Gender differences and burden of chronic conditions: impact on quality of life among the elderly in Taiwan

  • Tsung Yu
  • Nomin Enkh-Amgalan
  • Ganchimeg Zorigt
  • Yea-Jen Hsu
  • Hsin-Jen Chen
  • Hsing-Yu YangEmail author
Original Article



Multiple chronic conditions affect people’s health-related quality of life (QoL) and the distributions of the conditions may differ between genders. Our goal was to examine gender differences in chronic conditions and QoL among community-living elderly in Taiwan and to examine whether differences in QoL between genders, if present, were attributable to the distribution of chronic conditions.


We used data from the Nutrition and Health Survey in Taiwan (NAHSIT, 2005–2008), which interviewed a representative sample of the Taiwanese population. The survey questions included the SF-36 questionnaire to assess participants’ QoL and items for participants’ medical history. We used multiple linear regressions to examine the difference in QoL between genders.


We included 1179 elders for our analysis; men accounted for 52% (612/1179). The mean age was 73; women were slightly younger. The mean (standard deviation) of SF-36 physical and mental health component score (PCS and MCS) was 44.5 (11.1) and 55.6 (9.0), respectively, and women reported a significantly lower PCS than men (difference − 4.85, p < 0.001). Urinary incontinence, arthritis, stroke, and kidney disease were associated with a clinically meaningful decrease in PCS (≤ − 6.5 points). The difference in PCS between genders was not attenuated after we accounted for chronic conditions in regression analysis.


Our findings suggest that women tend to report that their physical health-related QoL is poorer than that of men, and such a difference does not seem to be attributable to the distribution of chronic conditions. Elderly men and women may perceive health-related QoL differently.


Health-related quality of life Gender differences Chronic conditions Health survey 



Mental health component score


Nutrition and health survey in Taiwan


Physical health component score


Quality of life


Short form 36



Data analyzed in this paper were collected by the research project “Nutrition and Health Survey in Taiwan (NAHSIT 2005–2008)” sponsored by the Department of Health in Taiwan (DOH94-fs-6-4). This research project was carried out by the Center for Survey Research of the Research Center for Humanities and Social Sciences of Academia Sinica, directed by Professor Wen-Harn Pan. The Office of Nutrition Survey, the Institute of Biomedical Sciences, Academia Sinica is responsible for data distribution. The assistance provided by the institutes and efforts made by all contributed to the survey are greatly appreciated. The views expressed herein are solely those of the authors.

Author contributions

TY study design, data analysis, and manuscript preparation. NEA study design and manuscript preparation. GZ study design and manuscript preparation. YJH manuscript preparation. HJC manuscript preparation. HY study design and manuscript preparation. All authors read and approved the final version of manuscript.


TY was partly funded by the Ministry of Science and Technology in Taiwan. HY was funded by Mackay Medical College (1071B07 & 1061B05). NEA and GZ were partly funded by the Department of Public Health, China Medical University, Taiwan.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The survey implementation and instruments were approved by the Institutional Review Board of Academia Sinica, Taiwan.

Informed consent

All participants signed the informed consent forms.

Supplementary material

40520_2018_1099_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 33 KB)


  1. 1.
    Global Health Observatory (GHO) data. World Health Organization. Accessed 1 July 2018
  2. 2.
    Department of Statistics, Ministry of the Interior, Taiwan. Accessed 1 July 2018
  3. 3.
    Orfila F et al (2006) Gender differences in health-related quality of life among the elderly: the role of objective functional capacity and chronic conditions. Soc Sci Med 63:2367–2380CrossRefGoogle Scholar
  4. 4.
    Case A, Paxson C (2005) Sex differences in morbidity and mortality. Demography 42:189–214CrossRefGoogle Scholar
  5. 5.
    Bowling A et al (1999) Short form 36 (SF-36) health survey questionnaire: which normative data should be used? Comparisons between the norms provided by the Omnibus Survey in Britain, the Health Survey for England and the Oxford Healthy Life Survey. J Public Health Med 21:255–270CrossRefGoogle Scholar
  6. 6.
    Cherepanov D et al (2011) Gender differences in multiple underlying dimensions of health-related quality of life are associated with sociodemographic and socioeconomic status. Med Care 49:1021–1030CrossRefGoogle Scholar
  7. 7.
    Wilson IB, Cleary PD (1995) Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. Jama 273:59–65CrossRefGoogle Scholar
  8. 8.
    Lin YY, Huang CS (2016) Aging in Taiwan: building a society for active aging and aging in place. Gerontologist 56:176–183CrossRefGoogle Scholar
  9. 9.
    Fortin M et al (2004) Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes 2:51CrossRefGoogle Scholar
  10. 10.
    Tu SH et al (2011) Design and sample characteristics of the 2005–2008 nutrition and health survey in Taiwan. Asia Pac J Clin Nutr 20:225–237PubMedGoogle Scholar
  11. 11.
    Chiang PH et al (2013) Leisure time physical activities and dietary quality of the general and indigenous Taiwanese populations are associated with fat distribution and sarcopenia. Asia Pac J Clin Nutr 22:599–613PubMedGoogle Scholar
  12. 12.
    Tseng HM, Lu JF, Gandek B (2003) Cultural issues in using the SF-36 health survey in Asia: results from Taiwan. Health Qual Life Outcomes 1:72CrossRefGoogle Scholar
  13. 13.
    Hays RD,Sherbourne CD Mazel RM,1995 User’s manual for the Medical Outcomes Study (MOS) core measures of health-related quality of life Rand Corporation, Santa MonicaGoogle Scholar
  14. 14.
    StataCorp,2011 Stata survey data reference manual: release 13, Stata Press Publication: College StationGoogle Scholar
  15. 15.
    Ware JE Jr et al (1996) Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. Jama 276:1039–1047CrossRefGoogle Scholar
  16. 16.
    Heidelbaugh J, Lipid disorders: a multidisciplinary approach, 1e (clinics collections), Vol. Volume 5C, 1st Elsevier Amsterdam. 2015Google Scholar
  17. 17.
    Derby CA et al (2009) Lipid changes during the menopause transition in relation to age and weight: the Study of Women’s Health Across the Nation. Am J Epidemiol 169:1352–1361CrossRefGoogle Scholar
  18. 18.
    Ko Y, Coons SJ (2005) An examination of self-reported chronic conditions and health status in the 2001 Medicare Health Outcomes Survey. Curr Med Res Opin 21:1801–1808PubMedGoogle Scholar
  19. 19.
    Bartoli S, Aguzzi G, Tarricone R (2010) Impact on quality of life of urinary incontinence and overactive bladder: a systematic literature review. Urology 75:491–500CrossRefGoogle Scholar
  20. 20.
    Matcham F et al (2014) The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: a systematic review and meta-analysis. Semin Arthritis Rheum 44:123–130CrossRefGoogle Scholar
  21. 21.
    Hanmer J, Kaplan RM (2016) Update to the report of nationally representative values for the noninstitutionalized US adult population for five health-related quality-of-life scores. Value Health 19:1059–1062CrossRefGoogle Scholar
  22. 22.
    Greenspan JD et al (2007) Studying sex and gender differences in pain and analgesia: a consensus report. Pain 132:S26–S45CrossRefGoogle Scholar
  23. 23.
    Bowling A et al (2002) A multidimensional model of the quality of life in older age. Aging Ment Health 6:355–371CrossRefGoogle Scholar
  24. 24.
    Mondor L et al (2016) The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients. Qual Life Res 25:2619–2632CrossRefGoogle Scholar
  25. 25.
    Parker L et al (2014) The burden of common chronic disease on health-related quality of life in an elderly community-dwelling population in the UK. Fam Pract 31:557–563CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tsung Yu
    • 1
  • Nomin Enkh-Amgalan
    • 2
  • Ganchimeg Zorigt
    • 2
  • Yea-Jen Hsu
    • 3
  • Hsin-Jen Chen
    • 4
  • Hsing-Yu Yang
    • 5
    Email author
  1. 1.Department of Public Health, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  2. 2.Mongolian National University of Medical SciencesUlaanbaatarMongolia
  3. 3.Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Institute of Public HealthNational Yang-Ming UniversityTaipeiTaiwan
  5. 5.Department of NursingMackay Medical CollegeNew Taipei CityTaiwan

Personalised recommendations