The George Institute for Global Health India, New Delhi, India
The George Institute for Global Health India, New Delhi, India.
BMJ Open. 2023 Mar 27;13(3):e067994. doi: 10.1136/bmjopen-2022-067994.
Older male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in NCD-MM among older adults is vital, as this issue is understudied in low-income and middle-income country (LMIC) contexts such as India, and has been growing in the past few decades.
Large scale nationally representative cross-sectional study.
Longitudinal Ageing Study in India (LASI 2017-2018) had data on 27 343 men and 31 730 women aged 45+, drawn from a sample of 59 073 individuals across India.
We operationalised NCD-MM based on prevalence of the presence of two or more long-term chronic NCD morbidities. Descriptive statistics and bivariate analysis along with multivariate statistics were used.
Women aged 75+ had a higher prevalence of multimorbidity as compared with men (52.1% vs 45.17%). NCD-MM was more common among widows (48.5%) than widowers (44.8%). The female-to-male ratios of ORs (RORs) for NCD-MM associated with overweight/obesity and prior history of chewing tobacco were 1.10 (95% CI: 1.01 to 1.20) and 1.42 (95% CI: 1.12 to 1.80), respectively. The female-to-male RORs show that the odds of NCD-MM were greater in formerly working women (1.24 (95% CI: 1.06 to 1.44)) relative to formerly working men. The effect of increasing NCD-MM on limitations in activities of daily living and instrumental ADL was greater in men than women but reversed for the hospitalisation.
We found significant sex differences in NCD-MM prevalence among older Indian adults, with various associated risk factors. The patterns underlying these differences warrant greater study, given existing evidence on differential longevity, health burdens and health-seeking patterns all of which operate in a larger structural context of patriarchy. Health systems in turn must respond to NCD-MM mindful of these patterns and aim to redress some of the larger inequities they reflect.
老年男性和女性在疾病特异性预期寿命、健康行为和临床表现以及非传染性疾病多种慢性病（NCD-MM）等关键特征上存在差异。因此，检查老年人群中 NCD-MM 的性别差异至关重要，因为在低收入和中等收入国家（LMIC）背景下，如印度，这一问题研究不足，而且在过去几十年中一直在增加。
大规模全国代表性横断面研究。
印度纵向老龄化研究（LASI 2017-2018）的数据来自印度 59073 名个体的样本，涉及 27343 名男性和 31730 名 45 岁及以上的女性。
我们根据两种或两种以上长期慢性 NCD 合并症的存在情况来确定 NCD-MM 的患病率。使用描述性统计和双变量分析以及多变量统计。
与男性相比，75 岁及以上的女性 NCD-MM 的患病率更高（52.1%比 45.17%）。寡妇（48.5%）比鳏夫（44.8%）中 NCD-MM 更为常见。超重/肥胖和咀嚼烟草史相关的 NCD-MM 的女性与男性比值比（OR）分别为 1.10（95%CI：1.01 至 1.20）和 1.42（95%CI：1.12 至 1.80）。女性与男性的 OR 表明，与以前从事工作的男性相比，以前从事工作的女性 NCD-MM 的可能性更大（1.24（95%CI：1.06 至 1.44））。NCD-MM 对日常生活活动和工具性日常生活活动能力受限的影响在男性中大于女性，但在住院方面则相反。
我们发现印度老年成年人中 NCD-MM 的患病率存在显著的性别差异，并且存在各种相关的危险因素。鉴于现有关于长寿、健康负担和卫生保健寻求模式的差异的证据，这些差异背后的模式值得进一步研究，所有这些证据都在一个更大的父权制结构背景下运作。卫生系统必须对此做出回应，注意到这些模式，并努力纠正其中反映的一些更大的不平等。
