Abstract
SummaryBackgroundWomen are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations.MethodsLongitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895–1929, 1930–38, 1939–45, and 1946–60) were analysed before and after adjustment for socioeconomic factors (education and labour force status).FindingsThe prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895–1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6–4·7) and 1·7% (1·1–2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895–1929 cohort) was 3·2% (2·3–4·1) before adjustment for socioeconomic factors and 1·4% (0·9–1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4–17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7–15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations.InterpretationSocioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions.FundingNational Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration.
Highlights
Disability at older ages is associated with institutional isation, higher health-care costs, increased mortality risk, and poorer quality of life.[1]
After accounting for socioeconomic factors, we found sex differences to be considerably attenuated for limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), which typically occur in later life, and sex differences in ADL were no longer evident in recent birth cohorts
Data sources Data were taken from the English Longitudinal Study of Ageing (ELSA),[20] the Irish Longitudinal Study on Ageing (TILDA),[21] the Survey of Health, Ageing and Retirement in Europe (SHARE),[22] and the Health and Retirement Study (HRS)[23] in populations from England, Ireland, 11 European countries, and the USA, respectively
Summary
Disability at older ages is associated with institutional isation, higher health-care costs, increased mortality risk, and poorer quality of life.[1]. During the 20th century women have had progressively more access to education and have become more likely to enter the labour force.[7] Given this improvement, it is important to consider the historical context in analyses of sex differences in disability.[2] There is evidence of a reduction in the prevalence of functional limitations with increasing birth year,[8,9,10,11,12,13,14,15] for women.[10,11,12,16] socioeconomic factors are likely to underlie variations in sex differences in disability across birth cohorts, the role of such factors has not been well explored in this context. Dichotomous categorisation of functional limitations includes individuals with one or several limitations in the same category, failing to consider potential variation in sex differences by severity of limitations
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