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Gender inequality in health among elderly people in a combined framework of socioeconomic position, family characteristics and social support

Published online by Cambridge University Press:  21 April 2009

SILVIA RUEDA  and
LUCÍA ARTAZCOZ
SILVIA RUEDA*
Affiliation:
Universitat Pompeu Fabra, Barcelona, Spain.
LUCÍA ARTAZCOZ
Affiliation:
Agència de Salut Pública de Barcelona, and CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
*
Address for correspondence: Silvia Rueda Pozo, Universitat Pompeu Fabra, C/ Ramón Trias Fargas, 25–27 08005 Barcelona, Spain. E-mail: silvia.rueda@upf.edu
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Abstract

This study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants: socio-economic position, family characteristics and social support. Data came from the 2006 Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.

Keywords

genderinequalitieselderlysocio-economic factorsfamily characteristicssocial support
Type
Research Article
Information
Ageing & Society , Volume 29 , Issue 4 , May 2009 , pp. 625 - 647
Copyright
Copyright © 2009 Cambridge University Press

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References

Allen, S. M., Ciambrone, D. and Welch, L. C. 2000. Stage of life course and social support as a mediator of mood stage among persons with disability. Journal of Aging and Health, 12, 3, 318–41.CrossRefGoogle ScholarPubMed
Aneshensel, C. S., Pearlin, L. I. and Schuler, R. H. 1993. Stress, role captivity, and the cessation of caregiving. Journal of Health and Social Behavior, 34, 1, 54–70.CrossRefGoogle ScholarPubMed
Anson, O. 1988. Living arrangements and women's health. Social Science and Medicine, 26, 2, 201–8.CrossRefGoogle ScholarPubMed
Antonucci, T. C. 1990. Social supports and social relationships. In Binstock, R. H and George, L. K. (eds), Handbook of Aging and the Social Sciences. 3rd edition, Academic, New York, 205–6.Google Scholar
Arber, S. and Cooper, H. 1999. Gender differences in health in later life: the new paradox? Social Science and Medicine, 48, 1, 61–76.CrossRefGoogle ScholarPubMed
Arber, S. and Cooper, H. 2000. Gender and inequalities in health across the life course. In Annandale, E and Hunt, K. (eds), Gender Inequalities in Health. Open University Press, Buckingham, UK, 123–49.Google Scholar
Arber, S. and Ginn, J. 1993. Gender and inequalities in health in later life. Social Science and Medicine, 36, 1, 33–46.CrossRefGoogle ScholarPubMed
Arber, S. and Khlat, M. 2002. Introduction to social and economic patterning of women's health in a changing world. Social Science and Medicine, 54, 5, 643–47.CrossRefGoogle Scholar
Artazcoz, L., Borrell, C., Benach, J., Cortès, I. and Rohlfs, I. 2004. Women, family demands and health: the importance of employment status and socio-economic position. Social Science and Medicine, 59, 2, 263–74.CrossRefGoogle ScholarPubMed
Avlund, K., Holstein, B. E., Osler, M., Damsgaard, M. Y., Holm-Pedersen, P. and Rasmussen, N. K. 2003. Social position and health in old age: The relevance of different indicators ofsocial position. Scandinavian Journal of Public Health, 31, 2, 126–36.CrossRefGoogle Scholar
Backer, K. and Robertson, N. 2008. Coping with caring for someone with dementia: reviewing the literature about men. Aging and Mental Health, 12, 4, 413–22.CrossRefGoogle Scholar
Beckett, L., Brock, D., Lemke, J., Mendes de Leon, C., Guralnik, J., Fillenbaum, G., Branch, L., Wetle, T. and Evans, D. 1996. Analyses of change in self-reported physical functioning among older persons in four population studies. American Journal of Epidemiology, 143, 8, 766–78.CrossRefGoogle ScholarPubMed
Beckett, M. 2000. Converging health inequalities in later life: an artifact of mortality selection? Journal of Health and Social Behavior, 41, 1, 16–19.CrossRefGoogle ScholarPubMed
Bellón, J. A., Delgado, A., de Dios, J. and Lardelli, P. 1996. Validez y fiabilidad del cuestionario de apoyo social funcional. DUKE-UNC-11 [Validity and reliability of the functional social support questionnaire, DUKE-UNC-11]. Atención Primaria, 18, 4153–63.Google Scholar
Borrell, C., Muntaner, C., Benach, J. and Artazcoz, L. 2004. 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 Science and Medicine, 58, 10, 1869–87.CrossRefGoogle ScholarPubMed
Broadhead, W. E., Gehlbach, S. H., Degruy, F. V. and Kaplan, B. H. 1988. The Duke-UNC functional social support questionnaire: measurement of social support in family medicine patients. Medical Care, 26, 7, 709–23.CrossRefGoogle ScholarPubMed
Consejo Economíco y Social (CES) 2000. Vida laboral y prejubilaciones [Working Life and Pre-retirement]. Report 2/2002, CES, Madrid.Google Scholar
Cohen, S. and Wills, T. A. 1985. Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–57.CrossRefGoogle ScholarPubMed
Crocker Houde, S. 2002. Methodological issues in male caregiver research: an integrative review of the literature. Journal of Advanced Nursing, 40, 6, 626–40.Google Scholar
Dahl, E. and Birkelund, E. 1997. Health inequalities in later life in a social democratic welfare state. Social Science and Medicine, 44, 6, 871–81.CrossRefGoogle Scholar
Dalstra, J. A. A., Kunst, A. E., Mackenbach, J. P. and the EU Working Group on Socioeconomic Inequalities in Health 2006. A comparative appraisal of the relationship of education, income and housing tenure with less than good health among elderly people in Europe. Social Science and Medicine, 62, 8, 2046–60.CrossRefGoogle ScholarPubMed
De la Revilla, L., Bailón, E., De Dios, J., Delgado, A., Prados, M. A. and Fleitas, L. 1991. Validación de una escala de apoyo social funcional para su uso en la consulta del médico de familia [Validity of a functional social suport scale for its use on the primary health care]. Atención Primaria, 8, 688–92.Google Scholar
Dean, A., Kolody, B. and Wood, P. 1990. Effects of social support from various sources on depression in elderly persons. Journal of Health and Social Behavior, 31, 2, 148–61.CrossRefGoogle ScholarPubMed
Eachus, J., Williams, M., Chan, P., Davey Smith, G., Grainge, M., Donovan, J. and Frankel, S. 1996. Deprivation and cause-specific morbidity: evidence from the Somerset and Avon Survey of Health. British Medical Journal, 312, 287–92.CrossRefGoogle ScholarPubMed
Eurostat. 2007. Europe in Figures. Eurostat Yearbook 2006–07. Office for Official Publication of the European Communities, Luxembourg.Google Scholar
Evandrou, M., Falkingham, J., Rake, K., Scott, A. and The Research Group Simulating Social Policy for an Ageing Society (SAGE) 2001. The dynamics of living arrangements in later life: evidence from the British Household Panel Survey. Population Trends, 105, 1, 37–44.Google Scholar
Ferraro, K. and Famer, M. 1996. Double jeopardy. Aging as leveler, or persistant health inequality? A longitudinal analysis of white and black Americans. Journal of Gerontology, 51, 6, S319–28.CrossRefGoogle ScholarPubMed
George, L. K., Blazer, D. G., Hughes, D. C. and Fowler, N. 1989. Social support and the outcome of major depression. British Journal of Psychiatry, 154, 478–85.CrossRefGoogle ScholarPubMed
Goldberg, D. 1972. The Detection of Psychiatric Illness by Questionnaire. Oxford University Press, Oxford.Google Scholar
Goldberg, D., Cooper, B., Eastwood, M. R., Kedwart, H. B. and Shepherd, M. 1970. A standardised psychiatric interview for use in community surveys. British Journal of Preventive Social Medicine, 24, 1, 18–23.Google ScholarPubMed
Groffen, D., Bosma, H., Van den Akker, M., Kempen, G. and van Eijk, J. 2007. Material deprivation and health-related dysfunction on older Dutch people: findings from the SMILE study. European Journal of Public Health, 18, 3, 258–63.CrossRefGoogle ScholarPubMed
Gregory, D. M., Peters, N. and Cameron, C. F. 1990. Elderly male spouses as caregivers: toward an understanding of their experience. Journal of Gerontological Nursing, 16, 1, 20–4.CrossRefGoogle ScholarPubMed
Grundy, E. and Holt, G. 2001. The socioeconomic status of older adults: how should we measure it in studies of health inequalities? Journal of Epidemiology and Community Health, 55, 12, 895–904.CrossRefGoogle ScholarPubMed
Grundy, E. and Jitlal, M. 2007. Socio-demographic variations in moves to institutional care 1991–2001: a record linkage study from England and Wales. Age and Ageing, 36, 4, 424–30.CrossRefGoogle ScholarPubMed
Grundy, E. and Sloggett, A. 2003. Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances. Social Science and Medicine, 56, 5, 935–47.CrossRefGoogle ScholarPubMed
Harlow, S. D., Goldberg, E. L. and Comstock, G. W. 1991. A longitudinal study of risk factors for depressive symptomatology in elderly widowed and married women. American Journal of Epidemiology, 134, 5, 526–38.CrossRefGoogle ScholarPubMed
Hirst, M. 2005. Carer distress: a prospective, population-based study. Social Science and Medicine, 61, 3, 697–708.CrossRefGoogle ScholarPubMed
Horowitz, A. 1985. Sons and daughters as caregivers to older parents: difference in role performance and consequences. The Gerontologist, 25, 6, 612–17.CrossRefGoogle ScholarPubMed
Hosmer, D. and Lemeshow, S. 2000. Applied Logistic Regression. Second edition, Wiley, New York.CrossRefGoogle Scholar
Huisman, M., Kunst, A. E. and Mackenbach, J. P. 2003. Socioeconomic inequalities in morbidity among the elderly: a European overview. Social Science and Medicine, 57, 5, 861–73.CrossRefGoogle ScholarPubMed
Hyde, M. and Jones, I. R. 2007. The long shadow of work? Does time since labour market exit affect the association between socio-economic position and health in a post-working population? Journal of Epidemiology and Community Health, 61, 6, 532–38.CrossRefGoogle Scholar
Idler, E. L. 1993. Age differences in self-assessments of health: age changes, cohort differences, or survivorship? Journal of Gerontology, 48, 6, S289–300.CrossRefGoogle ScholarPubMed
Idler, E. L. and Benyamini, Y. 1997. Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 1, 21–37.CrossRefGoogle ScholarPubMed
IMSERSO 2006 a. Las personas mayores en España. Informe 2006 [Older People in Spain. 2006 Report]. Volume I, Institute for Older Persons and Social Services, Ministry of Labour and Social Affairs, Madrid.Google Scholar
IMSERSO 2006 b. Ley de Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia [Law on the Promotion of Personal Autonomy and Care for Dependent Persons]. Institute of the Elderly and Social Services, Ministry of Labour and Social Affairs, Madrid.Google Scholar
IMSERSO 2007. A Propósito de las condiciones de vida de las personas mayores. Encuesta 2006. [About Elderly People's Life Conditions. 2006 Survey]. Observatory for Elderly People, Ministry of Labour and Social Affairs, Madrid.Google Scholar
IMSERSO 2008. Las personas mayores: Indicadores claves por Comunidades Autónomas [Elderly People: Key Indicators by Autonomous Communities]. Available online at http://www.seg-social.es/imserso/estadisticas/1_estadisticas.html [Accessed March 2008].Google Scholar
Jang, Y., Haley, W. E., Small, B. J. and Mortimer, J. A. 2002. The role of mastery and social resources in the associations between disability and depression in later life. The Gerontologist, 42, 6, 807–13.CrossRefGoogle ScholarPubMed
Kaye, L. W. and Applegate, J. S. 1993. Family support groups for male caregivers: benefits of participation. Journal of Gerontological Social Work, 20, 3/4, 167–85.CrossRefGoogle Scholar
Kessler, R. C. and McLeod, J. D. 1985. Social support and mental health in community samples. In Cohen, S and Syme, S. L. (eds), Social Support and Health. Academic Orlando, Florida, 219–40.Google Scholar
Lahelma, E., Arber, S., Kivelä, K. and Roos, E. 2003. Multiple roles and health among British and Finnish women: the influence of socio-economic circumstances. In Arber, S and Khlat, M. (eds), Social and Economic Patterning of Health among Women. Committee for International Research in Demography, Paris, 175–202.Google Scholar
Lahelma, E., Martikainen, P., Rahkonen, O. and Silventoinen, K. 1999. Gender differences in ill-health in Finland: patterns, magnitude and change. Social Science and Medicine, 48, 1, 7–19.CrossRefGoogle Scholar
Macintyre, S., Kunt, H. and Sweeting, H. 1996. Gender differences in health: are things really as simple as they seem? Social Science and Medicine, 42, 4, 617–24.CrossRefGoogle Scholar
Manor, O., Matthews, S. and Power, C. 2000. Dichotomous or categorical response? Analysing self-rated health and lifetime social class. International Journal of Epidemiology, 29, 1, 149–57.CrossRefGoogle ScholarPubMed
Marmot, M., Kogevinas, M. and Elston, M. 1987. Social/economic status and disease. Annual Review of Public Health, 8, 111–35.CrossRefGoogle ScholarPubMed
Marmot, M. and Shipley, M. 1996. Do socio-economic differences in mortality persist after retirement? 25 years follow up of civil servants from the first Whitehall Study. British Medical Journal, 313, 1177–80.CrossRefGoogle Scholar
Matthews, S., Manor, O. and Power, C. 1999. Social inequalities in health: are there gender differences? Social Science and Medicine, 48, 1, 49–60.CrossRefGoogle ScholarPubMed
McMunn, A., Breeze, E., Goodman, A., Nazroo, J. and Oldfield, Z. 2006. Social determinants of health in older age. In Marmot, M and Wilkinson, R. G. (eds), Social Determinants of Health. Oxford University Press, Oxford, 267–96.Google Scholar
Michael, Y., Berkman, L., Colditz, G. and Kawachi, I. 2001. Living arrangements, social integration, and change in functional health status. American Journal of Epidemiology, 153, 2, 123–31.CrossRefGoogle ScholarPubMed
Minkler, M. and Fuller-Thomson, D. 2001. Physical and mental health status of American grandparents providing extensive care to their children. Journal of American Medicine Women's Association, 56, 4, 199–205.Google Scholar
Mompart, A., Medina, A., Brugulat, P. and Tresserras, R. 2007. Encuesta de Salud de Catalunya 2006. Un instrumento de planificación sanitaria. [Catalonian Health Survey 2006. A tool for health planning]. Índice. Revista de Estadística y Sociedad, 20, 19–22.Google Scholar
Mossey, J. and Shapiro, E. 1982. Self-rated health: a predictor of mortality among the elderly. American Journal of Public Health, 72, 8, 800–8.CrossRefGoogle Scholar
Mui, A. 1995. Caring for frail elderly parents: a comparison of adult sons and daughters. The Gerontologist, 35, 1, 86–93.CrossRefGoogle ScholarPubMed
Musil, C. and Ahmad, M. 2002. Health of grandmothers: a comparison by caregiver status. Journal of Aging and Health, 14, 1, 96–121.CrossRefGoogle ScholarPubMed
Nathanson, C. A. 1980. Social roles and health status among women: the significance of employment. Social Science and Medicine, 14a, 6, 463–71.Google ScholarPubMed
Oakley, A. and Rajan, L. 1991. Social class and social support, the same or different? Sociology, 25, 1, 31–59.CrossRefGoogle Scholar
Orfila, F., Ferrer, M., Lamarca, R. and Alonso, J. 2000. Evolution of self-rated health status in the elderly: cross-sectional vs. longitudinal estimates. Journal of Clinical Epidemiology, 53, 6, 563–570.CrossRefGoogle ScholarPubMed
Otero, A., Zunzunegui, M. V., Béland, F., Rodríguez Laso, A. and García de Yebenes, M. J. 2006. Relaciones sociales y envejecimiento saludable [Social Relations and Healthy Ageing. Working Paper 9] Fundación BBVA, Madrid.Google Scholar
Oxman, T. E., Berkman, L. F., Kasl, S., Freeman, D. H. and Barret, J. 1992. Social support and depressive symptoms in the elderly. American Journal of Epidemiology, 135, 4, 356–68.CrossRefGoogle ScholarPubMed
Pavalko, E. and Woodbury, S. 2000. Social roles as process: caregiving careers and women's health. Journal of Health and Social Behavior, 41, 1, 91–105.CrossRefGoogle ScholarPubMed
Pearce, D. 1978. The feminisation of poverty: women, work and welfare. Urban and Social Change Review (Special Issue on Women and Work), 11, 28–36.Google Scholar
Rahkonen, O. and Takala, P. 1998. Social class differences in health and in functional disability among older men and women. International Journal of Health Services, 28, 3, 511–24.CrossRefGoogle ScholarPubMed
Rogers, R. G. 1996. The effects of family composition, health, and social support linkages on mortality. Journal of Health and Social Behavior, 37, 4, 326–38.CrossRefGoogle ScholarPubMed
Ross, C. E. and Mirowsky, J. 1995. Does employment affect health? Journal of Health and Social Behavior, 36, 3, 230–243.CrossRefGoogle ScholarPubMed
Sarwari, A., Fredman, L., Langenberg, P. and Magaziner, J. 1998. Prospective study on the relation between living arrangements and change in functional health status of elderly women. American Journal of Epidemiology, 147, 4, 370–8.CrossRefGoogle ScholarPubMed
Schulz, R. and Beach, S. R. 1999. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. Journal of the American Journal Association, 282, 23, 2215–19.Google ScholarPubMed
Shye, D., Mullooly, J. P., Freeborn, D. K. and Pope, C. 1995. Gender differences in the relationship between social network support and mortality: a longitudinal study. Social Science and Medicine, 41, 7, 935–47.CrossRefGoogle ScholarPubMed
Sonnenberg, C., Beekman, A., Deeg, D. and van Tilburg, W. 2000. Sex differences in late-life depression. Acta Psychiatrica Scandinavica, 101, 4, 286–92.Google ScholarPubMed
Stansfeld, S. 1999. Social support and social cohesion. In Marmot, M and Wilkinson, R. G. (eds), Social Determinants of Health. Oxford University Press, Oxford, 155–78.Google Scholar
Taylor, M. G. and Lynch, S. M. 2004. Trajectories of impairment, social support, and depressive symptoms in later life. Journal of Gerontology, 59, 4, S238–46.CrossRefGoogle ScholarPubMed
Thorslund, M. and Lundberg, O. 1994. Health and inequalities among the oldest old. Journal of Aging & Health, 6, 1, 51–69.CrossRefGoogle ScholarPubMed
Turner, R. J. and Noh, S. 1988. Physical disability and depression: a longitudinal analysis. Journal of Health and Social Behavior, 29, 1, 23–37.CrossRefGoogle ScholarPubMed
United Nations Organisation 2005. Living Arrangements of Older Persons Around the World. Department of Economic and Social Affairs, UNO, New York.Google Scholar
United Nations Organisation 2006. World Population Prospects: The 2006 Revision. UNO, New York. Available online at http://www.un.org/esa/population/publications/wpp2006/wpp2006.htm. [Accessed February 2008].Google Scholar
Victoria, C. G., Huttly, S. R., Fuchs, S. C. and Olinto, M. T. 1997. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International Journal of Epidemiology, 26, 1, 224–7.CrossRefGoogle Scholar
Von Dem Knesebeck, O., Wahrendorf, M., Hyde, M. and Siegrist, J. 2007. Socio-economic position and quality of life among older people in 10 European countries: results of the SHARE study. Ageing & Society, 27, 2, 269–84.CrossRefGoogle Scholar
Vvorisalmi, M., Lintonen, T. and Jylhä, M. 2006. Comparative vs. global self-rated health: associations with age and functional ability. Aging Clinical and Experimental Research, 18, 3, 211–7.CrossRefGoogle Scholar
Walker, A., Pratt, C. and Eddy, L. 1995. Informal caregiving to aging family members: a critical review. Family Relations, 44, 4, 402–11.CrossRefGoogle Scholar
Wethington, E. and Kessler, R. C. 1986. Perceived support, received support, and adjustment to stressful life events. Journal of Health and Social Behavior, 2, 1, 78–89.CrossRefGoogle Scholar
Zimmer, Z. 2001. A further discussion on revisiting the classification of household composition among elderly people. Journal of Cross Cultural Gerontology, 18, 247–50.CrossRefGoogle Scholar
Zunzunegui, M. V., Béland, F., Yacer, A. and León, V. 1998. Gender differences in depressive symptoms among Spanish elderly. Social Psychiatry and Psychiatric Epidemiology, 33, 5, 195–205.CrossRefGoogle ScholarPubMed
Zunzunegui, M. V., Koné, A., Johri, M., Béland, F., Wolfson, C. and Bergman, H. 2004. Social networks and self-assessed health in two French-speaking Canadian community dwelling populations over 65. Social Science and Medicine, 58, 10, 2069–81.CrossRefGoogle Scholar