The gender health gap in China: A decomposition analysis

Around the world, and in spite of their higher life expectancy, women tend to report worse health than men until old age. Explanations for this gender gap in self-perceived health may be different in China than in other countries due to the traditional phenomenon of son preference. We examine several possible reasons for the gap using the Chinese SAGE data. We first rule out differential reporting by gender as a possible explanation, exploiting information on anchoring vignettes in eight domains of health functioning. Decomposing the gap in general self-assessed health, we find that about 31% can be explained by socio-demographic factors, most of all by discrimination against women in education in the 20th century. A more complete specification including chronic conditions and health functioning fully explains the remainder of the gap (about 69%). Adding chronic conditions and health functioning also explains at least two thirds of the education contribution, suggesting how education may affect health. In particular, women's higher rates of arthritis, angina and eye diseases make the largest contributions to the gender health gap, by limiting mobility, increasing pain and discomfort, and causing sleep problems and a feeling of low energy.     

Shared interests or sexual conflict? Spousal age gap,women's wellbeing and fertility in rural Tanzania

The marriage of older men to younger women is common across cultures. On one hand, husband-older marriage may serve the interests of both sexes, a conclusion broadly consistent with reported gender differences in mate preferences. On the other hand, men alone may benefit from such marriages at a cost to women if seniority enables men to exert dominance in conflicts of interest. Indeed, in public health large spousal age gaps are generally deemed “pathological”, both as a cause and consequence of gender inequalities harmful to women. We investigate these alternative models of spousal age gap using data from a cross-sectional survey of women in Mwanza, northwestern Tanzania (n = 993). Consistent with the notion that spousal age gaps are a product of sexual conflict, women typically married with a larger age gap than stated ideals. However, adjusting for potential confounds, spousal age gap was not associated with fertility or the risk of divorce. Furthermore, women's mental health and autonomy in household decision-making was higher in husband-older marriages compared to rare cases of same-age or wife-older marriage. Beyond this comparison, the magnitude of spousal age gaps was unrelated to either measure of women's wellbeing among the overwhelming majority of marriages where the husband was older. Together these findings suggest husband-older marriage does not influence marital stability, relatively large spousal age gaps are neither especially costly nor beneficial to women, and that alternative sociodemographic factors are more important in driving variation in women's wellbeing and reproductive success in this context. Our results support neither a model of mutual benefits, nor a pathological conceptualization of spousal age gaps. We conclude by both encouraging evolutionary human scientists to engage more fully with models of sexual conflict in future studies of marriage and mating, and suggesting that public health scholars consider more neutral interpretations of spousal age differences.     

Cause‐specific mortality among older African‐Americans: Correlates and consequences of age misreporting

Abstract

This paper examines the quality of age reporting on death certificates of elderly African‐Americans by major causes of death. We utilize a sample of death certificates linked to early census records and to Social Security Administration records to establish a “true” age at death. We then examine the patterns, predictors, and consequences of age misreporting for major causes of death. We find a pattern of greater age misreporting among females, identify educational background as a key predictor of accurate age reporting, and show that mortality crossovers are eliminated for most causes of death when more accurate age data are used.     

Gender differences in sexual jealousy: Adaptionist or social learning explanation?

It has often been speculated, and some evidence suggests, that men and women differ in the elicitation of jealousy: Men appear to be more likely than women to become upset over threats to sexual exclusivity; whereas women are more likely than men to react negatively to potential loss of partner time and attention. Both adaptionist and traditional social learning theories have been used to explain these apparent gender differences. In the present article we outline both explanations and review the relevant psychological literature on gender differences in the elicitation of jealousy. We propose that the difference in men's and women's psychological mechanisms for elicitation of jealousy is best characterized (at least in this culture) as a greater sensitivity among men to cues indicative of possible sexual infidelity rather than greater emotional upset in response to the occurence of extradyadic sex on the part of one's mate. We also provide data testing a traditional social learning explanation for the elicitation of jealousy. Results of a survey administered to college students (N = 223) demonstrate the subtle nature of gender differences in the elicitation of jealousy within this culture. Men and women were most likely to differ (in the hypothesized directions) when items pertained to concern over a partner's potential extradyadic sex rather than to reactions to sexual infidelity that is suspected to have already occurred. Although men reported placing more value on sexual activity within dating relationships and women reported placing more value on emotional intimacy, these ratings of relationship rewards did not explain the gender differences in reported jealousy. Results failed to support a traditional social learning explanation of jealousy and are discussed with regard to evolutionary theory and directions for future research.     

C-Reactive Protein for Predicting Prognosis and Its Gender-Specific Associations with Diabetes Mellitus and Hypertension in the Development of Coronary Artery Spasm

Background

While hypertension is negatively associated with coronary artery spasm (CAS), scarce data are available on diabetes mellitus in relation to CAS. In addition, outcome prediction in patients with CAS is challenging due to the lack of appropriate biomarkers. Therefore, we sought to identify the roles that gender, high-sensitivity C-reactive protein (hs-CRP), diabetes mellitus and hypertension play in CAS development and prognosis.

Methodology/Prinicpal Findings

Patients (350 women and 547 men) undergoing diagnostic coronary angiography with or without proven CAS but without obstructive stenosis were evaluated at long-term follow-up (median 102 months). Diabetic women and diabetic men with low hs-CRP levels had a low and high risk of CAS (odds ratio [OR]: 0.16, 95% confidence interval [CI]: 0.01–1.88 and OR: 5.02, 95% CI: 1.03–24.54, respectively). The ORs of CAS in both women and men with the highest hs-CRP tertile (>3 mg/L) reduced from 4.41 to 1.45 and 2.98 to 1.52, respectively, if they had diabetes mellitus, and from 9.68 to 2.43 and 2.60 to 1.75, respectively, if they had hypertension. Hypertension had a more negative effect on CAS development in diabetic than non-diabetic women, which was not observed in men. The highest hs-CRP tertile was an independent predictor of adverse outcomes. Patients with the highest hs-CRP tertile had more coronary events than patients with the lowest hs-CRP tertitle (p = 0.021, log-rank test).

Conclusions

Diabetes mellitus contributes to CAS development in men with low hs-CRP levels, but not in women. There are negative effects of diabetes mellitus and hypertension on CAS development in patients with high hs-CRP levels and especially in women. Elevated hs-CRP level independently predicts adverse outcomes.     

Option to cooperate increases women's competitiveness and closes the gender gap

We advance the hypothesis that women are as competitive as men once the incentive for winning includes factors that matter to women. Allowing winners an opportunity to share some of their winnings with the low performers has gendered consequences for competitive behavior. We ground our work in an evolutionary framework in which winning competitions brings asymmetric benefits and costs to men and women. In the new environment, the potential to share some of the rewards from competition with others may afford women the benefit of reaping competitive gains without incurring some of its potential costs. An experiment (N = 438 in an online convenience sample of U.S. adults) supports our hypothesis: a 26% gender gap in performance vanishes once a sharing option is included to an otherwise identical winner-take-all incentive scheme. Besides providing a novel experiment that challenges the paradigm that women are not as motivated to compete as men, our work proposes some suggestions for policy: including socially-oriented rewards to contracts may offer a novel tool to close the persistent labor market gender gap.     

Correlates of BMI misreporting among apparently healthy individuals: the ATTICA study

Objective: The aim of this study was to investigate correlates of misreporting in BMI, based on self‐reported weight and height, in a randomly selected population sample of Greek adults and to evaluate the effect of obesity status misclassification on the associations between obesity and disease. Research Methods and Procedures: During 2001 to 2002, we randomly enrolled 1514 men (18 to 87 years old) and 1528 women (18 to 89 years old) from the Attica area, Greece; the sampling was stratified by the age‐sex distribution of the region. Various sociodemographic, clinical, and psychological characteristics were self‐reported, and weight and height were measured and recorded in all participants. Results: The proportions of true positives and true negatives for correct obesity status identification were 62% and 97%, respectively. Women were 9 times more likely to be under‐reporters than men, whereas men were 7.5 times more likely to be over‐reporters. A 10‐year increase in age was associated with a 48% higher likelihood of being an under‐reporter and 26% lower likelihood of being an over‐reporter, irrespective of sex and other characteristics of the participants. Clinical status, such as the presence of hypertension and diabetes, was associated with under‐reporting of body weight. Furthermore, the use of self‐reported data may substantially exaggerate associations between obesity and obesity‐related diseases, such as diabetes, hypercholesterolemia, and hypertension. Discussion: The study indicates that, apart from age and sex, disease status may be another factor that influences misreporting of obesity status, with diabetic and hypertensive people to be more likely to under‐report their overweight. Use of self‐reported data may bias obesity—disease associations.     

Stag Parties Linger: Continued Gender Bias in a Female-Rich Scientific Discipline

Discussions about the underrepresentation of women in science are challenged by uncertainty over the relative effects of the lack of assertiveness by women and the lack of recognition of them by male colleagues because the two are often indistinguishable. They can be distinguished at professional meetings, however, by comparing symposia, which are largely by invitation, and posters and other talks, which are largely participant-initiated. Analysis of 21 annual meetings of the American Association of Physical Anthropologists reveals that within the subfield of primatology, women give more posters than talks, whereas men give more talks than posters. But most strikingly, among symposia the proportion of female participants differs dramatically by the gender of the organizer. Male-organized symposia have half the number of female first authors (29%) that symposia organized by women (64%) or by both men and women (58%) have, and half that of female participation in talks and posters (65%). We found a similar gender bias from men in symposia from the past 12 annual meetings of the American Society of Primatologists. The bias is surprising given that women are the numerical majority in primatology and have achieved substantial peer recognition in this discipline.     

Gender Difference in Relationship between Health-Related Quality of Life and Work Status

This study investigated the association of employment status with health-related quality of life in adult Koreans, as well as the gender difference in the relationship, using a large, nationally representative sample. Using data from the Korea Health Panel survey, we examined the relationship between quality of life measured by EQ-5D and work status among Korean adults. We also tested whether and how the relationship between quality of life and work status differed by gender. Quality of life among working adults was better than among non-working adults. The gap between the two groups was larger among male than female participants. Further, the gender differential effect was larger in the 41–60-year-old age group than in the 18–40-year-old and 61-or-older groups. Being employed has a positive relation to quality of life among adults. Work status plays a more important role in quality of life for men than for women, especially for the working elderly men than working elderly women.     

Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective,cross-sectional study

Background:Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario.Methods:We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location.Results:We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10–15 years into practice.Interpretation:We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.

A gender pay gap in physician incomes has been described across numerous jurisdictions.¹ Previous analyses have found income differences between women and men in the general physician population, among academic physicians and among physicians within the same specialty, ^2–8 and when controlling for years of experience, hours worked, geographic location, race and practice type.^9–13Although the difference in physician income between women and men is well described in the United States, fewer studies have looked at a Canadian cohort. An analysis of surgeons in Ontario found that female surgeons earned less per hour spent operating than male surgeons, and suggested that female physicians were more likely to perform less lucrative procedures than male physicians.¹⁴ A recent report released by the Ontario Medical Association highlighted income disparity between men and women physicians in Ontario, but did not provide a detailed breakdown by specialty.¹⁵ Transparent and detailed reporting on gender differences in physician payments can provide data to guide advocacy for greater pay equity.In this study, we aimed to describe payments to physicians across the province of Ontario by gender when controlling for specialty choice, career stage and physician demographics.     

Studying informal care during the pandemic: mental health,gender and job status

Unexpected negative health shocks such as COVID-19 put pressure on households to provide more care to relatives and friends. This study uses data from the UK Household Longitudinal Study to investigate the impact of informal caregiving on mental health during the COVID-19 pandemic. Using a difference-in-differences analysis, we find that individuals who started providing care after the pandemic began reported more mental health issues than those who never provided care. Additionally, the gender gap in mental health widened during the pandemic, with women more likely to report mental health issues. We also find that those who began providing care during the pandemic reduced their work hours compared to those who never provided care. Our results suggest that the COVID-19 pandemic has had a negative impact on the mental health of informal caregivers, particularly for women.     

Low Testosterone Concentrations in Men Contribute to the Gender Gap in Cardiovascular Morbidity and Mortality

BackgroundAcross the industrialized world, men experience an earlier onset of cardiovascular disease (CVD) and a life expectancy 5 to 10 years shorter than women. Low total testosterone (TT) concentrations in men have been suggested as a novel CVD risk factor, but its contribution to this gender gap is less well studied.MethodsWe used data of 4152 individuals (2113 women and 2039 men) aged 20 to 79 years from the longitudinal population-based cohort Study of Health in Pomerania, Germany. Multivariable Poisson and Cox proportional hazard regression models were used to investigate the risk of incident cardiovascular morbidity (5-year examination follow-up), as well as all-cause and CVD mortality (10-year follow-up) between men and women. Additionally, the added risk attributable to low TT in men (<10th percentile) was assessed.ResultsCompared with women, men were uniformly at higher risk of incident cardiovascular morbidity, including overweight, hypertension, dyslipidemia, metabolic syndrome, and type 2 diabetes mellitus. Men were also at increased all-cause mortality (hazard ratio = 2.05; 95% CI, 1.61–2.60) and 10-year CVD risk compared with women. In subgroup analyses, men with low TT showed the highest 10-year CVD and mortality risk compared with both men with higher TT and women. TT was also negatively associated with cardiovascular risk as defined by the Framingham risk score (P < 0.001), after multivariable adjustment.ConclusionsAnalyzing a large population-based sample, we observed that men have a generally higher risk of incident cardiovascular morbidity and mortality. Furthermore, men with low TT concentrations were identified as high-risk individuals with regard to 10-year CVD and mortality risk.     

What do men want? Re-examining whether men benefit from higher fertility than is optimal for women

Several empirical observations suggest that when women have more autonomy over their reproductive decisions, fertility is lower. Some evolutionary theorists have interpreted this as evidence for sexual conflicts of interest, arguing that higher fertility is more adaptive for men than women. We suggest the assumptions underlying these arguments are problematic: assuming that women suffer higher costs of reproduction than men neglects the (different) costs of reproduction for men; the assumption that men can repartner is often false. We use simple models to illustrate that (i) men or women can prefer longer interbirth intervals (IBIs), (ii) if men can only partner with wives sequentially they may favour shorter IBIs than women, but such a strategy would only be optimal for a few men who can repartner. This suggests that an evolved universal male preference for higher fertility than women prefer is implausible and is unlikely to fully account for the empirical data. This further implies that if women have more reproductive autonomy, populations should grow, not decline. More precise theoretical explanations with clearly stated assumptions, and data that better address both ultimate fitness consequences and proximate psychological motivations, are needed to understand under which conditions sexual conflict over reproductive timing should arise.     

Racial differences in correlates of misreporting of energy intake in adolescent females

Objective: To determine the extent of misreporting of energy intake (EI) and its anthropometric, demographic, and psychosocial correlates in a bi‐racial cohort of young women. Research Methods and Procedures: This was a cross‐sectional study of 60 black and 60 white young women, 18 to 21 years old, enrolled in a longitudinal study. Total energy expenditure was assessed using doubly labeled water. Self‐reported EI was obtained from 3‐day food records. BMI was computed from height and weight. Fat mass was assessed by DXA. Multivariate analyses examined racial differences on the extent of misreporting and its effect on other potential correlates of misreporting. Race‐specific step‐wise linear regression analysis was performed to examine the effect of BMI, parental education, and drive for thinness on misreporting of EI. Results: More white women tended to under‐report EI than black women (22% vs. 13%, p = 0.07). In black women, under‐reporting was significantly (p = 0.01) associated with drive for thinness score but was only marginally (p = 0.1) associated with BMI. Each point increase in drive for thinness score was associated with under‐reporting by 40 kcal/d. In white women, under‐reporting was significantly (p = 0.03) associated with higher parental education by 440 kcal/d and also only marginally (p = 0.09) with BMI. Discussion: This tendency for under‐reporting of EI limits the use of self‐reported EI in studying energy balance in free‐living subjects. Most black and almost all white women in their late teens significantly under‐reported their EI, whereas under‐reporting was not as evident among lean young black women.     

Evolution of obesity by social status in France, 1981-2003

Although France is less affected by the rise in obesity than neighboring countries, the prevalence of obesity has increased, changing the distribution of this pathology in the population. We analyze this evolution by social status, education, income and gender, region of residence, using the three French national Health Surveys conducted in 1981, 1992 and 2003. The average body weight of both women and men has increased in France since 1981 and accelerated since the 1990s. This trend is obtained among all age groups. Nevertheless, this process did not affect all socioeconomic groups similarly. Geographical differences increased between north-east, where the prevalence of obesity is higher, and the Mediterranean region, where it is lower. Likewise, the gap between social and occupational categories has greatly widened: obesity has increased much faster among farmers and blue-collar workers than among managers and professionals. In contrast to women, poorer men are not more likely to be more obese than others. Our findings suggest that differences in BMI values increased substantially among social groups in France, in particular among women.     

Evolved gender differences in mate preferences: Evidence from personal advertisements

Evolutionary theorists have posited that contemporary men and women may differ in their specific psychological mechanisms having to do with mate selection because different strategies would have benefitted men versus women in our distant ancestral past. From these theorized gender differences in mating strategies, several hypotheses were generated and subsequently tested in the current study using a large sample of personal advertisements (N = 1111). The results were generally supportive of evolutionary predictions: men were more likely than women to offer financial resources and honesty/ sincerity, and to seek attractiveness, appealing body shape, and a photograph in selecting a potential mate; women were more likely than men to offer an appealing body shape and to seek financial resources, qualities likely to lead to resource acquisition, and honesty/sincerity in potential mates. Women were also more likely than men to seek male friendship and/or companionship and to offer greater involvement only after the establishment of such friendship, whereas men more frequently than women made explicit requests for a sexual relationship. In general, men sought potential mates who were younger than themselves, a trend which became more pronounced among older advertisers. Women generally sought mates who were older than themselves, a trend which decreased slightly with the age of the advertiser. Results are discussed with regard to implications for hypothesized gender differences in evolved psychological mechanisms.     

Income deprivation and mental well-being: The role of non-cognitive skills

We show that the positive relation between income deprivation and mental health is affected by an individual's non-cognitive skills. Income deprivation is operationalized as the Yitzhaki index, i.e., as a function of the sum of income differences between an individual and others in her reference group who are more affluent. Non-cognitive skills are extracted from a Locus of Control questionnaire and the Big Five Inventory, a self-report measurement of an individual in regard to five aspects of personality: conscientiousness, neuroticism, extraversion, agreeableness and open-mindedness. The results, based on the 2002–2010 waves of the German Socio-Economic Panel dataset (SOEP), show that deprivation is negative and significantly related with mental health. However, neurotic individuals are more deprivation-sensitive than are others. Compared to the mean effect, a one standard deviation rise in neuroticism is associated with a deprivation effect that is 36.6% and 51.9% larger among men and women, respectively. Although to a lesser extent, extraverted men and conscientious women are also found to be more deprivation-sensitive than are others, the corresponding figures being 31.1% and 45.9%, respectively. These findings suggest that personality differences should be taken into account in the design of policies, practices and initiatives aimed at alleviating the well-being costs of income deprivation.     

Gender Differentials in Self-Rated Health and Self-Reported Disability among Adults in India

Background

The extant literature on gender differentials in health in developed countries suggests that women outlive men at all ages, but women report poorer health than men. It is well established that Indian women live longer than men, but few studies have been conducted to understand the gender dimension in self-rated health and self-reported disability. The present study investigates gender differentials in self-rated health (SRH) and self-reported disability (SRD) among adults in India, using a nationally representative data.

Methods

Using data on 10,736 respondents aged 18 and older in the 2007 WHO Study on Global Ageing and Adult Health in India, prevalence estimates of SRH are calculated separately for men and women by socio-economic and demographic characteristics. The association of SRH with gender is tested using a multinomial logistic regression method. SRD is assessed using 20 activities of daily living (ADL). Further, gender differences in total life expectancy (TLE), disability life expectancy (DLE) and the proportion of life spent with a disability at various adult ages are measured.

Results

The relative risk of reporting poor health by women was significantly higher than men (relative risk ratio: 1.660; 95% confidence Interval (CI): 1.430–1.927) after adjusting for socio-economic and demographic characteristics. Women reported higher prevalence of severe and extreme disability than men in 14 measures out of a total20 ADL measures. Women aged less than 60 years reported two times more than men in SRD ≥ 5 ADLs. Finally, both DLE and proportion of life spent with a disability were substantially higher for women irrespective of their ages.

Conclusion

Indian women live longer but report poorer health than men. A substantial gender differential is found in self-reported disability. This makes for an urgent call to health researchers and policy makers for gender-sensitive programs.     

The Impact of Gender Norms on Condom Use among HIV-Positive Adults in KwaZulu-Natal,South Africa

Critical to preventing the spread of HIV is promoting condom use among HIV-positive individuals. Previous studies suggest that gender norms (social and cultural constructions of the ways that women and men are expected to behave) may be an important determinant of condom use. However, the relationship has not been evaluated among HIV-positive women and men in South Africa. We examined gender norms and condom use at last sex among 550 partnerships reported by 530 sexually-active HIV-positive women (372) and men (158) who had sought care, but not yet initiated antiretroviral therapy in a high HIV-prevalence rural setting in KwaZulu-Natal, South Africa between January 2009 and March 2011. Participants enrolled in the cohort study completed a baseline questionnaire that detailed their socio-demographic characteristics, socio-economic circumstances, religion, HIV testing history and disclosure of HIV status, stigma, social capital, gender norms and self-efficacy. Gender norms did not statistically differ between women and men (p = 0.18). Overall, condoms were used at last sex in 58% of partnerships. Although participants disclosed their HIV status in 66% of the partnerships, 60% did not have knowledge of their partner’s HIV status. In multivariable logistic regression, run separately for each sex, women younger than 26 years with more equitable gender norms were significantly more likely to have used a condom at last sex than those of the same age group with inequitable gender norms (OR = 8.88, 95% CI 2.95–26.75); the association between condom use and gender norms among women aged 26+ years and men of all ages was not statistically significant. Strategies to address gender inequity should be integrated into positive prevention interventions, particularly for younger women, and supported by efforts at a societal level to decrease gender inequality.     

Straight but Not Narrow; Within-Gender Variation in the Gender-Specificity of Women’s Sexual Response

Gender differences in the specificity of sexual response have been a primary focus in sexual psychophysiology research, however, within-gender variability suggests sexual orientation moderates category-specific responding among women; only heterosexual women show gender-nonspecific genital responses to sexual stimuli depicting men and women. But heterosexually-identified or “straight” women are heterogeneous in their sexual attractions and include women who are exclusively androphilic (sexually attracted to men) and women who are predominantly androphilic with concurrent gynephilia (sexually attracted to women). It is therefore unclear if gender-nonspecific responding is found in both exclusively and predominantly androphilic women. The current studies investigated within-gender variability in the gender-specificity of women’s sexual response. Two samples of women reporting concurrent andro/gynephilia viewed (Study 1, n = 29) or listened (Study 2, n = 30) to erotic stimuli varying by gender of sexual partner depicted while their genital and subjective sexual responses were assessed. Data were combined with larger datasets of predominantly gyne- and androphilic women (total N = 78 for both studies). In both studies, women reporting any degree of gynephilia, including those who self-identified as heterosexual, showed significantly greater genital response to female stimuli, similar to predominantly gynephilic women; gender-nonspecific genital response was observed for exclusively androphilic women only. Subjective sexual arousal patterns were more variable with respect to sexual attractions, likely reflecting stimulus intensity effects. Heterosexually-identified women are therefore not a homogenous group with respect to sexual responses to gender cues. Implications for within-gender variation in women’s sexual orientation and sexual responses are discussed.