Gender and Health

1
Gender and Health

• Vicki S. Helgeson
• Carnegie Mellon University

2008 PMBC Summer Institute
2
Number of Deaths per 100,000 in 2005
Age Male Female MaleFemale ratio
01-4 32 28 1.14
5-14 19 14 1.36
15-24 113 43 2.63
25-34 137 63 2.17
35-44 240 142 1.69
45-54 539 311 1.73
55-64 1121 706 1.59
65-74 2647 1761 1.50
75-84 6409 4539 1.41
85 and over 15100 13355 1.13
Source Adapted from U.S. Census Bureau (2007)
3
Life Expectancies Over the Twentieth Century
Men Women White men White women Black men Black women
2005 75.2 80.4 75.7 80.8 69.5 76.5
2000 74.1 79.5 74.8 80.0 67.2 74.7
1990 71.8 78.8 72.7 79.4 64.5 73.6
1980 70.0 77.5 70.7 78.1 63.8 72.5
1970 67.1 74.7 68.0 75.6 60.0 68.3
1960 66.6 73.1 67.4 74.1 61.1 66.3
1950 65.6 71.1 66.5 72.2 59.1 62.9
1940 60.8 65.2 62.1 66.6 51.5 54.9
1930 58.1 61.6 59.7 63.5 47.3 49.2
1920 53.6 54.6 54.4 55.6 45.5 45.2
1910 48.4 51.8 48.6 52.0 33.8 37.5
1900 46.3 48.3 46.6 48.7 32.5 33.5
Source National Center for Health Statistics
(2008) Note The figures from 1900 to 1960 for
black people reflect black and other people
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Sex Differences in Mortality ? Over the 20th
Century
Sex Difference Male Female
1900 2 years 46.3 48.3
1980 7.5 years 70.0 77.5
2000 5.4 years 74.1 79.5
2005 5.2 years 75.2 80.4
What are the leading causes of death?
5
Age-Adjusted Death Rates (per 100,000) for the
Leading Causes of Death in 2005
Cause of Death All M/F B/W H/W
Heart Disease 220.0 1.5 1.3 0.7
Cancer 188.7 1.4 1.2 0.7
Cerebrovascular disease 48.4 1.0 1.5 0.8
Chronic lower respiratory disease 44.2 1.3 0.7 0.4
Accidents 39.7 2.2 1.0 0.8
Diabetes mellitus 25.3 1.3 2.1 1.6
Alzheimers disease 24.2 0.7 0.8 0.6
Pneumonia and influenza 21.3 1.3 1.1 0.8
Kidney disease 14.8 1.4 2.3 0.9
Septicemia 11.5 1.2 2.2 0.8
Suicide 11.0 4.1 0.4 0.4
Liver disease 9.3 2.1 0.8 1.6
Hypertension and renal disease 8.4 1.0 2.6 1.0
Parkinsons disease 6.6 2.2 0.4 0.6
Homicide 6.1 3.8 5.7 2.8
Source National Vital Statistics (2008)
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Paradox

• Women live longer than men but
• women report worse health than men.
• Men have higher rates of mortality.
• Women have higher rates of morbidity.

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Morbidity

• Females greater
• Arthritis
• Immune disorders
• Digestive disorders
• Pain-related disorders
• Migraine
• Carpal tunnel
• Multiple Sclerosis
• Females worse subjective health perceptions
• Females greater symptoms (physical and
  psychological)
• starts in adolescence

8
Odds ratio of Women Having More Health Symptoms
than Men Across 29 European and North American
Countries low GDI medium GDI high
GDI 11-year-olds 1.56 1.17
1.18 13-year-olds 1.88 1.70
1.56 15-year-olds 2.27 1.91
1.88 Note higher number female gt male GDI
Gender Development Index, high GDI signifies
women have higher education ad income.
Torsheim (2006)
9
Incidence of Major Depression Across Cultures
Lifetime rate of depression
Source Adapted from Weissman et al. (1996)
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Classes of Explanations

• Biology
• Genes
• Immune system
• Hormones
• Health behaviors
• Stressful life events
• Social roles

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Artifacts Physician Bias

• Depression
• Women are 2x likely to be depressed as men
• Clinicians more likely to classify symptoms as
  depression in women than men
• Clinicians less likely to detect depression in
  men than women
• PCPs detection of depression compared to
  independent screening of 19,000 patients
  (Borowsky et al., 2000)
• Clinicians more likely to provide medication to
  women than men, when symptoms are similar
• Due to patient?
• Due to provider?

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Also, response bias in the area of depression
Depression
14
12
10
8
6
4
2
0
Depression Hassles
Depression Hassles
Male Female
Source Adapted from Page Bennesch (1993)
13
Artifacts Physician Bias

• Coronary Heart Disease
• FACT men have higher rates of heart disease
  than
• women
• FACT heart disease is 1 killer of women, too
• FACT onset of heart disease occurs later in
  women
• than men
• FACT once diagnosed, womens disease is more
• advanced than men even when
  controlling for age
• FACT women have more complications from
• treatment and higher mortality rates
  than men

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Are women treated differently than men?

• Same symptoms more likely to be attributed to CHD
  in men than women
• Partly because men and women have different
  symptoms men have classic chest pain
• Men more likely than women to be referred for
• Catheterization
• Cholesterol-lowering medication
• Invasive treatment (PTCA, CABG)
• These relations generally hold when controlling
  for age
• Men fare better following invasive treatment than
  women

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Classes of Explanations.
Health Behaviors

• Smoking men more (but)
• Alcohol men more (but)
• Diet possibly women better
• Exercise men more
• Preventive health care women more

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Current Smoking
Percentage
Source Adapted from Centers for Disease Control
and Prevention (2006)
17
Overweight Children and Adolescents
Overweight Prevalence
Source Adapted from Ogden et al. (2002) Ogden
et al. (2006)
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Life Events

• Meta-analysis of trauma (Tolin Foa, 2006)
• Males gt Females BUT
• Females 6x adult sexual assault, 2.5x child
  sexual assault
• Males 3.5x combat, war, terrorism, 1.5x
  nonsexual assault
• Meta-analysis of stressful life events (Davis,
  Matthews Twamley, 1999)
• Females gt Males d .12
• Moderator type of rating
• Stress exposure d .08
• Stress impact d .18
• Moderator type of event
• Interpersonal d .17
• Personal d .07

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Sex Comparisons of Interpersonal Stress and
Non-interpersonal Stress Among Preadolescents and
Adolescents
Interpersonal stress
Non-interpersonal stress
Source Adapted from Rudolph Hammen (1999)
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Differential Exposure? or Differential
Vulnerability?
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Social Role Men

• Hazardous jobs (93 fatalities)
• Drive more (3x fatalities)
• Sex difference decreasing with time
• Risk-taking behavior
• Own guns
• Leisure activities (hunting, skydiving, skiing,
  mountain climbing)
• Participation in risky sports (football,
  wrestling) and playing while injured

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Encouragement of Risk-Taking Behavior in Boys

• Parent watched video of boy/girl on playground
  (ages 6-10)
• Stop tape and report what they would say

Boys Girls
Neutral .1 .1
No Risk 1.1 .8
Risk 1.2 4.4
- Attn getting 2.5 3.8
Attn getting .4 .3

• Verbalization during risk-taking

Boys Girls
Encouragement 3.0 .5
Directives to stop .6 9.3
Caution .7 3.9
Source Morrongiello Dawber (2000)
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Social Role Women

• Social network double-edged sword
• Provides support and potential to reduce stress
• Provides people to take care of
• Nurturant Role Hypothesis (Gove Hughes, 1979)
• Exposed to more infectious agents
• Caretaking leads to fatigue and vulnerability to
  illness
• Time spent caring for others leads to less time
  spent caring for self

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Gender-Related Traits Female
Overinvolved in Others Problems
Focus on Others
COMMUNION
UNMITIGATED COMMUNION
Self-Neglect
?
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Links to Well-Being

• Communion
• Provides social support
• Linked to social skills
• Unrelated to psychological distress
• Unmitigated communion
• Linked to psychological distress
• Linked to self-neglect
• Linked to rumination about others
• Linked to poor adjustment to disease
• Linked to poor metabolic control

?
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UC Laboratory Studies

• Exposed to person who self-discloses problem
• Study 1 Friend
• Study 2 Stranger

Intrusive thoughts about problem Study 1 Study 2
Unmitigated Communion .46 .35
Communion .24 .08
Fritz Helgeson (1998)
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Adolescents with Diabetes (Helgeson Fritz, 1996)
Psychological Distress
Unmitigated Communion
Relationship Stressors
Metabolic Control
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Poor Metabolic Control
__ Early Adolescence __ Middle Adolescence
-1 SD 1 SD
Unmitigated Communion
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Adolescents with Diabetes (Helgeson et al., 2007)

• 132 adolescents with diabetes
• 131 healthy adolescents
• Average age 12 (11-13)
• Interviewed annually
• UC ? ? distress
• ? self-esteem
• ? metabolic control
• UC ? ? eating disturbances
• UC ? eating disturbances ? distress
• self-esteem
• metabolic control

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Gender-Related Traits Male
Distrust of Others
Focus on Self
UNMITIGATED AGENCY
AGENCY
Self-Absorption
?
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Links to Well-Being

• Agency
• Linked to good health behavior (exercise)
• Linked to self-efficacy, perceptions of control
• Linked to high self-esteem
• Linked to reduced stress
• Unmitigated agency
• Linked to psychological reactance
• Linked to poor health behavior
• Linked to noncompliance
• Linked to problem behaviors (delinquency,
  smoking, etc.)
• Linked to hostility

?
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Change in Self-Efficacy
Change in Mental Health
Change in Prostate-specific Function
-.29
.51
.68
UA
.67
.66
-.30
Bowel
Urine
Intrusive thoughts
.88
-.81
MCS
Depression
Helgeson Lepore (2004)
33
.31
Change in Prostate-specific Function
Change in Self-Esteem
Depression
Agency
-.55
.48
.23
.76
.61
Bowel
Urine
Helgeson Lepore (2004)
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Which explanation accounts for the Gender
Paradox?

• Health Behaviors ? Mens mortality
• Social Role Factors ? Womens morbidity