Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.
Eur J Public Health. 2019 Feb 1;29(1):99-104. doi: 10.1093/eurpub/cky138.
Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population.
Data comprised 17 549 individuals age 50+, who participated in the 2008-09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity.
Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1-12.0) and women (16.0%, CI 13.6-18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5-6.9%), and for women anxiety-depression (4.0, CI 3.1-5.0%) closely followed by heart diseases (3.8%, CI 2.9-4.7%). Women's higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women's higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions.
The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.
女性的残疾报告比男性多，这可能是由于疾病的性别差异和/或其致残影响的性别差异所致。我们比较了法国男女慢性疾病对残疾的影响，并研究了排除机构化人口的影响。
数据包括年龄在 50 岁及以上的 17549 名个体，他们参加了 2008-09 年法国残疾健康调查，包括居住在机构中的人。残疾是根据健康问题导致人们通常活动受限的情况来定义的（总体活动限制指标）。分别按性别拟合加性回归模型，以考虑多发病情况来估计疾病对残疾的贡献。
肌肉骨骼疾病是男性（10.1%，95%置信区间：8.1-12.0）和女性（16.0%，95%置信区间：13.6-18.2）残疾的主要原因。男性的第二大病因是心脏病（5.7%，95%置信区间：4.5-6.9%），女性的第二大病因是焦虑-抑郁（4.0%，95%置信区间：3.1-5.0%），紧随其后的是心脏病（3.8%，95%置信区间：2.9-4.7%）。女性肌肉骨骼疾病的高患病率和致残影响反映了其更高的残疾贡献；女性焦虑-抑郁的高患病率和心脏病的低患病率反映了性别差异。排除机构化人口并没有改变总体结论。
女性残疾比男性高的最大原因是患病率高但致残程度中等的疾病。尽管传统的致残疾病，如肌肉骨骼疾病，在女性中更为普遍和致残，但心血管疾病等致命疾病也是女性和男性的重要致残原因。
