Cross-national comparison of sex differences in ADL and IADL in Europe: findings from SHARE

  • Lasse Lybecker Scheel-Hincke
  • Sören Möller
  • Rune Lindahl-Jacobsen
  • Bernard Jeune
  • Linda Juel AhrenfeldtEmail author
Original Investigation


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.


Sex 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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10433_2019_524_MOESM1_ESM.docx (29 kb)
Supplementary material 1 (DOCX 28 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Unit of Epidemiology, Biostatistics and Biodemography, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
  2. 2.OPEN – Odense Patient data Explorative NetworkOdense University HospitalOdenseDenmark
  3. 3.Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark

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