Department of Public Health and Clinical Medicine, Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Glob Health Action. 2010 Sep 27;3. doi: 10.3402/gha.v3i0.5420.
Declining rates of fertility and mortality are driving demographic transition in all regions of the world, leading to global population ageing and consequently changing patterns of global morbidity and mortality. Understanding sex-related health differences, recognising groups at risk of poor health and identifying determinants of poor health are therefore very important for both improving health trajectories and planning for the health needs of ageing populations.
To determine the extent to which demographic and socio-economic factors impact upon measures of health in older populations in Africa and Asia; to examine sex differences in health and further explain how these differences can be attributed to demographic and socio-economic determinants.
A total of 46,269 individuals aged 50 years and over in eight Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network were studied during 2006-2007 using an abbreviated version of the WHO Study on global AGEing and adult health (SAGE) Wave I instrument. The survey data were then linked to longitudinal HDSS background information. A health score was calculated based on self-reported health derived from eight health domains. Multivariable regression and post-regression decomposition provide ways of measuring and explaining the health score gap between men and women.
Older men have better self-reported health than older women. Differences in household socio-economic levels, age, education levels, marital status and living arrangements explained from about 82% and 71% of the gaps in health score observed between men and women in South Africa and Kenya, respectively, to almost nothing in Bangladesh. Different health domains contributed differently to the overall health scores for men and women in each country.
This study confirmed the existence of sex differences in self-reported health in low- and middle-income countries even after adjustments for differences in demographic and socio-economic factors. A decomposition analysis suggested that sex differences in health differed across the HDSS sites, with the greatest level of inequality found in Bangladesh. The analysis showed considerable variation in how differences in socio-demographic and economic characteristics explained the gaps in self-reported health observed between older men and women in African and Asian settings. The overall health score was a robust indicator of health, with two domains, pain and sleep/energy, contributing consistently across the HDSS sites. Further studies are warranted to understand other significant individual and contextual determinants to which these sex differences in health can be attributed. This will lay a foundation for a more evidence-based approach to resource allocation, and to developing health promotion programmes for older men and women in these settings.
生育率和死亡率的下降正在推动世界所有地区的人口转型，导致全球人口老龄化，从而改变全球发病率和死亡率的模式。因此，了解与性别相关的健康差异、识别健康状况不佳的风险群体以及确定健康状况不佳的决定因素，对于改善健康轨迹和规划老龄化人口的健康需求都非常重要。
确定人口和社会经济因素对非洲和亚洲老年人口健康指标的影响程度；研究健康方面的性别差异，并进一步解释这些差异如何归因于人口和社会经济决定因素。
在 2006-2007 年期间，使用世界卫生组织全球老龄化和成人健康研究（SAGE）第一波的简化版问卷，对 INDEPTH 网络内的 8 个健康和人口监测系统（HDSS）站点内的 46269 名 50 岁及以上的个体进行了研究。然后将调查数据与纵向 HDSS 背景信息相联系。根据来自 8 个健康领域的自我报告健康状况，计算了一个健康评分。多变量回归和回归后分解提供了衡量和解释男女健康评分差距的方法。
老年男性的自我报告健康状况好于老年女性。在南非和肯尼亚，家庭社会经济水平、年龄、教育程度、婚姻状况和居住安排方面的差异，分别解释了男女健康评分差距的 82%和 71%左右，而在孟加拉国，这些差异几乎可以忽略不计。不同的健康领域对每个国家男女的总体健康评分有不同的贡献。
即使在调整了人口和社会经济因素的差异后，这项研究也证实了在中低收入国家中自我报告健康方面存在性别差异。分解分析表明，健康方面的性别差异在不同的 HDSS 站点之间存在差异，在孟加拉国，不平等程度最高。分析表明，在解释非洲和亚洲老年男女自我报告健康状况差距方面，社会人口和经济特征的差异有很大的变化。总体健康评分是健康的一个强有力的指标，两个领域，疼痛和睡眠/能量，在所有 HDSS 站点都一致存在。有必要进一步研究以了解可归因于这些健康性别差异的其他重要个体和背景决定因素。这将为在这些环境中为老年男女分配资源和制定健康促进计划奠定基础。
