Cross-national comparison of sex differences in ADL and IADL in Europe: findings from SHARE
Women experience greater longevity than men, but have poorer health, although sex differences vary across health measures and geographical regions. We aim to examine sex differences in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) over age across European regions in a cross-sectional setting including 51,292 men and 62,007 women aged 50+ from a pooled sample of waves 1 (2004–2005) to 6 (2015) in the Survey of Health, Ageing and Retirement in Europe. ADL and IADL were dichotomised into no limitations and at least one limitation. Binomial regression models were used to estimate absolute and relative sex differences. Women had higher risk than men of ADL limitations (RR = 1.21, 95% CI 1.16; 1.27) and IADL limitations (RR = 1.54, 95% CI 1.48; 1.60), corresponding to risk differences of 1.3% and 5.7%, respectively. When we stratified by age groups and regions, sex differences in ADL were found in all age groups in Southern Europe, in the age groups 65–79 years and 80+ years in Western and Eastern Europe, and from the age of 80 in Northern Europe. For IADL, sex differences were found in all age groups in the four European regions, except from ages 50–64 in Eastern Europe. The absolute sex differences increased with age in all European regions. In conclusion, our results lend support for the male–female health survival paradox by showing that European women have higher risk of ADL and IADL limitations than European men and that sex differences increase with advancing age.
KeywordsSex differences ADL IADL Age SHARE Europe
This paper uses data from SHARE waves 1, 2, 4, 5 and 6, see Börsch-Supan et al. (2013) for methodological details (Börsch-Supan et al. 2013). The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: No. 211909, SHARE-LEAP: No. 227822, SHARE M4: No. 261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged.
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Conflict of interest
The authors declare that they have no conflict of interest.
- Alcser KH et al (2005) The survey of health, aging, and retirement in europe—methodology. Mannheim Mannheim Research Institute for the Economics of Aging (MEA), MannheimGoogle Scholar
- Bergmann MM, Byers T, Freedman DS, Mokdad A (1998) Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults. Am J Epidemiol 147:969–977. https://doi.org/10.1093/oxfordjournals.aje.a009387 CrossRefGoogle Scholar
- Bergmann M, Kneip T, De Luca G, Scherpenzeel A (2017) Survey participation in the Survey of Health, Ageing and Retirement in Europe (SHARE), Wave 1-6. SHARE Working Paper Series 31-2017. Munich Center for the Economics of Aging (MEA), MunichGoogle Scholar
- Buchmann C, DiPrete TA, McDaniel A (2008) Gender inequalities in education. Annu Rev Sociol 34:319–337. https://doi.org/10.1146/annurev.soc.34.040507.134719 CrossRefGoogle Scholar
- Eurostat (2019) Tobacco consumption statistics. Eurostat. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Tobacco_consumption_statistics#Context. Accessed 6 June 2019
- Jerez-Roig J, Bosque-Prous M, Gine-Garriga M, Bagur-Calafat C, Bezerra de Souza DL, Teixido-Compano E, Espelt A (2018) Regional differences in the profile of disabled community-dwelling older adults: a European population-based cross-sectional study. PLoS ONE 13:e0208946. https://doi.org/10.1371/journal.pone.0208946 CrossRefGoogle Scholar
- Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ (2004) Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol 57:1096–1103. https://doi.org/10.1016/j.jclinepi.2004.04.005 CrossRefGoogle Scholar
- Van Oyen H, Cox B, Jagger C, Cambois E, Nusselder W, Gilles C, Robine J-M (2010) Gender gaps in life expectancy and expected years with activity limitations at age 50 in the European Union: associations with macro-level structural indicators. Eur J Ageing 7:229–237. https://doi.org/10.1007/s10433-010-0172-2 CrossRefGoogle Scholar