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4102.0 - Australian Social Trends, 1998  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 03/06/1998   
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Contents >> Health >> Health Status: Health experiences of men and women

Health Status: Health experiences of men and women

Men have higher death rates at all ages and report more serious conditions than women. Women report the less serious conditions more often than men and assess their own health more negatively.

Many measures of health status show differences between the health of men and women. Compared to women, men have higher death rates at all ages and have more serious illness conditions. On the other hand, women report the less serious conditions more often, are more likely to visit the doctor, and assess their own health more negatively than do men. These differences result from an interaction of biological and environmental factors.

Males and females do not face the same biological risk of disease. Females are thought to have an advantage which makes them more resistant to a range of conditions. One specific difference is that female sex hormones protect against diseases associated with the build up of harmful cholesterol (this protection is lost at menopause).1 Women's reproductive function, however, increases their biological risk. Pregnancy and childbirth can cause illness, be generally debilitating and in rare cases cause death.

Differences in the behavioural pattern of men and women and in the environments in which they spend their time also expose them to different risks. For example, men are more likely to smoke, to be overweight and to consume alcohol in amounts considered a health risk (see Australian Social Trends 1998, Health - State summary tables). Boys and men tend to be more physically active, take more physical risks and spend more time outdoors than girls and women. Men as a whole spend longer periods in the workforce and the mix of occupations is different, with men predominating in the more hazardous occupations. Women spend more time caring for children and doing housework. These differences in occupation and role affect health risk in many ways, for example, in levels of exercise, stress, and exposure to infection and injury. Men and women also perceive and report their health and use health services differently.


Definitions

Biological risk derives from the differences in genes, physiology and hormones between males and females.

Environmental risk broadly defined, includes risk from differences in the social and physical environment, including differences in the behavioural patterns of males and females.

Male to female ratio is the male death or illness prevalence rate divided by the female rate; a ratio greater than one indicates a higher rate for males than females.

Fetal death refers to the delivery of a child who did not show a sign of life such as a heart beat after delivery was complete (where birthweight was at least 500 grams, equivalent to 22 weeks' gestation).

Infant death refers to the death before the first birthday of a live-born child (one who showed a sign of life such as a heart beat after delivery was complete).

DEATH RATES BY AGE GROUP(a), 1996

Males
Females
Male to female ratio
rate
rate
ratio

Fetal death rate
5.8
5.3
1.1
Infant mortality rate
6.5
5.0
1.3
Age-specific rates
    1-14 years
25
18
1.4
    15-24 years
102
31
3.3
    25-44 years
154
68
2.3
    45-54 years
343
214
1.6
    55-64 years
993
570
1.7
    65-74 years
2,828
1,517
1.9
    75+
9,240
7,107
1.3
Crude rate (all ages)
749
659
1.1

(a) Fetal death rate is deaths per 1,000 births; infant mortality rate is deaths per 1,000 live births; age-specific death rate and crude death rate are deaths per 100,000 population.

Source: Causes of Death, 1996 (cat. no. 3303.0).


Mortality
In 1996 the life expectancy of a newborn boy was 75 years, and that of a newborn girl 81 years. The higher life expectancy for females is consistent with the pattern observed in other developed countries (see Australian Social Trends 1998, International health status summary table). In Australia the difference in life expectancy has decreased from a peak of seven years in the early 1980s to about six years in the mid 1990s. This is because decreases in certain causes of death, such as heart disease and motor vehicle accidents, have had a proportionally greater impact on the total death rate for males.2 Death rates from some of these causes also declined more rapidly for males than females.

Death rates were higher for males than females at all ages in 1996. The differences in the infant mortality rate mainly result from biological factors.3 However from ages 1-44, accidents (mostly motor vehicle accidents) and suicide were the leading causes of death, together accounting for 47% of deaths. Death rates from these causes were much higher for males, and age groups in the range 1-44 years therefore showed the most pronounced differences between the total death rates for males and females. The most extreme difference was in those aged 15-24 (male to female ratio of 3.3).

In each age group over 44, cancer and heart disease were the leading causes of death. Many cancer sites are common to men and women and for most of these the death rate was higher for men. Among those aged 25-54, the death rate from cancer was slightly higher for women than men, mostly attributable to deaths from breast cancer. Deaths from ischaemic heart disease (mostly heart attacks) were more common in men than women at all ages.

The death rates for nine of the leading ten causes were higher for males (after adjusting for age differences between the male and female populations). The two leading causes of death were cancer and ischaemic heart disease, together accounting for 50% of all deaths. Male to female ratios for these causes of death were 1.7 and 1.9 respectively. The greatest disparities were for accidents and suicide (male to female ratios of 2.6 and 4.2 respectively), which together accounted for only 6% of all deaths despite their prominence in the younger age groups.

LEADING CAUSES OF DEATH(a), 1996

Males
Females
Male to female ratio
Cause of death
rate
rate
ratio

Cancer
230
139
1.7
Ischaemic heart disease
196
105
1.9
Cerebrovascular disease (stroke)
66
57
1.2
Chronic obstructive pulmonary disease (includes emphysema, bronchitis, asthma)
51
24
2.1
All accidents
36
14
2.6
    Motor vehicle traffic accidents
16
6
2.7
Diabetes Mellitus
18
12
1.5
Diseases of the arteries, arterioles and capillaries
19
11
1.7
Organic psychotic conditions (includes senile dementia)
12
13
0.9
Suicide
21
5
4.2
Hereditary and degenerative diseases of the central nervous system
14
9
1.6
Total
824
498
1.7

(a) Age-standardised death rate per 100,000 persons.

Source: Causes of Death 1996 (cat. no. 3303.0).


Illness
The 1995 National Health Survey revealed that females were more likely than males to have experienced an illness (either temporary or long term) in the previous two weeks. The rate for females was 872 per 1,000 compared to 842 for males (after adjustments for age differences between the male and female population). However, when illnesses were classified by severity, based on how likely they were to require surgery, or result in complications, disability or death, it can be seen that serious conditions were more prevalent among males. Of the 18 conditions rated as serious reported in 1995, ten were more common among males than females. For four conditions there was little difference in their prevalence (male to female ratios of 1.0) and only four were more common in females - these were rheumatism, congenital anomalies, thyroid disorders and complications of pregnancy and childbirth.

Females were more likely to have a condition rated as either minor or intermediate but not all intermediate and minor conditions were more common in females. The degree of difference ranged widely. For example, osteoporosis was five times more common in females and deafness was almost twice as common in males. However, out of the ten most common intermediate and minor conditions, eight were more prevalent among females.

Biological sex differences play a role in the prevalence of less serious conditions, as they do in serious conditions. Those less serious conditions with the lowest male to female ratios include those associated with female hormonal cycles (e.g. migraine), pregnancy (e.g. varicose veins) or menopause (e.g. osteoporosis).

The large proportion of the population with sight or hearing disorders made diseases of the nervous system and sense organs the largest group of conditions, with a rate of 548 per 1,000 for females compared to 511 for males. Nervous system conditions rated as serious are epilepsy, paralysis and hereditary and degenerative diseases. Epilepsy and hereditary and degenerative diseases were equally common in males and females while paralysis was more common among males (possibly reflecting greater rates of injury). Females were more likely to have a sight disorder (minor conditions) while males were more likely to be blind or deaf (intermediate conditions). Migraines, an intermediate condition, were more common in females.

Conditions of the respiratory system were the second most commonly reported group (356 per 1,000 for males and 392 per 1,000 for females). Bronchitis/emphysema (rated as serious) was equally common in males and females. Females were more likely than males to report hayfever, asthma, sinusitis, the common cold and coughs or sore throats, while influenza was equally common.

The rate for musculoskeletal conditions was 254 per 1,000 for males and 274 per 1,000 for females. Running counter to the general pattern, rheumatism, the only condition classified as serious within this category, was more common in females. All other musculoskeletal conditions are rated as intermediate because of the great variation in severity that can exist among people who report the same condition (e.g. 'back problems'). Males were more likely to have back problems and disorders of the intervertebral disc while females reported higher rates of arthritis and osteoporosis.

Females were more likely than males to have a condition relating to the circulatory system (243 per 1,000 compared to 184 per 1,000 for males). However, heart disease, atherosclerosis (both serious) and stroke (an intermediate condition) were more common in males. Conditions which were more common among females were varicose veins, haemorrhoids, and ill-defined symptoms of heart disease (all rated as intermediate or minor). Hypertension was equally common in males and females.

Two less common groups of conditions made the largest individual contributions to the overall difference in the rates of illness for males and females. These were: symptoms and ill-defined conditions (a miscellaneous group of which headaches are the leading component) with rates of 205 per 1,000 for males compared to 278 per 1,000 for females; and diseases of the genito-urinary system with rates of 28 per 1,000 for males compared to 100 for females.


Severity of conditions

The classification of severity of conditions used in this review was adapted by the Australian Institute of Health and Welfare from a system devised by the Royal College of General Practitioners (United Kingdom).4 In this classification:

Serious conditions are: those that at the time are invariably serious; those that require surgical intervention; those that carry a high probability of serious complications or significant recurring disability.

Intermediate conditions are: those that, although sometimes potentially serious, span a wide range of severity or are embraced by a diagnostic term used with widely disparate meaning by general practitioners; those that, although not often serious, are usually brought to the attention of the general practitioner.

Minor conditions are: those commonly treated without recourse to medical advice; minor self-limiting illnesses that require no specific treatment; diseases not included above.

PREVALENCE(a) OF SERIOUS CONDITIONS, 1995

Males
Females
Male to female ratio
Conditions
rate
rate
ratio

Bronchitis/Emphysema
43.5
43.7
1.0
Ulcer
33.4
25.0
1.3
Heart disease
34.7
21.7
1.6
Hernia
32.6
22.2
1.5
Diabetes Mellitus
22.9
21.1
1.1
Neoplasms (cancer)
21.2
21.5
1.0
Kidney disease
15.7
16.3
1.0
Gout
27.9
6.4
4.4
Rheumatism
14.5
18.9
0.8
Thyroid disorders
5.2
27.3
0.2
Mental retardation
11.9
6.6
1.8
Epilepsy
6.8
6.7
1.0
Psychoses
3.3
2.0
1.7
Congenital anomalies
3.5
3.9
0.9
Other hereditary and degenerative disease
2.6
2.3
1.1
Paralysis
2.0
1.3
1.5
Atherosclerosis
1.8
1.1
1.6
Complications of pregnancy and childbirth
n.a.
4.8
n.a.
Total(b)
211.1
193.2
1.1

(a) Age-standardised rate per 1,000 population.
(b) As people could have more than one condition, components do not add to total.

Source: 1995 National Health Survey, Summary of Results (cat. no. 4364.0).

PREVALENCE(a) OF INTERMEDIATE AND MINOR CONDITIONS, 1995

Males
Females
Male to female ratio
Conditions
rate
rate
ratio

Leading conditions
Far-sightedness (incl. presbyopia)
257.3
294.7
0.9
Short-sightedness
180.3
225.9
0.8
Hayfever
130.7
147.4
0.9
Arthritis
121.9
170.1
0.7
Deafness
126.4
66.1
1.9
Asthma
108.2
117.7
0.9
Hypertension
105.0
107.9
1.0
Headache
106.7
153.2
0.7
Sinusitis
84.2
121.5
0.7
Allergy
48.9
72.7
0.7
Other selected conditions
Common cold
53.1
61.0
0.9
Varicose veins
26.9
81.4
0.3
Back problems
47.2
39.5
1.2
Influenza
31.6
31.7
1.0
Cough or sore throat
26.6
33.4
0.8
Disc disorders
26.9
16.1
1.7
Migraine
11.4
26.7
0.4
Ill-defined symptoms of heart disease
19.5
20.7
0.9
Blindness
12.5
8.7
1.4
Osteoporosis
3.6
23.5
0.2
Stroke (incl. after effects)
7.5
4.9
1.5

Total(b)
824.1
857.8
1.0

(a) Age-standardised rate per 1,000 population.
(b) As people could have more than one condition, components do not add to total; total includes conditions not included in table.

Source: 1995 National Health Survey, Summary of Results (cat. no. 4364.0)

Assessed health status
The greater prevalence of minor and intermediate conditions among women may be related to differences in the way men and women perceive their health. The National Health Survey included a set of questions which aimed to measure physical, mental and social well being as opposed to the presence or absence of illness, among those aged 18 years or more. Answers were used to calculate scores for eight dimensions of health and well being. Scores ranged from 0 to 100; the higher the score the more positive the state of health or well being.

Women scored somewhat lower than men on all dimensions except general health, for which their scores were slightly higher (all data were age-standardised). The differences were small but statistically significant. The greatest differences were in vitality, a measure of energy level and fatigue (a mean score for men of 66.4 compared to 62.5 for women) and mental health (a mean score for men of 77.3 compared to 74.6 for women).

ASSESSED HEALTH STATUS, 1995

Males
Females
Dimension
Mean score(a)
Mean score(a)

Physical functioning
83.6
81.5
Role limitations due to physical problems
80.3
79.1
Bodily pain
77.7
75.9
General health
71.0
72.1
Vitality
66.4
62.5
Social functioning
85.7
84.2
Role limitations due to emotional problems
83.9
81.7
Mental health
77.3
74.6

(a) Age-standardised mean scores.

Source: National Health Survey: SF36 Population Norms, Australia (cat. no. 4399.0).


Health-related actions
Health-related actions varied from using medication to having hospital treatment. In 1995 females were more likely to have taken a health-related action in the previous two weeks (80% compared to 71% for males). The most common health-related action for both sexes was using medication, reported by 64% of males and 74% of females. Most of the specific types of medications on which information was collected were more likely to have been used by females than males.

However, for certain medications and age groups medication use was greater for males than females (see Australian Social Trends 1998, The use of medication).

Visiting a doctor was the second most common health-related action taken, reported by 26% of females and 21% of males. Males and females shared the three most common reasons for visiting a doctor. These were respiratory conditions (4% of the male population had attended a doctor for this reason in the previous two weeks compared to 5% of females), check-ups (4% of males and 5% of females) and musculoskeletal conditions (2% of males and 2% of females).

Some of the less common reasons for visiting the doctor made relatively large contributions to the overall differences between male and female rates. These were: tests, reported by 0.8% of males and 1.7% of females; symptoms and ill-defined conditions, reported by 1.2% of males and 1.9% of females; diseases of the genito-urinary system, reported by 0.3% of males and 1.3% of females; and 1.7% of women attended pregnancy supervision. The reason with the highest male to female ratio was injuries, reported by 1.6% of males and 1.1% of females.

Other than attending casualty, emergency or outpatients (2.9% of males compared to 2.6% of females), females were more likely to take other types of health-related actions. The largest difference was for having a day of reduced activity (4.9% of males and 6.6% of females).

Information from the 1995 National Health Survey is broadly consistent with administrative information from the health system. The greater likelihood of females to have visited a doctor is consistent with their more frequent use of Medicare services (see Australian Social Trends 1998, Health - National summary tables). Hospital administration data also shows greater use by women (as measured by hospital separation rates) mainly because of their use of obstetric services. In 1995-96, separation rates were higher for women than men among those aged 15-54 years and 75 years and over, while at other ages rates were higher for males. When uses related to pregnancy and childbirth were excluded from the 15-54 age group, the difference was reduced, and when diseases and disorders of the reproductive system were also removed, the female rates were lower than the male.5

PEOPLE TAKING A HEALTH ACTION(a), 1995

Males
Females
Male to female ratio
'000
%(b)
'000
%(b)
ratio

Total persons who took no action
2,665.0
29.3
1,798.0
20.1
1.5
Total persons who took action(c)
6,329.0
70.8
7,269.0
79.9
0.9
Used medication(d)
5,706.0
63.9
6,711.0
73.6
0.9
Consulted doctor
1,836.0
20.8
2,370.0
25.9
0.8
Consulted other professionals
1,176.0
13.1
1,508.0
16.6
0.8
Took day off work/school
685.0
7.5
674.0
7.6
1.0
Day of reduced activity
431.0
4.9
601.0
6.5
0.8
Visited hospital casualty/emergency/outpatients
254.0
2.9
243.0
2.6
1.1
Visited hospital day clinic
105.0
1.2
139.0
1.5
0.8
Hospital inpatient episode
64.0
0.7
75.0
0.8
0.9

Total
8,994
100.0
9,067
100.0
1.0

(a) People who took a health action in the two weeks prior to interview.
(b) Age-standardised.
(c) People could report more than one type of health action; therefore components do not add to total. Total includes some actions not included in table.
(d) Includes vitamins, minerals and natural and herbal medications.

Source: 1995 National Health Survey, Summary of Results (cat. no. 4364.0).


Endnotes

1 Smith, D. W. E., Warner, H. R. 1990, 'Overview of biomedical perspectives: possible relationships between genes on the sex chromosomes and longevity', in M. G. Ory and H. R. Warner (eds) Gender, health and longevity: a multidisciplinary perspective, Springer Publishing Co., New York.

2 Jain, S. 1994, Trends in mortality, cat. no. 3313.0, National Centre for Epidemiology and Population Health and ABS, Canberra.

3 Waldron, I. 1983, 'Sex differentials in human mortality: the role of genetic factors', Social Science and Medicine, Vol 17 (6), Pergamon Press, Oxford.

4 Mathers, C. 1994, Appendix A of
Health differentials among adult Australians aged 25-64 years, AIHW, Canberra.

5 Australian Institute of Health and Welfare, 1997, Australian hospital statistics 1995-96, AIHW: Health Services Series No. 10, AGPS, Canberra.


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