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Female disability disadvantage: a global perspective on sex differences in physical function and disability


The objectives were to determine whether women always fare more poorly in terms of physical function and disability across countries that vary widely in terms of their level of development, epidemiologic context and level of gender equality. Sex differences in self-reported and objective measures of disability and physical function were compared among older adults aged 55–85 in the United States of America, Taiwan, Korea, Mexico, China, Indonesia and among the Tsimane of Bolivia using population-based studies collected between 2001 and 2011. Data were analysed using logistic and ordinary least-squares regression. Confidence intervals were examined to see whether the effect of being female differed significantly between countries. In all countries, women had consistently worse physical functioning (both self-reported and objectively measured). Women also tended to report more difficulty with activities of daily living (ADL), although differences were not always significant. In general, sex differences across measures were less pronounced in China. In Korea, women had significantly lower grip strength, but sex differences in ADL difficulty were non-significant or even reversed. Education and marital status helped explain sex differences. Overall, there was striking similarity in the magnitude and direction of sex differences across countries despite considerable differences in context, although modest variations in the effect of sex were observed.

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Address for correspondence: Felicia V. Wheaton, Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles, CA 90089–0191, USA E-mail:
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B. E. Alvarado , R. O. Guerra and M. V. Zunzunegui 2007. Gender differences in lower extremity function in Latin American elders: seeking explanations from a life-course perspective. Journal of Aging and Health, 19, 6, 1004–24.

H. Chun , S. I. Cho , Y. H. Khang , M. Kang and I. H. Kim 2012. Trends in gender-based health inequality in a transitional society: a historical analysis of South Korea. Journal of Preventive Medicine and Public Health, 45, 2, 113–21.

R. Clark and B. M. Peck 2012. Examining the gender gap in life expectancy: a cross-national analysis, 1980–2005. Social Science Quarterly, 93, 3, 820–37.

S. Conti , G. Farchi , M. Masocco , G. Minelli , V. Toccaceli and M. Vichi 2003. Gender differentials in life expectancy in Italy. European Journal of Epidemiology, 18, 2, 107–12.

E. M. Crimmins , J. K. Kim and A. Solé-Auró 2011. Gender differences in health: results from SHARE, ELSA and HRS. European Journal of Public Health, 21, 1, 8191.

M. Denton , S. Prus and V. Walters 2004. Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health. Social Science & Medicine, 58, 12, 2585–600.

M. Ferrer , R. Lamarca , F. Orfila and J. Alonso 1999. Comparison of performance-based and self-rated functional capacity in Spanish elderly. American Journal of Epidemiology, 149, 3, 228–35.

E. Gakidou , K. Cowling , R. Lozano and C. J. L. Murray 2010. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. The Lancet, 376, 9745, 959–74.

J. M. Guralnik , L. G. Branch , S. R. Cummings and J. D. Curb 1989. Physical performance measures in aging research. Journal of Gerontology, 44, 5, M141–6.

M. Gurven , H. Kaplan and A. Z. Supa 2007. Mortality experience of Tsimane Amerindians of Bolivia: regional variation and temporal trends. American Journal of Human Biology, 19, 3, 376–98.

T. Kaneda and Z. Zimmer 2007. Education, gender, and functional transitions among Indonesian elderly. Journal of Cross-cultural Gerontology, 22, 3, 303–22.

T. Kaneda , Z. Zimmer , X. Fang and Z. Tang 2009. Gender differences in functional health and mortality among the Chinese elderly. Research on Aging, 31, 3, 361–88.

G. Kempen , M. Van Heuvelen , R. Van den Brink , A. Kooijman , M. Klein , P. J. Houx and J. Ormel 1996. Factors affecting contrasting results between self-reported and performance-based levels of physical limitations. Age and Ageing, 25, 6, 458–64.

E. O. Lee and J. Lee 2013. Education, functional limitations, and life satisfaction among older adults in South Korea. Educational Gerontology, 39, 7, 514–26.

J. C. Leung 1997. Family support for the elderly in China: issues and challenges. Journal of Aging & Social Policy, 9, 3, 87101.

S. Macintyre , K. Hunt and H. Sweeting 1996. Gender differences in health: are things really as simple as they seem? Social Science & Medicine, 42, 4, 617–24.

S. S. Merrill , T. E. Seeman , S. V. Kasl and L. F. Berkman 1997. Gender differences in the comparison of self-reported disability and performance measures. Journals of Gerontology: Biological Sciences and Medical Sciences, 52A, 1, M1926.

N. Minicuci , M. Noale , S. Pluijm , M. V. Zunzunegui , T. Blumstein , D. Deeg , C. Bardage and M. Jylha 2004. Disability-free life expectancy: a cross-national comparison of six longitudinal studies on aging: the CLESA project. European Journal of Ageing, 1, 1, 3744.

K. N. Murtagh and H. B. Hubert 2004. Gender differences in physical disability among an elderly cohort. American Journal of Public Health, 94, 8, 1406–11.

M. B. Ofstedal , Z. Zimmer , A. I. Hermalin , A. Chan , Y. L. Chuang , J. Natividad and Z. Tang 2007. Short-term trends in functional limitation and disability among older Asians: a comparison of five Asian settings. Journal of Cross-cultural Gerontology, 22, 3, 243–61.

A. Oksuzyan , E. Crimmins , Y. Saito , A. O'Rand , J. W. Vaupel and K. Christensen 2010. Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. European Journal of Epidemiology, 25, 7, 471–80.

F. C. Pampel 2002. Cigarette use and the narrowing sex differential in mortality. Population and Development Review, 28, 1, 77104.

B. Park , M. Jung and T. Lee 2009. Associations of income and wealth with health status in the Korean elderly. Journal of Preventive Medicine and Public Health, 42, 5, 275–82.

M. K. Peek and R. T. Coward 1999. Gender differences in the risk of developing disability among older adults with arthritis. Journal of Aging and Health, 11, 2, 131–50.

B. M. Popkin 1999. Urbanization, lifestyle changes and the nutrition transition. World Development, 27, 11, 1905–16.

O. Rahman , J. Strauss , P. Gertler , D. Ashley and K. Fox 1994. Gender differences in adult health: an international comparison. The Gerontologist, 34, 4, 463–9.

K. Roy and A. Chaudhuri 2008. Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India. Social Science & Medicine, 66, 9, 1951–62.

L. M. Verbrugge and A. M. Jette 1994. The disablement process. Social Science & Medicine, 38, 1, 114.

L. M. Verbrugge and D. L. Wingard 1987. Sex differentials in health and mortality. Women & Health, 12, 2, 103–45.

L. A. Wray and C. S. Blaum 2001. Explaining the role of sex on disability. The Gerontologist, 41, 4, 499510.

K. M. Yount and E. M. Agree 2005. Differences in disability among older women and men in Egypt and Tunisia. Demography, 42, 1, 169–87.

K. M. Yount , J. Hoddinott and A. D. Stein 2010. Disability and self-rated health among older women and men in rural Guatemala: the role of obesity and chronic conditions. Social Science & Medicine, 71, 8, 1418–27.

M. Yu and R. Sarri 1997. Women's health status and gender inequality in China. Social Science & Medicine, 45, 12, 1885–98.

Z. Zimmer 2005. Health and living arrangement transitions among China's oldest-old. Research on Aging, 27, 5, 526–55.

Z. Zimmer , G. M. Linda and M. C. Chang 2002. Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999. Population Studies, 56, 3, 265–76.

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Ageing & Society
  • ISSN: 0144-686X
  • EISSN: 1469-1779
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