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

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

doi:10.1590/1980-549720200002

Abstract

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. 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. 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 (γgini = 0.022, p < 0.001) among federative units. In addition, gender differences in disability were associated with social gender inequalities (γmgiiXsex = 0.020, p = 0.004). 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.

Highlights

Activity limitations are difficulties an individual may experience performing physical tasks
The activity limitation index was developed from the item response theory, using activities of daily living and instrumental activities of daily living variables
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

Summary

Introduction

Activity limitations are difficulties an individual may experience performing physical tasks. They are considered negative aspects of functionality and constitute an important part of an individual’s disability status[1,2], which is defined within the context of health as the person’s feature directly caused by disease, trauma or other health condition that requires medical care provided in the form of individual treatment by professionals (medical model)[2]. In Brazil, the population pyramid is in the process of contraction, resulting from a constant decrease of fertility rates, from 6.3 children per woman, in 1960, to 1.9 children per woman, in 2010. In Brazil, there is coexistence of old and new health problems, in which despite the predominance of chronic and degenerative diseases, the communicable ones still play an important role[8]

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