性功能障碍的性别差异及社会经济因素的作用：一项多队列分析。
Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis.
机构信息
Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK.
Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.
出版信息
Lancet Healthy Longev. 2021 Dec;2(12):e780-e790. doi: 10.1016/S2666-7568(21)00249-X.
BACKGROUND
Women are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations.
METHODS
Longitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895-1929, 1930-38, 1939-45, and 1946-60) were analysed before and after adjustment for socioeconomic factors (education and labour force status).
FINDINGS
The prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895-1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6-4·7) and 1·7% (1·1-2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895-1929 cohort) was 3·2% (2·3-4·1) before adjustment for socioeconomic factors and 1·4% (0·9-1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4-17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7-15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations.
INTERPRETATION
Socioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions.
FUNDING
National Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration.
背景
女性比男性更容易出现功能障碍，部分原因是社会经济地位较低。然而，功能障碍严重程度不同的性别差异尚不清楚。我们研究了功能障碍方面的性别差异，同时关注社会经济因素和功能障碍的严重程度。
方法
从 14 个国家的 62375 名参与者中提取了基本日常生活活动（ADL）和工具性日常生活活动（IADL）以及活动能力受限的纵向数据。根据受限活动的数量（0、1、2 或≥3），对 ADL、IADL 和活动能力进行分类。在调整了社会经济因素（教育和劳动力状况）后，分析了四个出生队列（1895-1929 年、1930-1938 年、1939-1945 年和 1946-1960 年）中 ADL 和 IADL 受限方面的性别差异。
结果
与男性相比，女性 IADL 和 ADL 受限的发生率更高。调整社会经济因素后，这种性别差异减弱。调整社会经济因素前，1895-1929 年队列中，75 岁时 IADL 受限的性别差异为 3.7%（95%CI 2.6-4.7），调整后为 1.7%（1.1-2.2）。对于 ADL，调整社会经济因素前，1895-1929 年队列中，75 岁时 ADL 受限的性别差异为 3.2%（2.3-4.1），调整后为 1.4%（0.9-1.8）。调整社会经济因素后，75 岁时的移动能力受限（16.1%，95%CI 14.4-17.7）仍然存在（14.3%，12.7-15.9）。85 岁以后，女性更有可能有三种或更多的 IADL 或活动能力受限，而男性更有可能有一到两种受限。
解释
社会经济因素在很大程度上解释了 IADL 和 ADL 受限方面的性别差异，但不能解释活动能力受限的性别差异。中年时期移动能力受限的性别差异是未来研究和干预的重要目标。
资金
美国国家老龄化研究所、英国国家卫生研究院、欧盟委员会和美国社会保障管理局。
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