Gender differences in health expenditure determinants: A follow-up study

Researchers' aim was to investigate if patients/physicians characteristics could differently affect males/females health care expenditure.

In 2009/2010, a health-related-quality-of-life (HRQL) measure was distributed to 887 general practitioners' (GP) patients in Siena's province-Italy. Severity of diseases was calculated through Cumulative Illness Rating Scale Severity Index (CIRS-SI). Information about GPs' gender and age and patients' gender, age, and socio-economic variables were recorded. 2012 data about pharmaceutical, outpatient and hospital expenditure were obtained. Multivariate regression was carried out.

In males, hospital expenditure increased with higher CIRS-SI and female GP whilst in females it was not influenced by any of the variables. Outpatient and pharmaceutical expenditure increased with aging, higher CIRS-SI, and lower HRQL and education, both in males and females.

Gender differences in health expenditure determinants emerged for hospital expenditure.     

Gender differences in determinants of marital disruption

"Because the family is a highly gendered institution, the authors anticipated that characteristics of husbands and wives would have differing influences on marital disruption. Longitudinal data from the [U.S.] National Survey of Families and Households were used to examine the influence of sociodemographic and attitudinal characteristics of each spouse on the likelihood of marital disruption. In general, wives' variables have a stronger influence than do husbands' variables, suggesting that wives play a greater role in maintenance of marital relationships and are more sensitive to problems in the relationship. The relative influence of each spouse's characteristics is more similar in egalitarian marriages, however. Findings confirm the gendered nature of marital relationships."     

Gender differences in physical symptoms and illness behavior. A health diary study.

Recent studies on symptom perception have highlighted the role of psychological factors, such as mood states and external involvement, in physical symptom reporting. To date, the consistently found higher physical symptom reports in women have not been studied from this perspective. The present study aimed to investigate the psychological determinants of gender differences in physical symptoms and illness behavior on a daily basis. During four adjacent weeks, a healthy primary care sample of 92 women and 61 men kept health diaries, containing scales for physical symptoms, illness behavior, external information and positive and negative mood. The daily health records showed the typical gender difference in physical symptoms, but not in illness behavior. Negative mood was found to be the strongest predictor of physical symptoms. Physical symptoms in turn were the strongest predictor of illness behavior. The modest gender difference in physical symptoms disappeared after controlling for positive and negative mood. Thus, mood states seem to mediate gender differences in symptom reporting.     

The social determinants of health: a contribution to the analysis of gender differences in health and illness

While it is established that socioeconomic status and social integration influence the distribution of health and illness among men and women, little attention has been paid to the different ways in which women and men experience socioeconomic opportunities and social attachments to others. Drawing on evidence from the literature, the position developed in this article is that gender mediates the influence of both socioeconomic status and social integration on health, and for women, these are intricately linked. Women's relationship to the labour market establishes and perpetuates their socioeconomic inequality relative to men, and may produce contradictory influences on women's health. Furthermore, for women, the marital relationship is paradoxical: marriage may at once improve economic and social support opportunities, while diminishing control over paid and unpaid work--potentially increasing as well as compromising the health status of women. The article is intended to contribute to the growing body of literature on gender and the determinants of health.     

Gender differences in structural and behavioral determinants of health: an analysis of the social production of health

This paper explores aspects of the social production of health by focussing on the ways in which levels of health are shaped by structures of social inequality and behaviors or 'lifestyles'. We address two questions: What is the relative importance of the social, structural and behavioral determinants of health? And, are there gender differences in the determinants of health? These questions are explored using multiple regression analyses of data from the 1994 Canadian National Population Health Survey. Two measures of health are used: subjective health status and the Health Utilities Index (a measure of functional health status). By structural determinants we refer to age, family structure, main activity, education, occupation, income and social support. Behavioral determinants include lifestyle factors related to smoking, drinking, weight and physical activity. Findings indicate that the structures of social inequality are the most important determinants of health acting both independently and through their influence on the behavioral determinants of health. There are very real differences in the factors that predict women's and men's health. For women, social structural factors appear to play a more important role in determining health. Being in the highest income category, working full-time and caring for a family and having social support are more important predictors of good health for women than men. Smoking and alcohol consumption are more important determinants of health status for men than women, while body weight and being physically inactive are more important for women than men. Our findings suggest the value of models which include a wide range of structural and behavioral variables and affirm the importance of looking more closely at gender differences in the determinants of health.     

Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health

Gender-based inequalities in health have been frequently documented. This paper examines the extent to which these inequalities reflect the different social experiences and conditions of men's and women's lives. We address four specific questions. Are there gender differences in mental and physical health? What is the relative importance of the structural, behavioural and psychosocial determinants of health? Are the gender differences in health attributable to the differing structural (socio-economic, age, social support, family arrangement) context in which women and men live, and to their differential exposure to lifestyle (smoking, drinking, exercise, diet) and psychosocial (critical life events, stress, psychological resources) factors? Are gender differences in health also attributable to gender differences in vulnerability to these structural, behavioural and psychosocial determinants of health? Multivariate analyses of Canadian National Population Health Survey data show gender differences in health (measured by self-rated health, functional health, chronic illness and distress). Social structural and psychosocial determinants of health are generally more important for women and behavioural determinants are generally more important for men. Gender differences in exposure to these forces contribute to inequalities in health between men and women, however, statistically significant inequalities remain after controlling for exposure. Gender-based health inequalities are further explained by differential vulnerabilities to social forces between men and women. Our findings suggest the value of models that include a wide range of health and health-determinant variables, and affirm the importance of looking more closely at gender differences in health.     

Mental health consequences of unintended childlessness and unplanned births: Gender differences and life course dynamics

The discordance between fertility intentions and outcomes may be associated with mental health in the general population. This requires data directly linking individuals' fertility intentions with their outcomes. This study brings together two streams of research on fertility and psychological distress to examine whether unintended childlessness and unplanned births are associated with psychological distress, compared with intended childlessness and planned births. We also examine whether unintended childlessness and unplanned births are differently associated with distress at two stages of the individuals' life course: in early and late 30s. As women are more directly affected by the decline in fertility with age and the experience of motherhood is more central to women's identity, we also examined gender differences in these associations. Thus, we examined the association between four possible fertility events (planned and unplanned births, intended and unintended childlessness) and psychological distress of men and women, at two different stages over the life course (early and late 30s). We used longitudinal data from the US National Longitudinal Study of Youth 1979 (N = 2524) to link individuals' fertility intentions and outcomes to evaluate the association of depressive symptoms (CES-D) with four possible fertility events occurring in two-year intervals, for men and women separately. Contrary to our first hypothesis, unintended childlessness and unplanned births were not associated with psychological distress for women. Among men, only unplanned births in their early 30s were associated with increases in psychological distress. We did not find support for our second hypothesis that unintended childlessness and unplanned births have a different association with psychological distress for men and women and as a function of the stage of life. These findings are discussed in the context of previous literature in this area.     

Gender differences in worksite health promotion activities

A model of intentional health-related behaviors was tested to predict men's and women's participation in six worksite health promotion programs. The model was best at predicting participation in programs that treat unhealthy conditions or behaviors. It was least successful at predicting participation in programs than can appeal to both those with 'health risks' and to health 'maximizers'. Women had higher rates of participation than men in three of the four 'treatment' programs, and they participated in more programs. In every program type, the factors that influence women's participation were different from those affecting men; and women with children showed different patterns of influence from women without children. The patterns of influence are consistent with two sources for women's greater concern with treating poor health: their nurturant role responsibilities, and a particular emphasis by the medical profession on women and women's concerns.     

Socioeconomic differences in weight gain and determinants and consequences of coronary risk factors

BACKGROUND: The increasing prevalence of overweight and obesity is a major public health concern in many developed countries. OBJECTIVE: We aimed to describe socioeconomic differences in change in body mass index (BMI; in kg/m2) from age 25 y, assess possible factors behind these differences, and study whether socioeconomic differences in a variety of coronary risk factors can be accounted for by change in BMI. DESIGN: The data come from a cohort study of London-based civil servants (Whitehall II), who participated in the first (1985-1988) and third (1991-1993) phases of the study and were 35-55-y old at phase 1: altogether there were 5507 men and 2466 women. Both study phases included a questionnaire and a screening examination. RESULTS: In men and women, employment grade--the measure of socioeconomic status used in this cohort--was strongly related to BMI gain from age 25 y to phase 3 (25 y apart on average). The lower the grade the larger the gain in BMI. Adjustment for health behaviors reduced the grade differences in BMI gain by approximately 20%. A substantial part of the grade differences in diastolic and systolic blood pressure and plasma triacylglycerol concentrations could be accounted for by BMI change from age 25 y. CONCLUSIONS: Grade differences in BMI change are evident, but many of the determinants of these differences remain unknown. If lower-status persons continue to gain weight more rapidly than higher-status persons, overweight is likely to be of growing importance as a pathway to social inequalities in ill health.     

Gender differences in long-term health consequences of physical abuse of children: data from a nationally representative survey

OBJECTIVES: This study investigated the effects of physical abuse in childhood on health problems in adulthood and assessed gender differences in these associations. METHODS: We used data from 8000 men and 8000 women who were interviewed in the National Violence Against Women Survey. We used multivariate logistic regression to test for main and interactive effects and conducted post hoc probing of significant moderational effects. RESULTS: Men were more likely than women to have experienced physical abuse during childhood. Whereas abuse had negative consequences for both boys and girls, it was generally more detrimental for girls. CONCLUSIONS: Findings suggest the need to consider gender differences and long-term adverse health consequences in the development of intervention strategies to address physical abuse in childhood.     

Gender differences in leadership in the health professions

The leadership characteristics and behaviors of men and women differ. As increasing numbers of women enter positions of leadership, understanding of these differences can increase the quality and productiveness of relationships in the workplace. This article describes the evolution of women in leadership, gender differences in leadership style, and the way gender may affect behaviors in the workplace.     

The labor market consequences of race differences in health

Differences in health status across different race and ethnic groups in the United States, particularly between black and white Americans, have been the subject of considerable medical and social science research. For instance, numerous studies using a variety of health measures have shown the health of black men and women to be worse than that of whites (e.g., Manton, Patrick, and Johnson 1987 ). The health disadvantage of Native Americans, relative to that of whites, has also been documented extensively. Patterns for other major ethnic groups (e.g., Hispanics and Asians) have been somewhat more variable, depending on the measure, the age of the study sample, and other factors such as place of birth and acculturation ( Hayward and Heron 1999 ; Shalala et al. 1999 ). Systematic health disparities are likely to have profound—and self‐reinforcing—consequences for the relative well‐being of different population groups. In this article, we focus on one dimension of such consequences: the association between race differences in health status and race differences in labor market outcomes.     

Gender differences in health status and life quality of students

The study has revealed that the leading hygienic risk factor of disorders and low life quality in medical students are an excess educational load at the expense of lecture and extra lecture hours, which is not characteristic of engineering students for whom the organization of a training process mostly meets the sanitary requirements. Gender differences have been found in life quality assessed by young males and females. Social factors have been proved to be the most significant parameters modifying the student's life quality. Moreover, the students of both institutes show decreased mental capacity by the third year of studies, by the fourth year, there are signs of its enhancement irrespective of gender.     

Gender differences in the utilization of health care services

BACKGROUND: Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services. METHODS: New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses. RESULTS: Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations. CONCLUSIONS: Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.     

Female illness rates and illness behavior: testing hypotheses about sex differences in health

Health surveys repeatedly show that females have higher rates of illness, disability days, and health services utilization than do males. Numerous reasons for these sex differences have been hypothesized, based on four general factors thought to differ by sex and to influence self-reported health: genetic characteristics, physical risks, illness behavior, and reporting behavior. This paper briefly reviews these hypotheses, then discusses research strategies to test them. The strategies vary in the type of dependent variables used (medical vs. sociomedical health indicators) and the main method of controlling predictor factors (elimination vs. statistical control). A study was completed in 1978 in the Detroit metropolitan area to (a) explore reasons for sex differences in health and (b) reveal how strongly illness behavior (perception and evaluation of symptoms, propensities to take curative actions or disability days) affects common health indicators, particularly those for the national Health Interview Survey. The study's research design (use of a health diary, and focus on hypotheses about illness behavior) is described.     

Gender differences in the associations between health and neighbourhood environment

Multiple deprivation indicators are frequently used to capture the characteristics of an area. This is a useful approach for identifying the most deprived areas, and summary indices are good predictors of mortality and morbidity, but it remains unclear which aspects of the residential environment are most salient for health. A further question is whether the most important aspects vary for different types of residents. This paper focuses on whether associations with neighbourhood characteristics are different for men and women. The sociopolitical and physical environment, amenities, and indicators of economic deprivation and affluence were measured in neighbourhoods in the UK, and their relationship with self-rated health was investigated using multilevel regression models. Each of these contextual domains was associated with self-rated health over and above individual socioeconomic characteristics. The magnitude of the association was larger for women in each case. Statistically significant interactions between gender and residential environment were found for trust, integration into wider society, left-wing political climate, physical quality of the residential environment, and unemployment rate. These findings add to the literature indicating greater effects of non-work-based stressors for women and highlight the influence of the residential environment on women's health.     

Gender differences in work-related injury/illness: analysis of workers compensation claims

BACKGROUND: Risk of work-related injuries/illnesses among females has not been well documented. This study compares compensable work-related injuries/illnesses between females and males across all major industrial sectors and occupations using a state-managed Workers Compensation database. METHODS: Incidence rates were calculated by dividing the number of compensable injuries/illnesses among West Virginia Workers Compensation claimants by the total number of female and male workers in each specific industry class (based on SIC codes). Gender-specific denominators for occupations were estimated using 1990 U.S. Census data. RESULTS: The overall injury/illness rate was significantly lower in females than males (5. 5 vs. 11.5 per 100 employees), a trend that extended to all major industrial classes with the exception of service and agricultural sectors. The distribution of types of injury/illness varied by gender, occupation, and industry with significantly higher risk of carpal tunnel syndrome, burn, sprain, and fracture in females compared to males. CONCLUSIONS: Female workers have a greater risk of specific injury/illness compared to males in various industries. Further research will be needed to understand the role of differential job-tasks within each occupation in explaining the risk difference.     

Gender differences in the early careers of health care managers

In health care, as in many other fields, women's occupational advancement appears to occur more slowly than men's. Two main theories purport to explain this phenomenon: 1) the "glass ceiling" perspective which focuses on structural arrangements and/or the attitudes of those who make promotion decisions, and 2) "supply side" approaches which argue that characteristics of women themselves explain their relative lack of progress. There is also another view that challenges the glass ceiling, suggesting that it affects predominantly older cohorts of women, and that younger entrants experience few advancement obstacles. This study examines these questions using a population of health administrators who graduated between May, 1984 and May, 1995. Gender comparisons reveal considerable similarity between men and women graduates on a variety of early career outcome variables, disputing supply side arguments and suggesting that barriers to women, if they exist, become important after the early career period.     

Gender differences in the use of outpatient mental health services

Current economic constraints necessitats careful planning and evaluation of mental health services. Gender differences in need and use of outpatient mental health services are synthesized based on current epidemiological research. Although overall prevalence rates of mental disorder are similar, women use more outpatient mental health services than do men. This disparity exists largely within the primary care sector. The study of social roles and behavior may help explain these gender differences. Implications for planning and organizing outpatient mental health services are discussed.