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Health Status: Health experiences of men and women
DEATH RATES BY AGE GROUP(a), 1996
Source: Causes of Death, 1996 (cat. no. 3303.0).
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
Source: Causes of Death 1996 (cat. no. 3303.0).
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.
PREVALENCE(a) OF SERIOUS CONDITIONS, 1995
(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
(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
Source: National Health Survey: SF36 Population Norms, Australia (cat. no. 4399.0).
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
(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).
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.