Gender gap in self-rated health: A cohort perspective

doi:10.21203/rs.2.19230/v1

Background: The relation among gender differences and culture in self-rated health is not only bidirectional and static. In this sense, it is important to difference between effects of age and cohort. The aim of this study is analyzing gender gap differences in self-rated health from a generational perspective in order to explore health diversity from a multidisciplinary approach with policy implications.

Methods: We used data drawn from the European Health Interview Survey for 8 Eastern European Countries and EUROSTAT from 2006 through 2009. We conducted multilevel analyses to understand individual and national health determinants of self-rated health by gender and if national differences remain after controlling from micro variables. In order to analyse the role of equity (Gini Quartile) and capacity to create richness (GDPpc Quartile) in gender differences, Oaxaca analyses were developed.

Results: Self-rated health gender gap increases with age. Individual characteristics, such as educational level or smoking influence the citizens´ perceived health, with a stronger effect on women than on men. Both characteristics (endowment effects) and effects of individual characteristics (coefficient effects) on health are important to understand gender gaps among people from silent generation.

Conclusions: Our research points out that random effects are greater for men than for women. Besides, random effects might be explained to certain extent by both indexes (Gini and GDPpc). The combined effects of gender, cohort and geographical differences on self-rated health have to be taken into account to figure out public health policies.

Health Policy

health gender gap

self-rated health

wealth

economic inequity

health international comparison

European Health Interview Survey

health cohorts research.

Table 1. Descriptive statistics by generation stratified by sex. (Source: European Health Interview Survey).

Variable	Sample by generation cohort and gender
	Silent generation (1921-1946)		Baby boom (1945-1964)		X generation (1965-1980)		Y generation (1981- 1990)
	Men	Women	Men	Women	Men	Women	Men	Women
Low self-rated health	74%	83%	48%	55%	18%	20%	8%	10%
Age (mean)	73.1	74.0	54.2	54.5	36.9	36.8	21.8	21.8
Married	74%	36%	80%	70%	70%	74%	13%	23%
Single	3%	3%	9%	5%	25%	15%	86%	75%
Widow	20%	57%	3%	15%	1%	2%	0%	0%
Divorced/separated	4%	4%	8%	10%	5%	9%	0%	1%
Low Education	30%	45%	10%	13%	6%	5%	8%	8%
Intermediate	59%	49%	78%	73%	78%	71%	81%	76%
High Education	11%	7%	12%	14%	17%	24%	11%	17%
Employed	4%	3%	63%	46%	89%	76%	46%	36%
Unemployed	0%	0%	7%	5%	7%	8%	9%	8%
Student	0%	0%	0%	0%	0%	0%	43%	46%
Pensioner	95%	92%	29%	39%	3%	2%	1%	1%
Homemaker	0%	3%	0%	8%	0%	13%	0%	8%
Other	0%	2%	1%	2%	0%	1%	1%	1%
Daily smoker	14%	4%	36%	19%	37%	20%	24%	13%
Overweight	60%	57%	64%	57%	55%	33%	26%	12%
Sedentarism	35%	40%	20%	26%	13%	20%	18%	28%

Number of observations by birth cohorts: Silent generation: 16,662 (6,640 men and 10,022 women); Baby boom: 26,680 (12,373 men and 14,307 women); X generation: 18,596 (8,981 men and 9,615 women); Y generation: 17,549 (8,887 men and 8,662 women).

Table 2. Macro-Data (Source: EUROSTAT).

Country	Survey year	Gini¹	Gini²	GDP³	GDP²
Bulgaria	2008	30.35	2	4.9	1
Czech Republic	2008	25.15	1	14.1	3
Hungary	2009	25.95	2	9.3	2
Latvia	2008	37.7	3	11.2	2
Poland	2009	30.9	3	8.2	1
Romania	2008	34.9	3	6.9	1
Slovenia	2007	23.43	1	11.8	3
Slovakia	2009	25.45	1	17.4	3

¹Gini Index for the completion year of the survey. If there are available multiple measurements, or different sources of information for the same year, the average is taken.

² Distribution by tertiles.

³ Gross domestic products at market prices para el año de finalización de la encuesta. Unit: current prices, euro per capita (x1000).

Table 3. Low self-rated health for: Multilevel by countries.

	SILENT GENERATION		BABY BOOMERS		X GENERATION		Y GENERATION
	Men	Women	Men	Women	Men	Women	Men	Women
Fixed Effects
Age	0.555***	0.581***	0.615***	0.368***	-0.418**	0.320**	-0.141	0.219
Age²	-0.003***	-0.004***	-0.005***	-0.003***	0.007***	-0.003	0.004	-0.004
Married^a	--	--	--	--	--	--	--	--
Single	-0.257	0.015	0.151**	-0.059	-0.032	0.027	0.068	0.196
Widow	-0.058	0.105*	-0.079	0.076	0.850**	0.362**	1.552**	-0.071
Divorced/separated	-0.052	-0.144	0.063	-0.016	0.037	0.160*	-0.585	0.980
Low Education	0.934***	1.026***	1.095***	1.266***	0.772***	0.964***	0.712***	0.752
Intermediate	0.547***	0.741***	0.711***	0.722***	0.544***	0.498***	0.366**	0.302
High Education^a	--	--	--	--	--	--	--	--
Employed^a	--	--	--	--	--	--	--	--
Unemployed	0.992	1.112	0.563***	0.547***	0.675***	0.561***	0.249*	0.173
Student	0.471	2.419**	0.695	0.289	-0.782	0.159	-0.349**	-0.061
Pensioner	0.886***	0.803***	1.473***	1.145***	3.754***	3.008***	4.239***	3.965
Homemaker	0.954	0.610***	0.759*	0.337***	0.949**	0.181**	0.610	0.072
Other	0.302	0.277	1.166***	0.836***	1.613***	0.151	0.877**	-0.245
Daily smoker	-0.172**	-0.034	-0.032	0.011	0.109*	0.313***	0.190*	0.500
Overweight	-0.068	0.278***	-0.042	0.260***	0.026	0.359***	0.043	0.216
Sedentarism	0.644***	0.398***	0.377***	0.137***	0.344***	0.063	0.639***	0.111
Intercept	-22.772***	-23.498***	-18.393***	-11.473***	4.038	-9.741***	-1.883	-5.574
Random Effects
σ	0.570	0.443	0.486	0.554	0.570	0.494	0.606	0.419
Prob>chibar2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00

***, ** and * denote that explanatory variables are statistically significant at 99%, 95% and 90% levels.

^a Reference variable.

Table 4. Low self-rated health by sub-samples of countries according to a distribution of GINI tertiles: Oaxaca

SILENT GENERATION

BABY BOOMERS

X GENERATION

Y GENERATION

Gini T1

Gini T2

Gini T3

Gini T1

Gini T2

Gini T3

Gini T1

Gini T2

Gini T3

Gini T1

Gini T2

Gini T3

Men

0.669***

0.671***

0.750***

0.472***

0.350***

0.480***

0.184***

0.085***

0.179***

0.091***

0.026***

0.084***

Women

0.792***

0.780***

0.836***

0.500***

0.403***

0.559***

0.217***

0.149***

0.196***

0.104***

0.080***

0.094***

Difference

-0.122***

-0.109***

-0.087***

-0.028

-0.054***

-0.080***

-0.034**

-0.065***

-0.017***

-0.014

-0.054***

-0.010**

Endowment

-0.057***

-0.053***

-0.018***

-0.042***

-0.015

-0.020***

0.034***

-0.041***

0.033***

0.012

-0.008

0.013***

Coefficients

-0.066***

-0.069***

-0.068***

0.009

0.020

-0.027**

-0.009

-0.044*

-0.002

-0.017

-0.057***

-0.004

Interaction

0.000

0.014

-0.001

0.006

-0.059***

-0.034***

-0.059***

0.020

-0.047***

-0.009

0.012

-0.019*

***, ** and * denote that explanatory variables are statistically significant at 99%, 95% and 90% levels.

Gender gap in self-rated health: A cohort perspective

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