Gender differences in disability among older adults in the context of social gender and income inequalities: 2013 Brazilian Health Survey

Lima, André Luiz Barbosa de; Espelt, Albert; Bosque-Prous, Marina; Lima, Kenio Costa

doi:10.1590/1980-549720200002

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 23 • 2020 • https://doi.org/10.1590/1980-549720200002 copy

Gender differences in disability among older adults in the context of social gender and income inequalities: 2013 Brazilian Health Survey

Diferenças de gênero na incapacidade entre idosos no contexto de desigualdades sociais de gênero e de renda: Pesquisa Nacional de Saúde 2013

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objectives:

To estimate the magnitude of gender differences in disability among adults aged 60 and older and to evaluate whether they can be associated with social gender inequality and socioeconomic contextual factors at the level of Brazilian federative units.

Methods:

This is a multilevel study that used data from 23,575 older adults of 27 federative units who participated in the 2013 Brazilian Health Survey. The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables. The association of individual and contextual variables with disability was estimated by assessing the magnitude of differences between genders, using cross-level interaction effects in multilevel generalized linear models, including only the variables that were statistically significant in the final model.

Results:

The prevalence of disability was higher among women (37.6%) than among men (26.5%), totaling 32.7% of the older adults. In the adjusted multilevel analysis, disability was influenced by income inequality (γ_gini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γ_mgiiXsex = 0.020, p = 0.004).

Conclusion:

Women had higher disability disadvantages compared to men, and those differences were associated with social gender inequalities among the Brazilian federative units influenced by income inequality.

Keywords:
Health of the Disabled; Aging; Health Status Disparities; Multilevel analysis

Individual variables	Men		Women
Individual variables	n	%	n	%
Age group (years)
60 to 69	6,074	58.2	7,304	55.6
70 to 79	3,132	30.0	3,868	29.5
80+	1,237	11.9	1,960	14.9
Total	10,443	44.3	13,132	55.7
Restriction of activities in the last two weeks
No	9,449	90.5	11,481	87.4
Yes	994	9.5	1,237	12.6
Total	10,443	44.3	13,132	55.7
Self-perceived health
Very good or good	4,847	46.4	5,530	42.1
Fair, poor or very poor	5,596	53.6	7,602	57.9
Total	10,443	44.3	13,132	55.7
Social activity participation
Yes	994	90.5	1,651	87.4
No	9,449	9.5	11,481	12.6
Total	10,443	44.3	13,132	55.7
Health medical insurance
Yes	1,646	15.8	2,529	19.3
No	8,797	84.2	10,603	80.7
Total	10,443	44.3	13,132	55.7
Educational level
Secondary or tertiary studies	2,468	23.6	3,070	23.4
None or primary studies	7,975	76.4	10,062	76.6
Total	10,443	44.3	13,132	55.7
BR criteria (economic class)
A, B, C	8,572	82.08	10,417	79.33
E and D	1,871	17.92	2,715	20.67
Total	10,443	44.3	13,132	55.7
Functional tasks^*:
Activities of daily living	1,425	13.7	2,315	17.6
Instrumental activities of daily living	2,439	23.4	4,567	34.8
Total	10,443	44.3	13,132	55.7

	Model I		Model II		Model III
	Coefficient (SE)	p	Coefficient (SE)	p	Coefficient (SE)	p
Individual variables
Sex (Men)
Women	0.050 (0.012)	< 0.001	0.043 (0.008)	< 0.001	0.045 (0.009)	< 0.001
Age group (60 to 69 years)
70 to 79			0.133 (0.008)	< 0.001	0.132 (0.008)	< 0.001
80+			0.339 (0.017)	< 0.001	0.337 (0.015)	< 0.001
Restriction of activities in the last two weeks (Yes)
No			0.216 (0.015)	< 0.001	0.216 (0.015)	< 0.001
Self-perceived health (Very good or good)
Fair, poor or very poor			0.159 (0.018)	< 0.001	0.161 (0.019)	< 0.001
Social activity participation (No)
Yes			-0.110 (0.012)	< 0.001	-0.110 (0.011)	< 0.001
Health medical insurance (No)
Yes			-0.018 (0.018)	0.306
Educational level (Secondary or tertiary studies)
None or primary study			0.076 (0.015)	< 0.001	0.083 (0.016)	< 0.001
BR criteria (A, B, C economic class)
E and D economic class			0.013 (0.013)	0.337
Contextual variables (intercept)
MGII			0.004 (0.013)	0.764
Gini			0.021 (0.010)	0.028	0.022 (0.004)	< 0.001
GDP			-0.006 (0.012)	0.640
Life expectancy			0.001 (0.014)	0.983
Contextual variables (interaction with sex)
MGII			0.015 (0.007)	0.024	0.020 (0.007)	0.004
Gini			0.004 (0.010)	0.692
GDP			-0.021 (0.013)	0.092
Life expectancy			0.021 (0.014)	0.132
Intercept	-0.878 (0.013)	< 0.001	-1.232 (0.026)	< 0.001	-1.238 (0.030)	< 0.001
Variability
Intercept variability (% of change^*)	0.253				0.063 (75%)
Interaction with sex (% of change^*)	0.137				0.053 (61%)

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[1] Corresponding author: André Luiz Barbosa de Lima. Universidade Federal do Rio Grande do Norte. Avenida Senador Salgado Filho, 1.787, CEP: 59056-000, Lagoa Nova, Natal, RN, Brazil. E-mail: andreveterinario@hotmail.com