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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ahrenfeldt LJ, Lindahl-Jacobsen R, Rizzi S, Thinggaard M, Christensen K, Vaupel JW (2018a) Comparison of cognitive and physical functioning of Europeans in 2004–2005 and 2013. Int J Epidemiol. https://doi.org/10.1093/ije/dyy094
Ahrenfeldt LJ, Scheel-Hincke LL, Kjaergaard S, Möller S, Christensen K, Lindahl-Jacobsen R (2018b) Gender differences in cognitive function and grip strength: a cross-national comparison of four European regions. Eur J Public Health. https://doi.org/10.1093/eurpub/cky266
Ahrenfeldt LJ, Möller S, Thinggaard M, Christensen K, Lindahl-Jacobsen R (2019) Sex differences in comorbidity and frailty in Europe. Int J Public Health 64(7):1025–1036. https://doi.org/10.1007/s00038-019-01270-9
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), Mannheim
Arber S, Cooper H (1999) Gender differences in health in later life: the new paradox? Soc Sci Med 48:61–76
Austad SN, Fischer KE (2016) Sex differences in lifespan. Cell Metab 23:1022–1033. https://doi.org/10.1016/j.cmet.2016.05.019
Barberger-Gateau P, Fabrigoule C (1997) Disability and cognitive impairment in the elderly. Disabil Rehabil 19:175–193. https://doi.org/10.3109/09638289709166525
Barford A, Dorling D, Smith GD, Shaw M (2006) Life expectancy: women now on top everywhere: during 2006, even in the poorest countries, women can expect to outlive men. BMJ 332:808. https://doi.org/10.1136/bmj.332.7545.808
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
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), Munich
Bird CE, Fremont AM (1991) Gender, time use, and health. J Health Soc Behav 32:114–129
Bleijenberg N, Zuithoff NPA, Smith AK, de Wit NJ, Schuurmans MJ (2017) Disability in the individual ADL, IADL, and mobility among older adults: a prospective cohort study. J Nutr Health Aging 21:897–903. https://doi.org/10.1007/s12603-017-0891-6
Börsch-Supan A et al (2013) Data resource profile: the survey of health, ageing and retirement in Europe (SHARE). Int J Epidemiol 42:992–1001. https://doi.org/10.1093/ije/dyt088
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
Case A, Paxson C (2005) Sex differences in morbidity and mortality. Demography 42:189–214. https://doi.org/10.1353/dem.2005.0011
Chatterji S, Byles J, Cutler D, Seeman T, Verdes E (2015) Health, functioning, and disability in older adults–present status and future implications. Lancet 385:563–575. https://doi.org/10.1016/S0140-6736(14)61462-8
Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208. https://doi.org/10.1016/s0140-6736(09)61460-4
Christensen K et al (2013) Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart. Lancet 382:1507–1513. https://doi.org/10.1016/s0140-6736(13)60777-1
Crimmins EM, Kim JK, Solé-Auró A (2011) Gender differences in health: results from SHARE, ELSA and HRS. Eur J Public Health 21:81–91. https://doi.org/10.1093/eurpub/ckq022
Crimmins EM, Shim H, Zhang YS, Kim JK (2019) Differences between men and women in mortality and the health dimensions of the morbidity process. Clin Chem 65:135–145. https://doi.org/10.1373/clinchem.2018.288332
Dahlin J, Härkönen J (2013) Cross-national differences in the gender gap in subjective health in Europe: Does country-level gender equality matter? Soc Sci Med 98:24–28. https://doi.org/10.1016/j.socscimed.2013.08.028
Denton M, Prus S, Walters V (2004) Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health. Soc Sci Med 58:2585–2600. https://doi.org/10.1016/j.socscimed.2003.09.008
Eikemo TA, Huisman M, Bambra C, Kunst AE (2008) Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health Illn 30:565–582. https://doi.org/10.1111/j.1467-9566.2007.01073.x
Eurostat (2019) Tobacco consumption statistics. Eurostat. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Tobacco_consumption_statistics#Context. Accessed 6 June 2019
Fedarko NS (2011) The biology of aging and frailty. Clin Geriatr Med 27:27–37. https://doi.org/10.1016/j.cger.2010.08.006
Ferrera M (1996) The ‘Southern Model’ of welfare in social Europe. J Eur Soc Policy 6:17–37. https://doi.org/10.1177/095892879600600102
Herr M et al (2018) Frailty and associated factors among centenarians in the 5-COOP countries. Gerontology. https://doi.org/10.1159/000489955
Horackova K, Kopecek M, Machu V, Kagstrom A, Aarsland D, Motlova LB, Cermakova P (2019) Prevalence of late-life depression and gap in mental health service use across European regions. Eur Psychiatry 57:19–25. https://doi.org/10.1016/j.eurpsy.2018.12.002
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
Jeune B et al (2006) Handgrip strength among nonagenarians and centenarians in three european regions. J Gerontol Ser A 61:707–712
Kaneda T, Zimmer Z, Fang X, Tang Z (2009) Gender differences in functional health and mortality among the chinese elderly: testing an exposure versus vulnerability hypothesis. Res Aging 31:361–388. https://doi.org/10.1177/0164027508330725
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biologic and psychologic function. JAMA 185:94–99
Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186
Light KE, Thigpen MT (2017) Perception of physical capacity and IADL performance in older men. OAJ Gerontol Geriatr Med 2:1–12. https://doi.org/10.19080/OAJGGM.2017.02.555583
Lin SF, Beck AN, Finch BK, Hummer RA, Masters RK (2012) Trends in US older adult disability: exploring age, period, and cohort effects. Am J Public Health 102:2157–2163. https://doi.org/10.2105/ajph.2011.300602
McDonough P, Walters V (2001) Gender and health: reassessing patterns and explanations. Soc Sci Med 52:547–559
Merrill SS, Seeman TE, Kasl SV, Berkman LF (1997) Gender differences in the comparison of self-reported disability and performance measures. J Gerontol A Biol Sci Med Sci 52:M19–M26. https://doi.org/10.1093/gerona/52a.1.m19
Murtagh KN, Hubert HB (2004) Gender differences in physical disability among an elderly cohort. Am J Public Health 94:1406–1411. https://doi.org/10.1007/s10654-010-9460-6
Noelker LS, Browdie R, Sidney Katz MD (2014) A new paradigm for chronic illness and long-term care. Gerontologist 54:13–20. https://doi.org/10.1093/geront/gnt086
Noordzij M, van Diepen M, Caskey FC, Jager KJ (2017) Relative risk versus absolute risk: one cannot be interpreted without the other. Nephrol Dial Transplant 32:ii13–ii18. https://doi.org/10.1186/s12939-017-0673-0
Oeppen J, Vaupel JW (2002) Demography. Broken limits to life expectancy. Science 296:1029–1031. https://doi.org/10.1126/science.1069675
Oksuzyan A, Bronnum-Hansen H, Jeune B (2010a) Gender gap in health expectancy. Eur J Ageing 7:213–218. https://doi.org/10.1007/s10433-010-0170-4
Oksuzyan A, Crimmins E, Saito Y, O’Rand A, Vaupel JW, Christensen K (2010b) Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. Eur J Epidemiol 25:471–480. https://doi.org/10.1007/s10654-010-9460-6
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
Peek MK, Coward RT (1999) Gender differences in the risk of developing disability among older adults with arthritis. J Aging Health 11:131–150. https://doi.org/10.1177/089826439901100201
Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, Yusuf S (2015) The burden of disease in older people and implications for health policy and practice. Lancet 385:549–562. https://doi.org/10.1016/S0140-6736(14)61347-7
Rasmussen SH, Thinggaard M, Hojgaard MB, Jeune B, Christensen K, Andersen-Ranberg K (2017) Improvement in activities of daily living among danish centenarians? J Gerontol A Biol Sci Med Sci. https://doi.org/10.1093/gerona/glx113
Ross CE, Bird CE (1994) Sex stratification and health lifestyle: consequences for men’s and women’s perceived health. J Health Soc Behav 35:161–178. https://doi.org/10.2307/2137363
Schon P, Parker MG, Kareholt I, Thorslund M (2011) Gender differences in associations between ADL and other health indicators in 1992 and 2002. Aging Clin Exp Res 23:91–98
Schünemann J, Strulik H, Trimborn T (2017) The gender gap in mortality: How much is explained by behavior? J Health Econ 54:79–90. https://doi.org/10.1016/j.jhealeco.2017.04.002
Serrano-Alarcón M, Perelman J (2017) Ageing under unequal circumstances: a cross-sectional analysis of the gender and socioeconomic patterning of functional limitations among the Southern European elderly. Int J Equity Health 16:175. https://doi.org/10.1186/s12939-017-0673-0
Sheehan CM, Tucker-Drob EM (2017) Gendered expectations distort male–female differences in instrumental activities of daily living in later adulthood. J Gerontol B Psychol Sci Soc Sci. https://doi.org/10.1093/geronb/gbw209
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
Wahrendorf M, Reinhardt JD, Siegrist J (2013) Relationships of disability with age among adults aged 50–85: evidence from the United States, England and continental europe. PLoS ONE 8:e71893. https://doi.org/10.1371/journal.pone.0071893
Weber D, Skirbekk V, Freund I, Herlitz A (2014) The changing face of cognitive gender differences in Europe. Proc Natl Acad Sci 111:11673–11678. https://doi.org/10.1073/pnas.1319538111
Wheaton FV, Crimmins EM (2016) Female disability disadvantage: a global perspective on sex differences in physical function and disability. Ageing Soc 36:1136–1156. https://doi.org/10.1017/S0144686X15000227
Wray LA, Blaum CS (2001) Explaining the role of sex on disability: a population-based study. Gerontologist 41:499–510. https://doi.org/10.1093/geront/41.4.499
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.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Responsible editor: Susanne Iwarsson.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Scheel-Hincke, L.L., Möller, S., Lindahl-Jacobsen, R. et al. Cross-national comparison of sex differences in ADL and IADL in Europe: findings from SHARE. Eur J Ageing 17, 69–79 (2020). https://doi.org/10.1007/s10433-019-00524-y
- Sex differences