Ladwig K H, Marten-Mittag B, Formanek B, Dammann G
Institut und Poliklinik für Psychosomatische Medizin, Med. Psychologie und Psychotherapie des Klinikums Rechts der Isar der Technischen Universität München, Germany.
Eur J Epidemiol. 2000 Jun;16(6):511-8. doi: 10.1023/a:1007629920752.
Gender differences in morbidity have been widely confirmed in representative health surveys in North America and Europe. Significantly more women than men suffer from somatic complaints. It is less clear whether differences in symptom reporting provide an impact on health care utilization and to which degree psychosocial factors exhibit confounding influence.
We analyzed data from a representative health examination survey in Germany with 7466 participants in the age range of 25 to 69 years.
The analysis confirmed an overall excess in female symptom reporting, both in the total sample (n = 7460; p < or = 0.001) and in the healthy subsample (n = 906, p < or = 0.01). Also, female utilization of medical services was higher (p < or = 0.0001). A simultaneous age related increase in the prevalence of symptom reporting in both groups peaked in the age group of 55-59 years followed by a subsequent slight decrease in higher age groups whereas utilization steadily increased over the adult life span in both sexes. As expected, more medical utilization was associated with higher symptom reporting levels. Nevertheless, females constantly exhibited more medical utilization than males in all symptom reporting groups. Age and marital status had no univariate influence on symptom reporting whereas low social class status (p = 0.001), poor perceived/self assessed health (p < 0.0001), and high levels of chronic distress (p < 0.0001) were associated with more symptom reporting. In multivariate analysis, the female gender lost its significance on heightened symptom reporting. Poor perceived/self assessed health had the most pronounced impact on symptom count (F-value 59.1; p < 0.001).
The present study confirms a female excess of symptom reporting and utilization of medical services. Nevertheless, symptom reporting and utilization are not closely related. The gender gap in symptom reporting may be largely explained by low social class status, high levels of chronic distress and poor perceived/self assessed health.
北美和欧洲具有代表性的健康调查已广泛证实了发病率方面的性别差异。患有躯体不适的女性明显多于男性。症状报告的差异是否会对医疗保健利用产生影响，以及社会心理因素在何种程度上具有混杂影响，目前尚不清楚。
我们分析了德国一项具有代表性的健康检查调查的数据，该调查有7466名年龄在25至69岁之间的参与者。
分析证实，无论是在总样本（n = 7460；p≤0.001）还是健康子样本（n = 906，p≤0.01）中，女性的症状报告总体上都更多。此外，女性对医疗服务的利用率更高（p≤0.0001）。两组中症状报告患病率同时随年龄增长，在55 - 59岁年龄组达到峰值，随后在更高年龄组略有下降，而利用率在两性的成年期均稳步上升。正如预期的那样，更多的医疗利用与更高的症状报告水平相关。然而，在所有症状报告组中，女性的医疗利用率始终高于男性。年龄和婚姻状况对症状报告没有单变量影响，而低社会阶层地位（p = 0.001）、较差的感知/自我评估健康状况（p＜0.0001）和高水平的慢性困扰（p＜0.0001）与更多的症状报告相关。在多变量分析中，女性性别对症状报告增加不再具有显著意义。较差的感知/自我评估健康状况对症状计数的影响最为显著（F值59.1；p＜0.001）。
本研究证实女性在症状报告和医疗服务利用方面更为突出。然而，症状报告和利用并非密切相关。症状报告中的性别差距可能在很大程度上由低社会阶层地位、高水平的慢性困扰和较差的感知/自我评估健康状况所解释。
