.355, 95% CI: 0.137–0.924), use of health services was greater in married women with higher incomes compared with their male counterparts (aOR = 8.695 (95% CI: 1.233–61.296). The modifying effects of marital status and income appeared substantial in explaining gender differences in use of health services in later life. These findings have implications for health policy, health promotion and quality of life of older people.     

Area deprivation and trends in inequalities in self-rated health in Spain, 1987--2001

AIMS: This study examined the impact that individual social position and municipal area deprivation levels had on trends in inequalities in self-rated health in Spain, between 1987 and 2001. METHODS: The study was based on cross-sectional data of the National Health Surveys of Spain for the years 1987, 1993, 1995, 1997, and 2001 (n=84,567). The indicators used were educational level and occupational class, and deprivation level as the indicator of municipal areas. Multilevel logistic regression models were made, with individuals nested into municipal areas. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. To evaluate trends, the relative index of inequality was calculated. RESULTS: At the individual level, the likelihood of less-than-good health between those with no formal education as compared to those with graduate-level education increased from OR=2.66 (95% CI: 2.06-3.38) in 1987 to OR=3.62 (95% CI: 2.95-4.63) in 2001 among women. The values for men were OR=2.27 (95% CI: 1.89-2.72) and OR=2.94 (95% CI: 2.36-3.68) respectively. Living in areas with the highest deprivation levels as compared to the lowest systematically increased the likelihood of less-than-good health. The likelihood of reporting less-than-good health among women with no formal education as compared to women with graduate-level education in municipal areas with the highest deprivation levels increased from OR=3.61 (95% CI: 2.39-5.45) in 1987 to 4.85 (95% CI: 3.06-7.69) in 2001. Among men, the corresponding magnitudes were OR=2.07 (95% CI: 1.39-3.08) and OR=4.16 (95% CI: 2.52-6.89). CONCLUSIONS: Inequalities in self-rated health increased in Spain in this period. These inequalities may be explained by the social conditions existing throughout the period of reference, and the pattern varies according to gender, municipal area deprivation levels, and the individual indicator of social position used.     

Productive employment, gender and mental health

A cross-sectional study was conducted in Olinda, Pernambuco, to investigate a possible association between unemployment, informal work, and common mental disorders (CMD) assessed by the Self Reporting Questionnaire (SRQ - 20). While women working in the formal labor market showed significantly better mental health as compared to informal workers (OR = 3.02, 95% CI 1.3-7.2), housewives (OR = 2.29, 95% CI 1.0-5.0), and unemployed (OR = 2.66, 95% CI 1.1-6. 3) and inactive women (OR = 3.19, 95% CI 1.2-8.4), no difference was found among men. The actual pattern of the odds ratios suggests a modifying effect of gender in the association between employment status and CMD. However, the interaction term added to the final model was statistically significant for informal work, but not for unemployment. The results of the present study suggest that the experience of informal work may be different for men and women. This finding highlighted the need to incorporate a gender approach (reflecting a social dimension of sex-related inequalities) to the theoretical framework based on social classes adopted here.     

Social determinants of sexual satisfaction in Spain considered from the gender perspective

AimsTo describe gender- and social class-related inequalities in sexual satisfaction and analyze their relationship with self-perceived health status.MethodsThis population-based, cross-sectional study included 7384 sexually active people aged 16 years and over residing in Spain in 2009 (3951 men and 3433 women). The explanatory variables were gender, age, social class, share in performing domestic tasks, spend time looking after oneself, collaborate economically in supporting the family, caring for children, self-perceived health status, and the desire to increase or decrease frequency of having sexual relations. Bivariate and multivariate logistic regression models were fitted.ResultsAmong women, sexual satisfaction declines progressively after age 45. Sexual satisfaction is 1.7 times higher among women who look after themselves and who feel good compared with those who do not. The odds of wanting to increase sex is 3.3 times higher for women who are satisfied compared with women who desire a lower frequency of sexual intercourses; and good perceived health was associated with sexual satisfaction. In satisfied men, the corresponding odds is 1.9 times that of men desiring to reduce their frequency of sex.ConclusionsGender and social class inequalities are found in sexual satisfaction. This is associated with perceived health status, adding evidence in support of the World Health Organization definition of sexual health.